Conference Abstracts - Summit on Cancer Health Disparities (SCHD26)
Vol. 6, Issue Supplement 1, 2026 · S1-2
Financial Barriers to Precision Oncology: The Impact of HRD Testing Reimbursement in a Canadian Cancer Centre
Olivia McKeeman, M.Sc.,Sarah Freedman, MD,Walter Gotlieb, MD,Susie Lau, MD,Shannon Salvador, MD,Melica Brodeur, M.Sc.,Basile Tessier Cloutier, MD,Hana Badawi, MD,Angela Tatar, MD,Kim Ma, MD
Submission received: 2025-12-15 / Accepted: 2026-01-07 / Published: 2026-01-26
Abstract
Background
In 2019, the PRIMA trial demonstrated progression-free survival benefit of PARP inhibitors (PARPi) in BRCA1/2-mutated and homologous recombinant deficient (HRD) BRCA1/2-wildtype ovarian cancers. Patients without this molecular signature derive little benefit while still experiencing substantial adverse events, making somatic BRCA1/2 and HRDstatus imperative to clinical decision making. The Jewish General Hospital (JGH) was among the first Canadian centres to implement local BRCA1/2 testing. However, companion HRD tests (Myriad Genetics MyChoice, FoundationOne Medicine) are currently not reimbursed by the Canadian government, denying patient access to targeted therapy and reinforcing financial barriers to precision medicine.
Methods
This is a retrospective single tertiary centre (JGH, Montreal, Canada) study. Local somatic BRCA1/2 testing (JGH Molecular Pathology) and external HRD testing (Myriad myChoice CDx, FoundationOne CDx) were performed. HRD testing rates were compared using Poisson regression.
Results
From February 2023 to June 2025, a partnership with GSK enabled reimbursement for the Myriad MyChoice CDx HRD test. During these 29 months, 36 patients underwent reimbursed testing. In contrast, during a 79-month period (January 2019-July 2025), 35 patients underwent testing without reimbursement. HRD testing rates were significantly higher during the reimbursement period (14.9 vs 5.3 patients/year; IRR = 2.81, 95% CI 1.76-4.47, p < 0.0001). Median turnaround time from request to test date was 33 days (IQR 23-43;range 0-206) for JGH Pathology (n=166), 36 days (IQR 25.25-58 ;range 16-194) for Myriad (n=42), and 21 days (IQR 15-26;range 6-64) for FoundationOne (n=33), demonstrating substantial variability and delays in clinical timeline.
Conclusion
Reimbursement was associated with a nearly three-fold increase in HRD testing, highlighting this key determinant of equitable access to PARPi therapy. Variability in turnaround time underscores a need for streamlined testing to enable timely treatment decisions. This study is part of a Quality Improvement initiative to implement HRD testing as standard of care in Quebec.