National
State of Readiness in Canada
CCRAN Biomarkers Conference 2025
The State of Readiness Progress Report 2.0: How have Canadian Health Systems Improved?
Don Husereau, B.Sc. Pharm, M.Sc. , Adjunct Professor of Medicine, University of Ottawa
Adjunct Professor of Medicine at the University of Ottawa, Don Husereau presented a progress report covering how the Canadian health systems have improved in regards to readiness for the implementation of comprehensive genetic testing (CGP). He began by sharing data from an Australian study that compared standard diagnostic care to whole-exome sequencing, a type of CGP. Key points included the total costs of testing 40 patients ($AUD) which were $189,352.53 for standard diagnostic care vs $150,071.60 for CGP, as well as the total number of patients diagnosed using those techniques which were 7 vs 25 respectively. The results therefore suggest that CGP, specifically whole-exome sequencing, would be both less costly and more effective in the diagnosis process.
There are some key questions associated with developing new precision medicine approaches that are associated with patient & provider experiences, costs, health and innovation.
- How can I avoid care interruptions, wait times, or inequitable care?
- How can I avoid access challenges and avoid inappropriate identification of family members?
- How can I avoid inappropriate or inefficient/low value care?
- How can I support innovation policy and a better understanding of population health?
- How can I provide effective care and be prepared for future advances in testing?
Below are the three levels at which we must reach adequate readiness.
Infrastructure
- Creating communities of practice and healthcare system networks
- Resource planning
- Informatics – linked information systems
Operations
- Single entry/exit point for innovation proposals
- Evaluation function
- Service models – coordinate care
- Patients and caregivers must know where they can get tests, what the turnaround time is, etc.
- Tools for awareness and care navigation
Health care environment
- Integration of innovation and care delivery
- Financing approach
- Education and training
- Regulation data privacy legislation
Provincial Readiness
Five provinces were given readiness scores in 2023 and again in 2025 as a part of the progress report. Alberta scored the highest both times (B+), with a contributing factor being that they have an organization dedicated to laboratory testing that includes but is not limited to genetic testing, making it better established for a shift towards CGP. One of the 2023 critiques for Alberta was a lack of transparency, which they responded to by publishing a report soon after.
As for the other provinces, Quebec scored a B- both in 2023 & 2025, British Columbia maintained a score of C, Nova Scotia went from C- to B-, and finally the most improved province was Ontario, from a D to B (Table 1).
Nova Scotia’s higher readiness score is associated with the introduction and use of a committee after the 2023 score, improvements in education and regulation of service delivery, and a refined evaluative process for new proposals.
Ontario’s increase in score can be attributed to the novel implementation of a provincial genetics program that works closely with their pathology and laboratory medicine program, as well as the biomarker test menu that they now publish, some resource planning and coordination of care that has been done, as well as the province-wide standards for education and training that were established.
The recurrent issue of education is likely due to the fact that many provinces lack overarching education strategies and instead rely on labs or the private sector to help with education. In terms of the territories, they have referral arrangements set up with respective provinces, making their readiness dependent on those provinces. For more information on why each province received the scores they did, view their individual progress reports at the following links: Alberta, Quebec, British Columbia, Nova Scotia, and Ontario.
Table 1: Province Readiness Grades for 2023 vs 2025
| Province | 2023 | 2025 |
| Alberta | B+ | B+ |
| Quebec | B- | B- |
| British Columbia | C | C |
| Nova Scotia | C- | B- |
| Ontario | D | B |
*No marks were docked for affordability issues
When analyzing the 2025 readiness scores for provinces across Canada, Newfoundland came out on top. A contributing factor to their score of A- was the high level of transparency they have reached through their laboratory medicine program which clearly outlines what criteria they use, how they value tests, the open application process which enables people to fill out a form to propose a new test, to name a few. They also have the benefit of size by being small which allows for easier coordination. On the downside, they do still rely on the ministry to approve tests which results in lags when it comes to the funding of new tests.
Table 2: 2025 Provincial Grades Across Canada (High to Low)
| Province | Grade |
| Newfoundland | A- |
| Alberta | B+ |
| Ontario | B |
| Nova Scotia | B- |
| PEI | B- |
| Quebec | B- |
| New Brunswick | B- |
| Manitoba | B- |
| British Columbia | C |
| Saskatchewan | C |
To summarize, the provinces have taken a step in the right direction, but there remains work to be done regarding education strategies, interprovincial collaboration,test & care navigation, improving engagement/involvement of stakeholder community, and integration of laboratory
information across centres.
*Please note the following data may be subject to change as there is a final report that is yet to be released
International
Belgium
In Belgium, CGP for late stage cancer is being incorporated across hospitals for everyone via in-hospital testing. They are up to a 93% success rate, having reduced the time to patient down to 29 days and they have been able to identify 81% of actionable mutations. In fact, 69% of patients receive treatment recommendations based on the findings from CGP.
