Introduction: Current treatment paradigms for non-metastatic non-small cell lung cancer (NSCLC) are rapidly evolving. In addition to immunotherapy consolidation after chemoradiation, recent trials suggest benefit in the adjuvant and neoadjuvant settings. We review treatment trends in systemic therapy (ST) and examine overall survival. Method: In collaboration with our established expert Lung Cancer Quality and Safety Committee, we extracted data from Queensland Oncology Repository (QOR); a repository of demographic, diagnostic, and treatment data on Queenslanders diagnosed with cancer. The study includes people diagnosed with stage I-III NSCLC in 2011–2019. Oral ST was not included. An in-depth analysis was undertaken examining treatment trends to establish baseline patterns of ST care in Queensland. Results: 3019 stage I–III people received resection (17% of all NSCLC diagnosed in 2011–2019), of these 98 (3.2%) received neoadjuvant ST and 633 (21%) received adjuvant ST. The rate of neoadjuvant ST has fallen between 2011 (5.9%) and 2019 (2.7%), there was little difference in rates of adjuvant ST over the same period (25%–21%). Novel immunotherapy, Durvalumab, following chemoradiation in stage III has increased from 9% (n = 14) in 2017 to 58% (n = 78) in 2019 during clinical trials; we expect this rate would have increased as Durvalumab was PBS listed in 2020. For those who received treatment, 5 years relative survival has improved significantly from 19% in 2000 to 33% in 2019. Likely due to better staging and improved therapies. However, variations in 3-year overall survival rates remain significant across the stages considered in this study (stage I, 76%, stage II, 55%, and stage III, 33%). Contribution to policy/practice/research: The vast and readily available data through QOR has allowed for analysis of treatment trends and survival outcomes for Queenslanders diagnosed with NSCLC. This provides a foundation for ongoing monitoring, reporting and quality improvement.