Few Rural Lung Cancer Patients Get Gene Testing
A Johns Hopkins study finds fewer than four in ten rural Medicare patients with advanced lung cancer received tumor gene testing.
Updated on Nov. 9, 2026 in Cancer
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Researchers at Johns Hopkins found that 35.9% of rural Medicare patients with advanced non-small cell lung cancer had tumor gene testing. The study, published in JAMA Network Open on Nov. 5, 2026, analyzed 8,259 patients diagnosed between 2014 and 2019.
Why it matters
Gene testing identifies tumor changes that can guide targeted therapy, and patients who were tested were more likely to receive those treatments. The gap points to unequal access to precision cancer care for rural patients.
The retrospective Medicare analysis covered 8,259 rural patients aged 66 to 95, with 35.9% receiving molecular testing overall. Among patients with drug coverage who survived at least six months, 120 of 1,114 tested patients received targeted therapy compared with 16 of 932 untested patients, and the reasons for the testing gap remain unexplained by the study.
The players
Johns Hopkins
Johns Hopkins is a major academic medical institution in Baltimore, Maryland, known for its cancer research and clinical programs.
The details
The researchers used Medicare records to count tests that look for gene changes in the tumor, excluding PD-L1 testing used to guide immunotherapy. Patients who saw both an oncologist and a surgeon or procedure specialist were strongly more likely to be tested, while those with both Medicaid and Medicare were about 29% less likely.
Timeline
- Study period covering diagnoses: 2014 to 2019
- About 18% of patients tested within the first month after diagnosis
- About 36% of patients tested by six months after diagnosis
- Study published in JAMA Network Open on Nov. 5, 2026
Big Picture
Gene testing for advanced lung cancer has become standard guidance for matching patients to targeted drugs, yet this Medicare cohort shows it reached only about a third of rural patients through 2019. The authors note testing has likely grown since then, though the rural gap documented here reflects the 2014 to 2019 period specifically.
Patients with advanced lung cancer can ask their oncologist whether tumor gene testing has been ordered, since results can determine eligibility for targeted therapies. Rural patients may need to request referrals to centers that offer comprehensive molecular testing.
The takeaway
Asking about tumor gene testing early after a lung cancer diagnosis may open access to targeted treatments that are not available through standard chemotherapy alone. Patients who face travel or coverage barriers should raise those concerns with their care team early.
Further reading
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