Background
Precision medicine in oncology (PMO), which integrates genomic, molecular, and biological information to guide individualization of cancer prevention and treatment, has transformed cancer care. Despite its clinical promise, access to PMO remains uneven, even within high-income countries. These disparities likely arise from complex interactions between healthcare systems, socioeconomic conditions, policy environments, and patient-level factors. A comprehensive synthesis of evidence on access to PMO is needed to better understand and address both overall access and inequities in access.
Objectives
This ongoing systematic review aims to identify economic, geographic, educational, regulatory, technological, and patient-level factors that influence access to PMO among both adult and pediatric cancer patients in high-income countries. By integrating studies spanning the full breadth of quantitative and qualitative research designs the review will provide evidence regarding the determinants of PMO access, which is critical to effectively promoting equitable cancer care.
Methods
The reporting of this systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with PROSPERO (#CRD42025644949) on February 15, 2025. Comprehensive searches have been completed across several databases, including Ovid, Web of Science, and Embase, with a focus on publications in English and French. Inclusion criteria encompassed observational, interventional, qualitative, and mixed-methods studies conducted in high-income countries. Two reviewers are currently and independently screening titles and abstracts using Covidence software, with any discrepancies resolved through consensus or with the aid of a third reviewer. Data extraction is addressing study characteristics, barriers and facilitators to access, measures of access, and environmentally specific policy variables. The risk of bias in studies is being assessed using the Cochrane Risk of Bias tool (RoB 2) for randomized studies and the Newcastle–Ottawa Scale for non-randomized studies. The quality of qualitative studies is being assessed with the Critical Appraisal Skills Programme (CASP). Final analyses will be performed as a function of regional characteristics, healthcare system types, cancer sites, patient socioeconomic status and gender, and urban versus rural settings.
Results
As of the abstract submission date, the review was in progress. A librarian-led search strategy led to the identification of 8 804 articles. Initial screening has been completed for 68% of papers resulting in 336 papers being retained for further extraction and analysis. Preliminary observations on articles currently compiled indicate that access to PMO is associated with economic constraints, geographic inequities, limitations in insurance coverage, healthcare infrastructure deficiencies, and variations in institutional capacity. The review is expected to be completed by the end of April 2026.
Conclusions/Implications
In keeping with the implementation of other innovations in healthcare, there appear to be significant economic and health systems factors that either facilitate or impede access to PMO in high-income countries. Further analyses will allow for a nuanced portrait of the full range and impact of economic, geographic, educational, regulatory, technological, and patient-level factors associated with access to PMO. In turn, these factors could become targets for interventions and policies aimed at improving access to PMO and thus promoting equity.
Supported by the FRQ-S RRCancer.