Key takeaways
- Precision oncology works only when molecular testing is connected to interpretation, treatment decisions, trial access, and follow-up - not treated as a standalone test.
- Every step in the pathway needs a clear owner, from patient selection and tissue assessment to result review and documentation of what happens next.
- Molecular tumor boards are most useful when they support difficult cases and gradually integrate molecular decision-making into routine disease-specific care
- Community practices can start small, standardize one pathway well, integrate it into the EHR, measure outcomes, and then expand to other disease areas.
At the Community Oncology Global Congress (COGC 2026), organized by OncoDaily, Atlal Abusanad, Professor and Consultant of Medical Oncology at King Abdulaziz University and King Abdulaziz University Hospital in Jeddah, Saudi Arabia, focused on what it actually takes to make precision oncology work in community practice.
Precision oncology is often reduced to a familiar sequence: order genomic testing, receive a report, identify an actionable alteration. But the difficult part begins after the result arrives. Someone has to interpret it in the context of the patient’s disease and treatment history, determine whether another test is needed, identify an appropriate therapy or trial, navigate access, and make sure the decision is carried through.
The real question is therefore not whether a practice can order next-generation sequencing, but whether it has a system capable of turning molecular information into a clinical decision.
Precision Oncology Is More Than a Genomic Test
Modern molecular testing brings increasingly complex biomarkers, multiple testing platforms, and reports that can be difficult to interpret. Results may also sit outside the normal clinical workflow, with no clear ownership over what should happen next.
And even when an actionable alteration is found, the patient may still be unable to access the matched therapy or enroll in the appropriate clinical trial.
This creates a familiar failure pathway: NGS is ordered, the result returns, interpretation is delayed or uncertain, and no meaningful clinical action follows.
The solution is to treat precision oncology as a longitudinal service line, rather than as an isolated molecular test.
That pathway begins with selection: identifying which patients should be tested and deciding on the appropriate somatic and germline strategy.
It then moves through testing, which means obtaining adequate tissue, selecting the right assay, and having alternatives such as repeat biopsy or liquid biopsy when tissue is insufficient.
The next step is interpretation, where molecular findings have to be considered alongside clinical history, previous treatments, available evidence, and potential trial opportunities.
Then comes action. That may mean a matched therapy, enrollment in a clinical trial, a pharmacogenomic treatment modification, additional testing, or germline counseling and cascade testing for family members.
The final component is quality improvement: tracking what happened, identifying where the pathway failed, and determining whether patients were ultimately able to access the recommended intervention.
“Building the program has to be around the decision, not around the test.”
Five Pillars of a Precision Oncology Program
For community practice, the system can be organized around five essential pillars.
- Governance establishes clear clinical and administrative ownership of the program.
- People provide the multidisciplinary expertise needed to interpret and act on molecular findings.
- Workflow standardizes who should be tested, how tests are ordered, how specimens are handled, where results go, and what happens afterward.
- Technology integrates molecular information into the electronic health record, ideally with alerts and decision-support tools that make genomic results visible and usable during clinical care.
- And access determines whether the recommendation can actually reach the patient through a matched treatment or clinical trial.
The multidisciplinary team behind that system does not have to be large, but each function needs an owner. Oncologists and pathologists provide the clinical and diagnostic foundation, including determining testing indications and specimen adequacy. Genetic counselors address germline implications and cascade testing, while pharmacists with pharmacogenomics expertise can contribute to treatment selection and toxicity management. IT support is needed to retrieve, integrate, and monitor genomic information, while research networks are critical for connecting patients with biomarker-driven trials.
Importantly, not every expert needs to be physically located within the community practice. Telemedicine and external partnerships can provide expertise that would otherwise be difficult to maintain locally.
From Testing to Action: Give Every Step an Owner
A functioning pathway should begin before the test is ordered.
Eligibility criteria can be defined according to diagnosis, disease stage, and line of therapy. Once testing is indicated, pathology should determine whether enough appropriate tissue is available. If not, the next step – repeat biopsy, an alternative specimen, or liquid biopsy – should already be built into the workflow.