*The above information is from CCRAN Biomarkers Conference “Generating a Cost-Benefit Analysis to Help Support Access to Comprehensive Genomic Profiling (CGP) for Five Metastatic Cancers in Canada: Helping to Ensure CGP Becomes a Standard of Care in Canada!” by Eddy Nason, MPhil, B.Sc., Director, Health, Conference Board of Canada
CCRAN Biomarkers Conference 2025
What Can We Learn From Early Adopters of Comprehensive Genomic Profiling? An International Discussion
https://www.youtube.com/watch?v=YIn4bGvv-IM
United States
Speaker: Dr. Razelle Kurzrock, MD, FACP, Professor of Medicine, Associate Director, Clinical Research, Linda T. and John A. Mellowes Chair, Precision Oncology, MCW Cancer Center, Wisconsin, USA
Many topics were covered in a segment of the conference discussing precision medicine around the world, one of which was CGP cost/coverage. The healthcare system in the United States is funded by a mixture of public and private payers. The NGS type of CGP is available to any patient with advanced cancer, and there are around 9-10 treatments approved that target a specific biomarker. This testing is mainly covered by public payers and private insurers as well as through many large vendors who will often provide financial assistance if something is not covered.
Once something receives Food and Drug Administration (FDA) approval, insurance companies and Medicare will begin to cover it, leading to private payers also providing coverage since they tend to follow what Medicare does. Vendors aim to provide financial assistance to patients but charge Medicare. Also worth noting is that payers almost always pay when something is found in the National Comprehensive Cancer Network (NCCN) guidelines.
Dr. Kurzrock raised the point that one barrier could arguably be whether or not the physician orders the tests in the first place. Many don’t appear to have adequate training in interpreting the results or even know that these options are freely available. In regards to this, molecular tumour boards are established to familiarize physicians and aid in the interpretation of genetic test results. Further, there is also an umbrella protocol which covers the institution and allows patients to be treated with off-label drugs based on NGS testing. This comes into play for the treatments that are approved for one type of cancer but not another despite being designed specific to the same biomarker – which is one of the barriers in Canada. This umbrella system enables them to pivot, has no legal restrictions and is frequently used; 40% of oncology drug use in the U.S. is off-label. As for future directions, they are looking at making CGP available for everyone at the time of diagnosis, regardless of the stage of their cancer.
Israel
Speaker: Dr. Gilad W. Vainer, MD, Ph.D., Onco-Proteomics Lab, Pathology Department Head, Hadassah Medical Center, Jerusalem, Israel
Israel’s healthcare system is publicly funded. Their approach to precision medicine was to launch a pilot project in 2019 where they started to provide CGP to advanced non-small cell lung cancer patients and expanded from there. They now provide CGP for 18 types of cancers, including advanced colorectal, advanced prostate, triple negative breast cancer, and all patients 21 and under with late stage cancer, among others. This year CGP for non-small cell lung cancer is no longer limited to late stage and nearly anyone with this type of cancer can get tested.
Overall, they have early access to testing for more than 70-80% of cancers, all of which is publicly funded. Their perspective is that it’s more efficient and cost effective to do everything in one basket using this technology. These rapid results are critical because as a lung cancer pathologist, Dr. Vainer noted that 30% of his patients in the metastatic stage pass within 10 weeks, making reflex testing critical. Most lung cancer patients are already in a late stage at the time of diagnosis, so would be receiving testing anyways, meaning there is not a large fraction of extra patients to test when you cover testing for all cancer stages. In his words, they have the drugs so it makes no sense for their citizens to die because they are waiting on test results. In fact, in their system they are not allowed to provide a test without a drug and vice versa.
Australia
Speaker: Prof. David Thomas, Ph.D., FRACP, Director, UNSW Centre for Molecular Oncology; CSSO, Omico, New South Wales, Australia
The healthcare system in Australia is a publicly funded system with Standards of Care around diagnosis and testing that don’t currently include genomic profiling as a routine part of cancer care. The exception is non-small cell lung cancer for which a small panel was reimbursed as of November 2023, but overall, genetic profiling is not comprehensive in Australia.
In terms of the specifics as to how their funding works, the eight states & territories get public hospital healthcare funding by states, whereas reimbursement for some standard care healthcare is funded through pharmaceutical and medical benefits. Consequently, there can be variations between states when it comes to things like CGP, as this technology evolves from the hospitals, which are funded by the states and territories. Beyond the provincial accessibility concerns, there’s also the issue of regional accessibility where there’s often excellent care in urban areas while people in rural areas have more limited access to resources even though everyone pays the same taxes. Finally, it was mentioned that patient perspectives are included when it comes to funding assessments and recommendations.
