Molecular tumor boards implementation in Europe: a scoping review and thematic analysis of challenges and facilitators.

Background

Molecular Tumor Boards (MTBs) are increasingly recognized as key instruments for integrating genomic data into clinical decision-making in precision oncology. While evidence suggests that MTBs may improve patient outcomes, their implementation across European healthcare systems remains heterogeneous. This scoping review aims to explore challenges and facilitators of MTB implementation, focusing on feasibility, acceptability, equity, and resource use.

Methods

We conducted a literature search in PubMed, Embase and Web of Science up to 30 June 2026 to identify studies addressing implementation aspects of MTBs in Europe. Eligible studies included any design discussing feasibility, acceptability, equity, or resource use. Statements were extracted and coded using a hierarchical analytical framework based on domains, themes, and subthemes. Statements were classified as challenges or facilitators.

Results

One hundred and six studies were included out of 3307 studies identified. Most studies addressed feasibility (87.7%), followed by equity (47.2%), resource use (44.3%), and acceptability (32.1%). A total of 466 statements were extracted, divided between challenges (43.1%) and facilitators (56.9%). Feasibility challenges included technical and organizational barriers, particularly delays in turnaround time, lack of standardized workflows, and limited interoperability of digital systems. Facilitators included workflow optimization, multidisciplinary coordination, standardized procedures, and decision-support tools. Acceptability challenges involved limited genomic knowledge and readiness among healthcare professionals and concerns regarding the clinical benefits and potential risks of genomic testing among patients, while education and training emerged as key facilitators. Equity challenges included geographical disparities, limited access to clinical trials, and inequalities in access to molecular technologies across countries and healthcare centers; virtual MTBs, regional networks, and centralized services were identified as potential facilitators. Resource use challenges were mainly related to the costs of genomic testing and targeted therapies and uncertainties in reimbursement, whereas facilitators included declining sequencing costs, dedicated funding, and structured reimbursement pathways.

Conclusions

MTB implementation across Europe remains heterogeneous and is influenced by interconnected organizational, technical, educational, equity, and economic factors. Standardized processes, interoperable digital infrastructures, workforce training, equitable access, and sustainable financing may be key to supporting the integration and scalability of MTBs into routine oncology care.