Greek Cancer Patients Still Awaiting Biomarker Testing Access Eight Months After Reform
核心洞察
Greece's ministerial decision to expand reimbursed oncology biomarker testing remains non-operational eight months after introduction, leaving thousands of patients without free access.
Approximately 23,000 patients with lung, breast, prostate, pancreatic, bladder, colorectal, ovarian, and cervical cancers could benefit once the reimbursement framework is implemented.
Experts warn that errors in eligibility criteria, particularly for HRD (搜索) testing in advanced ovarian cancer (搜索), could exclude patients who need testing to determine PARP inhibitor (搜索) suitability.
Eight months after Greece introduced reforms to expand reimbursement for oncology biomarker testing through its public healthcare system, thousands of cancer patients remain without free access to these essential diagnostic tools. The delay has drawn sharp criticism from oncologists, patient advocacy groups, and industry leaders who argue that biomarker testing is not a luxury but a prerequisite for modern, personalized cancer care.
The ministerial decision, which updated the list of reimbursed oncology biomarkers and created a new framework for evaluating future tests, has yet to become fully operational. The National Organisation for Healthcare Services Provision (EOPYY (搜索)) is still completing the operational and contractual steps required before patients can receive reimbursed testing.
"The biomarker is not simply a laboratory test. It is the tool that allows us to select the right treatment for the right patient at the right time," said Emmanuel Saloustros, president of the Hellenic Society of Medical Oncology (EOPE). "Access to innovation begins with access to the biomarker."
Scope of the Unmet Need
EOPE estimates that approximately 23,000 patients could benefit from the new reimbursement framework once it is implemented. The tests could assist patients with lung, breast, prostate, pancreatic, bladder, colorectal, ovarian, and cervical cancers — covering a substantial proportion of Greece's oncology population.
Spyros Goulas, head of EOPYY (搜索)'s Directorate of Strategic Planning, said establishing the institutional framework was the first major step toward changing how biomarker testing is funded. Under the new system, biomarkers connected to specific medicines will be assessed through a coordinated process involving relevant negotiation committees, while laboratory services will be handled through EOPYY's separate healthcare services negotiation process.
"We are now at the stage of negotiations," Goulas said, expressing hope that the process would produce results during the second half of 2026. Rather than organizing traditional competitive tenders, EOPYY (搜索) intends to establish framework agreements that will allow qualified laboratories to participate. Three major laboratories have reportedly expressed interest in signing agreements.
Ovarian Cancer (搜索) Testing Criteria Under Scrutiny
Despite the progress, medical experts and patient representatives have identified possible errors in the eligibility criteria contained in the ministerial decision. One of the most serious concerns involves homologous recombination deficiency (HRD (搜索)) testing for patients with advanced ovarian cancer (搜索).
The current wording appears to state that testing should be provided to patients who have not responded to platinum-based chemotherapy. However, international guidelines and approved treatment indications generally refer to patients whose cancer has shown a complete or partial response to platinum-based treatment. Experts warn that this discrepancy could exclude the very patients who need HRD (搜索) testing to determine whether maintenance treatment with PARP inhibitors is appropriate.
A meeting between EOPYY (搜索) and the Health Ministry is reportedly expected to address outstanding problems and consider corrections to the framework.
Maria Papageorgiou, president of the Erifyli Association of Cancer Patients and Friends, highlighted the financial burden on patients. "Women are being asked to pay out of pocket for a test that determines the course of their treatment," she said. "It is absurd to have access to the medicine but not to the test that tells you whether you should receive it."
Papageorgiou added that the state would also save money by ensuring patients receive treatments that are more likely to work, rather than funding expensive therapies without first confirming their suitability.
Clinical Consequences of Delayed Testing
Oncologists have warned that delayed access to biomarker testing is not merely an administrative problem. When patients cannot undergo the necessary tests promptly, they may face delays in starting the most suitable treatment or may lose access to targeted therapies and immunotherapies that could improve their prognosis.
"If a patient cannot undergo the necessary test in time, the consequence is not merely an administrative delay," Saloustros said. "It may mean a delay in starting the optimal treatment or exclusion from a targeted therapy or immunotherapy that could improve prognosis."
Laboratory Capacity Constraints
Medical groups have also raised concerns about Greece's limited public laboratory capacity. Only three public hospitals currently have accredited laboratories capable of carrying out the required testing, despite public hospitals treating a large proportion of the country's cancer patients.
Evi Pouliou, a quality assessment evaluator at the Hellenic Accreditation System, said accreditation should not become another source of delay. Many oncology laboratories already use established diagnostic methods, including polymerase chain reaction tests and next-generation sequencing, which can assess several biomarkers simultaneously but requires reliable quality controls and specialist interpretation of complex data.
Eleftherios Eleftheriadis, vice-president of the Hellenic Society of Pathological Anatomy, warned that Greece could not depend on only three laboratories to provide the full range of biomarker tests. "We cannot rely on three laboratories for the full range of biomarkers," he said.
Eleftheriadis also argued that the framework focuses too heavily on molecular testing while failing to adequately recognize the work carried out by pathologists, who determine whether tissue samples are suitable for further analysis. He noted that standard biopsy histology remains reimbursed at just €21, based on a state price list dating back to 1991. Without appropriate reimbursement, he warned, it would be difficult to expect pathologists to take on additional specialized responsibilities.
Temporary Programs and the Push for Permanent Solutions
Since 2015, EOPE and pharmaceutical companies have funded free biomarker tests for more than 3,500 cancer patients through temporary programs. However, medical and industry representatives say patients should not have to rely on short-term initiatives for access to tests that are now an essential part of cancer treatment.
Elena Chouliara, president and chief executive of AstraZeneca Greece and Cyprus and vice-president of the Hellenic Association of Pharmaceutical Companies, emphasized the need for structural change. "We cannot speak about precision medicine, precision oncology or pharmaceutical innovation without a permanent solution to patients' access to quality testing," she said. "Many new medicines require specialized tests because they are targeted therapies. We need to build permanent structures, rather than resort to one-off, stopgap programmes."
Cancer specialists and patient organizations are now calling for reimbursement negotiations to be completed, errors in the eligibility criteria to be corrected, and Greece's public laboratory network to be strengthened. Until those changes are implemented, thousands of patients may continue to face delays or pay privately for tests that determine which treatment could offer them the best chance of recovery.