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89 experts. 96 statements. Here is what they actually agreed on. 🧠
A modified Delphi process brought 89 thoracic oncology experts together for a 3-day in-person meeting in Barcelona last September. They rated 96 clinical statements on non-metastatic NSCLC. According to the Journal of Thoracic Oncology, consensus was achieved for 62 of those statements, 31 remained without consensus, and 3 were rejected outright.
That means 1 in 3 statements could not reach agreement among the world’s leading thoracic oncology minds.
This is the most honest document in thoracic oncology right now. Not a guidelines memo. A real snapshot of where the field stands.
Here is what the consensus actually said, by domain.
📋 THE NSCLC CONSENSUS CHECKLIST: AGREED vs. CONTESTED
WHAT THE EXPERTS AGREED ON:
🔹Routine FDG PET-CT for staging
🔹Histologic confirmation of suspicious mediastinal nodes
🔹Reflex PD-L1 testing at diagnosis
🔹DNA-based next-generation sequencing at diagnosis
🔹Standardized post-neoadjuvant pathologic assessment
🔹Sublobar resection with systematic nodal evaluation for selected peripheral node-negative tumors 2 cm or smaller
🔹Consolidation durvalumab after definitive chemoradiotherapy for unresectable stage II-III disease, irrespective of PD-L1 expression
❌ WHERE CONSENSUS BROKE DOWN:
– Brain MRI in stage I disease
– Mediastinal restaging after induction therapy
– Routine RNA-based testing
– Using circulating tumor DNA or minimal residual disease to guide perioperative decisions
The contested areas are not minor edge cases. They are decisions your tumor board is making right now.
🔎 HOW TO APPLY THIS AT YOUR INSTITUTION
Step 1. Pull your last 10 non-metastatic NSCLC cases. Did every patient get FDG PET-CT, reflex PD-L1, and DNA-based NGS at diagnosis? If not, that is a workflow gap, not a judgment call.
Step 2. For your stage I patients: do you have a written local protocol on brain MRI? The experts could not reach consensus here. Your team needs its own position.
Step 3. For patients who received induction therapy: what triggers mediastinal restaging at your center? Contested ground means you need a standard, because the guidelines will not give you one.
Save this post. Print this checklist. Bring it to your next tumor board.
The field gave us 64% consensus. The other 36% is yours to own.
Most teams treat contested evidence as a reason to delay decisions. The strongest teams treat it as a reason to build institutional protocols.
That is the difference between a multidisciplinary tumor board and a real multidisciplinary program.
👉 Follow Jonathan Govette, CEO of Oatmeal Health, for daily healthcare insights on LinkedIn. Deeper dives in The Oatmeal Bite on Substack: https://news.oatmealhealth.com
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Author:
CEO/Co-Founder @ Oatmeal Health | AI Lung Cancer Screening | Almost Became a Doctor | Engineer | Follow to Share What I’ve Learned Along the Way
I help patients get the care they need earlier, preventing late-stage cancer.
That’s been the throughline across three companies and almost 20 years in healthcare. At ReferralMD, we fixed broken referral networks so patients didn’t fall through the cracks. At Oatmeal Health, it’s lung cancer: building the diagnostic and screening infrastructure so the 85% of cases caught too late get caught early instead.
Today as CEO of Oatmeal Health, I lead a team embedding AI into radiology workflows to turn routine lung CT scans into reimbursable cancer risk assessments. We partner with FQHCs to reach underserved communities, and with health systems and payers to make early detection economically sustainable. Think HeartFlow or Cleerly, but for lungs.
Between companies, I advised at Techstars and Plug and Play, mentoring founders building in digital health. That experience shaped how I think about what separates companies that ship from companies that stall: distribution, reimbursement, and clinical trust, not just technology.
I’m a CancerX alumnus, a 3x healthcare founder, and someone who believes the biggest problems in cancer aren’t scientific. They’re operational.
We’re hiring mission-driven builders at Oatmeal Health. If you want to work on something that matters, reach out.
When I’m not working, I’m traveling, mentoring, and keeping up with one very energetic husky. 🐾
Substack – The Oatmeal Bite:
Millions of patients get less care because of who they are, where they live, or how they look. I’m fighting to change that. CEO @OatmealHealth, a startup built for the underserved. The Oatmeal Bite: intel for clinicians, investors, and advocates.
Jonathan Govette
CEO of Oatmeal Health
Substack:
https://oatmealhealthjonathangovette.substack.com/
