e15083 Background: Comprehensive Genomic Profiling (CGP) was reimbursed in Japan in 2019. By 2025, physician awareness reached approximately 90%, whereas implementation rates remained limited to 10–30% across cancer types. In Japan, CGP requires mandatory Expert Panel (EP) review, and reimbursement is restricted to patients who have completed or are expected to complete standard therapies. This study examined temporal changes in barriers to CGP implementation from 2019 to 2025 and assessed the impact of Japan-specific institutional requirements on clinical practice. Methods: Web-based surveys were conducted once or twice annually from 2019 among physicians registered with Plamed Inc., collecting approximately 1,000 responses per wave. Using anonymized data, temporal trends were analyzed for perceived challenges to CGP implementation, factors required to promote CGP uptake, burden associated with EP meetings, and time required for EP-related tasks. Results: CGP implementation increased from approximately 1–5% in 2019 to 10–30% in 2025 but remained limited.In 2019, frequently cited challenges included uncertainty in identifying treatment options, lack of experience in explaining results to patients, and burden related to explaining hereditary findings to families, each reported by approximately 50% of physicians.By 2025, the main challenges shifted to low treatment reach (with only ~10% of tested patients leading to treatment), high costs including patient out-of-pocket burden, and prolonged turnaround time (TAT) of 2–3 months, each selected by approximately 30% of respondents and consistently high since 2022.To promote future CGP uptake, physicians emphasized simplifying procedures and reducing operational burden. EP meetings were identified as a major source of burden, with approximately 90% reporting EP-related burden since 2022, particularly for case preparation. No meaningful reduction in EP-related workload was observed over time. Conclusions: Key barriers to CGP implementation in Japan include low treatment reach, financial burden, and prolonged TAT. Mandatory EP review represents a significant operational burden and may contribute to procedural complexity and delayed result delivery. Policy discussions are ongoing regarding flexibilization of EP operations and expansion of eligible EP-performing institutions. Additionally, allowing CGP prior to completion of standard therapy may expand patient eligibility and improve treatment access. As physician awareness and willingness continue to increase, comprehensive systemic reforms addressing EP processes and testing timing are essential to further promote CGP adoption in Japan.
Igarashi et al. (Thu,) studied this question.