Turning clinical readiness into routine patient access
Reflections from the Private Cancer Physicians of Australia Cancer Summit 2026

A week on from the Private Cancer Physicians of Australia Cancer Summit, I remain energised by the clinical leadership, openness and shared commitment to improving access to contemporary cancer care.

I was honoured to join the panel on Re-engineering Access and HTA for Private Oncology. Expertly chaired by Dr Anu Agarwal and opened by Professor Robyn Ward AM, the panel included Associate Professor Christopher Steer, Associate Professor Colman Taylor, Vicki Durston, Nathalie McNeil and me. Together, the discussion brought perspectives from clinical practice, health economics, consumer advocacy, industry, genomics and precision medicine.

There was strong recognition that Australia needs systemic reform to improve how health technologies are assessed, funded and made available to patients. For InGeNA, this creates an important opening to ensure genomics has fit-for-purpose HTA and access pathways that benefit all Australians.

The Summit opened with remarks from Senator Michelle Ananda-Rajah and Senator the Hon Anne Ruston. Both recognised the importance of connecting innovation with equitable cancer care, including for Australians outside major metropolitan centres.

It was welcome to hear Senator Ananda-Rajah recognise genomics as a critical layer of cancer care, including its role in connecting patients with clinical trials. Australia’s world-leading clinical trial programs are important. The opportunity now is to ensure genomic testing is also more accessible through routine clinical care.

The discussion made clear that precision oncology is clinically ready. The challenge is that Australia’s HTA and funding pathways have not kept pace with the way genomic testing is now used in routine cancer care.

One of my strongest reflections from the Summit was how deeply engaged private cancer physicians are in genomics and precision medicine. In conversations with leading clinicians, they described genomic testing as providing diagnostic confidence, a common basis for clinical decisions and greater clarity and decision support for patients. Patients want the testing, and so do their doctors.

For these clinicians, genomics is increasingly a first port of call, not a last resort. The challenge is navigating a complex and fragmented funding environment, including the MBS, and achieving the scale required for consistent national access.

PCPA is a capable and cohesive clinical community. Associate Professor Christopher Steer’s leadership has helped build that strength, and the leadership transition announced at the Summit to Dr Cameron McLaren provides a strong platform for the next chapter. The strong and constructive engagement between PCPA and industry is also helping to build clinical capability, share emerging evidence and support the translation of genomic innovation into patient care. Collaboration between PCPA and LifeStrands Genomics Australia, including precision oncology education and molecular tumour boards, has also made a practical contribution to clinical capability and confidence.

The panel welcomed the direction towards systemic HTA reform. This is especially important for genomics because precision oncology has changed, while the unit of assessment has not.

Australia’s routine HTA processes are principally designed around one test linked to one treatment. Genomic platforms do not fit neatly within that model: a single test may clarify diagnosis, identify multiple actionable alterations, inform several treatment options, avoid ineffective treatment and connect a patient to an appropriate clinical trial.

The ctDNA and cancer of unknown primary (CUP) applications demonstrate how the system struggles once assessment moves beyond a one-test, one-treatment relationship. Applicants may be asked to quantify implications across multiple medicines using evidence that was not designed to evaluate a genomic test-led pathway. No individual applicant controls all the medicines, sponsors, data and funding decisions needed to resolve these system-level interdependencies.

Patients experience the consequences of this mismatch. When a clinically valuable test is not funded through routine care, access shifts to research programs, institutional or industry support, or self-funding. Cancer physicians must explain why a relevant test is available but not reimbursed, manage delays and difficult financial choices, or make treatment decisions without complete molecular information. This compounds inequity and prevents the scale needed to reduce costs and build sustainable access.

A fit-for-purpose approach must assess value across the whole care pathway—not only the cost of a matched medicine, but also greater diagnostic certainty, avoidance of ineffective treatment and toxicity, fewer invasive procedures and hospital presentations, and benefits that may fall across different health budgets.

InGeNA’s international comparisons indicate that Australia is the only comparable OECD country that continues to rely principally on its routine HTA processes for genomic tests rather than adapting its assessment and commissioning approach. Other jurisdictions have introduced mechanisms such as national genomic test directories, central commissioning, national clinical pathways or coverage with evidence.

The task is to retain rigour while making assessment proportionate to the technology, the evidence that can reasonably be generated and the value delivered across the care pathway. Industry supports rigorous and accountable assessment, but cannot by itself resolve fragmented policy responsibilities or recreate evidence that clinical trials were never designed to generate.

England’s National Genomic Test Directory provides a useful example of how assessment, commissioning and clinical delivery can operate as a connected and continuously updated system. It gives clinicians and patients clarity about which tests are available, for whom and through which pathway. The directory matters, but it is the visible component of a broader fit-for-purpose genomic assessment and commissioning model.

As InGeNA prepares to welcome Dame Professor Sue Hill to Australia in October 2026, our discussions about the NHS model have highlighted the value of a focused and efficient national function supporting the Genomic Test Directory. We understand its indicative annual operating cost to be approximately £400,000, covering the review and updating of tests and support for commissioning decisions. The lesson is not that Australia should simply copy England, but that a fit-for-purpose system can combine rigour, national consistency and practical access.

The panel was asked to identify one action for the next 12 months. For InGeNA, it is to commission an evaluation of the NHS model and other effective OECD approaches, and use that learning to design a fit-for-purpose Australian HTA and commissioning system for genomics. The priority is a future-focused, dynamic system that continually assesses, records and updates access decisions—not a retrospective exercise to reconstruct fragmented historical data.

Australia should also use the Australia–England genomics Memorandum of Understanding and its relationship with NHS England to advance regulatory and assessment harmonisation, including appropriate reliance on trusted international evidence and decisions. This would focus finite expertise and resources on implementation and patient access, rather than repeating high-quality assessments already completed in comparable systems.

PCPA and InGeNA are well placed to contribute the clinical and industry expertise needed for that work, alongside consumers, pathology providers, health economists and government.

The Summit reinforced that the clinical community is ready, patients are asking for precision care and systemic reform is now firmly on the agenda. This is the moment to ensure genomics is built into that reform so the right test and the right treatment can become part of routine care for every Australian who needs them.