Challenges and facilitators of Molecular Tumor Boards implementation in European health systems

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 remains heterogeneous. This scoping review explores challenges and facilitators of MTB implementation in Europe.

Methods

We searched PubMed up to 27 September 2025 for studies addressing implementation aspects of feasibility, acceptability, equity, or resource use of MTB in Europe. We extracted and coded statements using a hierarchical analytical framework based on domains, themes, subthemes and then classified them as challenges or facilitators.

Results

From 668 studies, 52 were included. Overall, we extracted 210 statements across feasibility (49.0%), resource use (20.0%), equity (19.0%), and acceptability (11.9%), almost equally divided between challenges (48.0%) and facilitators (52.0%). Feasibility challenges included technical and organizational barriers such as delays in turnaround time, lack of standardization and interoperability of digital systems, while facilitators focused on workflow optimization, standardized procedures, and decision-support tools. Acceptability issues involved limited genomic literacy and readiness among healthcare professionals, patient concerns, with training as key facilitators. Equity-related challenges involved geographic disparities, unequal access to clinical trials and molecular technologies, with virtual MTBs and national networks as solutions. Primarily challenges in resource use were high costs, and uncertainties in reimbursement, while facilitators included decreasing sequencing costs, structured funding and reimbursement.

Conclusions

The implementation of MTBs in Europe is shaped by complex, interrelated challenges across organizational, economic, and social domains. A comprehensive approach is essential to ensure sustainable and equitable access to precision oncology.

Key messages

• MTBs in Europe are limited by organizational complexity, high costs, fragmented systems, and unequal access to molecular diagnostics and clinical trials across different healthcare settings.

• Their implementation is facilitated by standardized workflows, interoperable digital platforms, virtual MTB structures, and targeted training programs for healthcare professionals.