Testing should also follow a defined laboratory and assay strategy, with reflex testing and authorization processes established in advance rather than being decided from scratch for every patient.
Once a molecular result returns, it should automatically reach a defined owner.
The case can then move into a molecular tumor board, disease-specific board, or expert consultation depending on its complexity. Most importantly, whatever happens next should be documented.
An action may be starting a treatment, offering a clinical trial, ordering additional testing, or deciding that no molecularly directed intervention is appropriate. Even no action is a clinical outcome that should be recorded.
External laboratory reports should ideally feed into a genomic layer within the electronic health record where molecular results, alerts, treatment history, and longitudinal information can be viewed together.
That integration can support testing prompts, make previous results easier to find, improve trial matching, and eventually allow practices to measure both quality and equity across the program.
How Molecular Tumor Boards Should Evolve
Molecular tumor boards can be particularly valuable when a precision oncology program is new.
Early on, a centralized board can review difficult cases, help clinicians interpret unfamiliar molecular findings, and gradually build institutional expertise.
As the program becomes more mature, precision oncology can increasingly move into the disease-specific setting. Breast, lung, gastrointestinal, and other tumor boards can incorporate molecular findings into their routine discussions, while the central molecular tumor board remains available for the most complex cases.
This avoids turning precision oncology into a separate process running alongside cancer care. Instead, molecular information gradually becomes part of ordinary treatment decision-making.
The recommendation from a molecular tumor board also needs to go beyond interpretation. If a clinical trial is suggested, the pathway to that trial should be documented. If a treatment is recommended, the team needs to know how the patient can realistically obtain it.
Access as a Core Part of Precision Oncology
Finding an actionable alteration does not make a precision oncology program successful.
“A precision oncology program is only successful if the patient can actually receive the recommended intervention.”
That means access has to be designed into the program from the beginning.
For treatment, this includes insurance coverage, prior authorization, financial assistance, and pathways for off-label therapy where appropriate and available.
The same principle applies to clinical trials. Community practices need mechanisms for local trial access, referral networks, or virtual trial matching so that identifying an appropriate study does not become the end of the process.
Access also needs to be measured.
A program should periodically examine whether patients are able to reach recommended treatments and trials regardless of geography or other characteristics. Otherwise, sophisticated molecular testing can simply reveal an opportunity without creating a realistic way for the patient to benefit from it.
Start Narrow, Standardize, Then Expand
Building every component at once is neither necessary nor realistic for most community practices.
A more practical approach is to sequence implementation over the first year.
During the first three months, a practice can select one high-impact disease area, establish clear testing criteria, choose its laboratory and testing strategy, and assign ownership of the program.
By around six months, the standardized pathway can be operational, molecular review established, financial and access processes defined, and outcomes beginning to be captured.
By nine months, genomic results can be more deeply integrated into the electronic health record, decision-support tools and trial matching can be added, and key performance indicators can begin to be measured.
By 12 months, the model can expand into additional disease areas while the practice audits access and equity and develops education and knowledge-sharing activities.
Measurement should follow the entire pathway. Process measures include the proportion of eligible patients tested, turnaround time, insufficient-sample rates, and whether results reach the electronic health record. Action measures include actionable findings, matched treatments, trial offers, and trial enrollment.
Access can be measured through authorization times, financial barriers, and use of patient-assistance programs, while equity and quality measures show whether the system is working consistently across the population.
The goal is not to increase the number of genomic tests ordered.
“Start narrow, standardize deeply, integrate molecular information into the electronic health record, connect patients to expertise, treatment, and clinical trials, and measure outcomes rather than just test volume.”
A community practice does not necessarily need a large precision medicine center to do this. What it needs is something more fundamental: a reliable system that converts molecular information into better clinical decisions.
Written by Eliz Baloyan, MD, Features Writer and Editor at OncoDaily and CancerWorld
