17 Psychological and holistic consequences of delays in molecular diagnosis after neuro-oncological surgery: a qualitative study

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Abstract Introduction The 2021 WHO Classification of Tumours of the Central Nervous System supports an integrated diagnosis combining histological, immunohistochemical and molecular parameters. Advanced molecular techniques such as DNA methylome arrays and Whole Genome/Next Generation Sequencing are now required to identify certain tumour entities confidently as well as sometimes determining eligibility for clinical trials. Complex molecular analysis however can lead to extended turnaround times and significant delays in patients receiving their final diagnosis. We aimed to study the psychological and holistic impact of these delays. Method Retrospective analysis of medical records was performed to assess the median wait time from surgery to the final integrated diagnosis at our institution between January 2024 and December 2024. A semi-structured interview framework was created with clinical Neuropsychological input, Neurosurgeons and a Neuro-oncology specialist clinical nurse. Purposive sampling was utilised to identify suitable participants. Semi-structured interviews were conducted with each participant, parent(s) or caregiver(s) individually. The semi-structured interviews were audio recorded and transcribed. Thematic analysis was conducted to explore recurring participant reported issues and concerns. Results The median delay from surgery to the final integrated histological and molecular diagnosis being available to the neuro-oncology multidisciplinary team meeting was 30 days. Semi-structured interviews revealed recurrent themes surrounding the impact of prolonged waits for final diagnosis. Thematic analysis was used to assess the psychological and holistic impact of prolonged waits for molecular diagnosis on adult patients and parents/caregivers of paediatric patients. Conclusions Patients and parents/caregivers experience a significant delay in obtaining a final integrated diagnosis due to the extended time needed for complex molecular analysis. We will present and discuss the recurrent themes regarding the psychological and holistic impact of these delays.