IPM Take
This study cuts through a common weakness in precision oncology policy: countries often talk about access to targeted treatments before fixing access to the testing infrastructure that makes those treatments usable. The real bottleneck is not only whether next-generation sequencing exists. It is whether testing is funded, organised, interpreted, connected to data systems and available to all eligible patients in time to guide care. Without that, precision oncology becomes a privilege of prepared centres, not a health-system capability.
Executive Summary
A 2026 Journal of Cancer Research and Clinical Oncology study examined the infrastructure needed to implement extended molecular diagnostics for precision cancer medicine in Europe. The mixed-methods study combined a survey, structured literature search and expert interviews. It included 44 survey respondents from 20 countries, 45 published papers and seven expert interviews. The authors identified six infrastructure categories needed for implementation: physical, financial, organisational, competency, data and legal infrastructure. They also highlighted centralisation of testing, sustainable reimbursement, stakeholder engagement, interoperable data infrastructure and interdisciplinary collaboration as key implementation needs.
Why it matters
- Diagnostics / pathology: Need sustainable funding, skilled staff, laboratory capacity and reporting workflows so molecular results are clinically usable.
- Payers / HTA bodies: Must assess not only the test itself, but the wider value of diagnostics for treatment selection, trial enrolment and evidence generation.
- Hospitals / providers: Need organised diagnostic pathways, molecular tumour board capacity and data systems that connect test results to treatment decisions.
Previously, the precision oncology debate often centred on the availability of targeted therapies and advanced sequencing technologies. This study shifts the question from technology availability to system readiness.
What changes is the framing. Extended molecular diagnostics are presented as routine-care infrastructure, not a specialist add-on. The relevant patient group is broad: patients for whom precision diagnostics are recommended, depending on tumour type, guideline indication and national pathway. But eligibility only matters if the system can deliver testing and return interpretable results in time for treatment decisions.
The study is especially useful because it separates infrastructure into concrete categories: laboratories and testing platforms, reimbursement and financial arrangements, organisational models, workforce competence, data systems and legal frameworks. It also makes clear that access to targeted treatments affects the value of molecular testing. A test result has limited clinical value if the patient cannot access the treatment or trial it identifies.
The implication is direct. Europe cannot measure precision oncology access only by medicines approved or tests listed. It needs to measure whether testing pathways are funded, staffed, interoperable and connected to treatment access across countries and regions.
