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Mau Ern Poh,1 Muthukkumaran Thiagarajan,2 Lye Mun Tho,3 Gwo Fuang Ho,4 Norhasanah Mohammad,5 Wuan Chin Tan,5 Soon Hin How6 1Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia; 2Department of Radiotherapy and Oncology, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia; 3Oncology Department, Beacon Hospital, Petaling Jaya, Selangor, Malaysia; 4M. Kandiah Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kuala Lumpur, Wilayah Persekutuan, Malaysia; 5Medical Affairs, Pfizer, Kuala Lumpur, Wilayah Persekutuan, Malaysia; 6Faculty of Medicine, International Islamic University Malaysia Medical Centre, Kuantan, Pahang, MalaysiaCorrespondence: Mau Ern Poh, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia, Tel +6 03-79494422, Email ernestpoh@um.edu.myPurpose: Next-generation sequencing (NGS) has transformed molecular diagnostics and precision oncology by enabling broad genomic profiling and informed treatment selection for non-small cell lung cancer (NSCLC). However, adoption in Southeast Asia remains limited, particularly in public healthcare settings. This study aimed to assess the landscape of NGS testing for NSCLC in Malaysia, identify barriers, and explore strategies clinicians use to improve patient access.Patients and Methods: A descriptive, cross-sectional survey comprising 18 questions was distributed to clinical oncologists and respiratory physicians across Malaysia over an eight-week period. The survey collected data on clinical experience with NGS, testing practices, perceived barriers, and access strategies. Descriptive statistics were used for analysis, and associations between healthcare sectors (public vs private) and NGS usage frequency were evaluated using the Chi-square test.Results: Seventy-one clinicians participated - 67.6% clinical oncologists and 32.4% respiratory physicians. Private hospitals had the highest NGS uptake (38.5% testing all NSCLC patients), with the lowest in Ministry of Health (MoH) institutions (8.3%) (p< 0.0001). Among oncologists, 45.8% used NGS for all or nearly all patients. For respiratory physicians, 35.3%, mainly from MoH, used it most of the time. NGS results were more frequently available in private referrals. Most private clinicians (84.6%) rated NGS accessibility as excellent. Key barriers included cost of testing and therapies, limited availability, long turnaround times, insufficient tissue, and unclear guidelines. Strategies to improve access included industry-subsidized programs, insurance coverage, and clinical trial enrolment.Conclusion: NGS adoption for NSCLC in Malaysia varies significantly across healthcare settings. Public hospitals face substantial barriers, particularly related to cost and access to testing and therapies. Addressing these challenges will require coordinated efforts across policy, infrastructure, clinician training, and public-private partnerships. This study offers key insights into the Malaysian NGS landscape and supports broader access to precision oncology.Keywords: genomic access, next generation sequencing, non-small cell lung cancer, Southeast Asia