ArticleFrontiers in cell and developmental biology2026
Unequal access to liquid biopsy in colorectal cancer care: a cross-sectional survey of clinicians across hospital tiers in Zhejiang, China.
Article in Frontiers in cell and developmental biology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: Liquid biopsy is increasingly used in colorectal cancer (CRC) management, but its real-world adoption remains limited by cost, evidence gaps, and uneven institutional capacity. This study assessed the clinical use, accessibility, and barriers to liquid biopsy among CRC-related clinicians in Zhejiang Province, China. Methods: A cross-sectional online survey was conducted among clinicians involved in CRC diagnosis and treatment. The questionnaire collected data on respondent characteristics, liquid biopsy use, clinical application scenarios, perceived barriers, and willingness for future adoption. Descriptive statistics, univariate logistic regression, and multivariable logistic regression were used for analysis. Results: Among 246 valid respondents, more than half reported having used liquid biopsy in CRC practice. Circulating tumor DNA was the most frequently used modality. The main applications were anti-EGFR resistance monitoring, postoperative minimal residual disease assessment, and recurrence risk monitoring. The leading barrier was high testing cost and lack of insurance coverage, followed by insufficient clinical evidence and uncertainty in result interpretation. Liquid biopsy accessibility was higher among clinicians from Grade III Class A hospitals, dedicated CRC treatment centers, and institutions treating more than 100 CRC cases annually; multivariable analysis identified annual case volume >100 cases as the sole independent predictor. A total of 89.8% of respondents expressed willingness to incorporate liquid biopsy into routine practice if reimbursement and accessibility improved. Conclusion: Liquid biopsy shows growing clinical acceptance in CRC care, but its adoption remains constrained by economic, evidentiary, and institutional barriers. Reimbursement support, standardized pathways, and targeted education are needed to promote equitable implementation.
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