What is INFORM?
INFORM is an international patient registry that contains information on the pediatric population with high-risk or late-stage cancer. It exists to store genetic information acquired from tumour & blood samples, such as any identified biomarkers. There are 1700+ patients that are a part of the registry, and it provides physicians and collaborating centres with information, which can then inform treatment or access to clinical trials.
In 2015, the registry was created in Germany but expanded to other countries by 2016; it now includes Austria, Belgium, Czech Republic, Finland, Greece, Israel, Norway, Poland, Portugal, Slovenia, Sweden, and Switzerland. The collaborating centres across Europe send their tumour samples to the Heidelberg University Hospital in Germany for scientists and physicians to categorize the biomarkers and identify studies or treatments for patients based on these. INFORM also has connections with other precision medicine programs across Europe, such as Mappyacts (France), iTHER (Netherlands), SM-PAEDS (UK), and in Denmark.
This project has further benefitted the healthcare system by highlighting the importance of sampling metastasized tumours as well, rather than strictly the original, as these can evolve and provide additional biological information. Altogether, the INFORM program creates an efficient system to analyze patient samples for actionable biomarkers and make clinical decisions based on the findings.
CITATIONS:
[1]Cornelis M. van Tilburg, Elke Pfaff, Kristian W. Pajtler, Karin P.S. Langenberg, Petra Fiesel, Barbara C. Jones, Gnana Prakash Balasubramanian, Sebastian Stark, Pascal D. Johann, Mirjam Blattner-Johnson, Kathrin Schramm, Nicola Dikow, Steffen Hirsch, Christian Sutter, Kerstin Grund, Arend von Stackelberg, Andreas E. Kulozik, Andrej Lissat, Arndt Borkhardt, Roland Meisel, Dirk Reinhardt, Jan-Henning Klusmann, Gudrun Fleischhack, Stephan Tippelt, Dietrich von Schweinitz, Irene Schmid, Christof M. Kramm, André O. von Bueren, Gabriele Calaminus, Peter Vorwerk, Norbert Graf, Frank Westermann, Matthias Fischer, Angelika Eggert, Birgit Burkhardt, Wilhelm Wößmann, Michaela Nathrath, Stefanie Hecker-Nolting, Michael C. Frühwald, Dominik T. Schneider, Ines B. Brecht, Petra Ketteler, Simone Fulda, Ewa Koscielniak, Michael T. Meister, Monika Scheer, Simone Hettmer, Matthias Schwab, Roman Tremmel, Ingrid Øra, Caroline Hutter, Nicolas U. Gerber, Olli Lohi, Bernarda Kazanowska, Antonis Kattamis, Maria Filippidou, Bianca Goemans, C. Michel Zwaan, Till Milde, Natalie Jäger, Stephan Wolf, David Reuss, Felix Sahm, Andreas von Deimling, Uta Dirksen, Angelika Freitag, Ruth Witt, Peter Lichter, Annette Kopp-Schneider, David T.W. Jones, Jan J. Molenaar, David Capper, Stefan M. Pfister, Olaf Witt; The Pediatric Precision Oncology INFORM Registry: Clinical Outcome and Benefit for Patients with Very High-Evidence Targets. Cancer Discov 1 November 2021; 11 (11): 2764–2779. https://doi-org.libaccess.lib.mcmaster.ca/10.1158/2159-8290.CD-21-0094
[2]INFORM Registry . German Cancer Research Center in the Helmholtz Association . (n.d.). https://www.dkfz.de/en/research/inform/inform-register/about-inform
[3] Wallin, S., Øra, I., Prochazka, G., Sandgren, J., Björklund, C., Ljungman, G., Vogt, H., Ek, T., van Tilburg, C. M., & Nilsson, A. (2024). Implementing data on targeted therapy from the INFORM registry platform for children with relapsed cancer in Sweden. Frontiers in Oncology, 14. https://doi.org/10.3389/fonc.2024.1340099
[4] Wallin, S., Øra, I., Prochazka, G., Sandgren, J., Björklund, C., Ljungman, G., Vogt, H., Ek, T., van Tilburg, C. M., & Nilsson, A. (2024). Implementing data on targeted therapy from the INFORM registry platform for children with relapsed cancer in Sweden. Frontiers in Oncology, 14. https://doi.org/10.3389/fonc.2024.1340099
[5] Wallin, S., Øra, I., Prochazka, G., Sandgren, J., Björklund, C., Ljungman, G., Vogt, H., Ek, T., van Tilburg, C. M., & Nilsson, A. (2024). Implementing data on targeted therapy from the INFORM registry platform for children with relapsed cancer in Sweden. Frontiers in Oncology, 14. https://doi.org/10.3389/fonc.2024.1340099