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Cancer care is increasingly delivered by multidisciplinary teams. Cath Taylor and colleagues argue that stronger evidence is needed of their effectiveness

Background Continued smoking after cancer adversely affects quality of life and survival, but one fifth of cancer survivors still smoke. Despite its demands, cancer presents an opportunity for positive behaviour change. Smoking often occurs in social groups, therefore interventions which target families and individuals may be more successful. This qualitative study explored patients, family members and health professionals’ views and experiences of smoking and smoking cessation after cancer, in order to inform future interventions. Methods In-depth qualitative interviews ( n  = 67) with 29 patients, 14 family members and 24 health professionals. Data were analysed using the ‘Framework’ method. Results Few patients and family members had used National Health Service (NHS) smoking cessation services and more than half still smoked. Most recalled little ‘smoking-related’ discussion with clinicians but were receptive to talking openly. Clinicians revealed several barriers to discussion. Participants’ continued smoking was explained by the stress of diagnosis; desire to maintain personal control; and lack of connection between smoking, cancer and health. Conclusions A range of barriers to smoking cessation exist for patients and family members. These are insufficiently assessed and considered by clinicians. Interventions must be more effectively integrated into routine practice.

Data from the Netherlands4 indicate that there may have been a shift in histological criteria, and, subsequently, an increase in the proportion of less aggressive forms of non-Hodgkin lymphoma between 1989 and 2007. [...]as the population ages, the incidence of cancers that predominantly affect the elderly will increase. The divergence of incidence and mortality rates, implying improved rates of survival, occurred well before biological treatments were available. [...]new treatments may only have had a minor effect on total mortality rates for these malignancies.

Cancer registries provide the raw material for analyses used to plan services and test hypotheses and no amount of analytical sleight of hand will fully compensate for data that that is corrupt or absent. In a survey, 44 of 123 pathologists said that they encountered fewer than eight rare cancers per year and 14 of 29 pathologists from eastern Europe rated their pathology standards as average or low.5 Is the difference between overall cancer incidence in Denmark (515 men per 100 000 people; 454 women per 100 000 people [European Age Standardised Rate, EASR]) and Bosnia-Herzegovina (254 men per 100 000 people; 196 women per 100 000 people, EASR)6 genuine or artefactual? The sheer variety of acronymically badged organisations and analyses is disconcerting (eg, EUROCARE, ENCR, RARECARE, GLOBOCAN, EURO-CHIP-3, EUROCOURSE, ECO [EUCAN EUREG EUROCIM], GBD): there is an alphabetic cacophony of confusion, competition, and occasional cooperation.8 The political reasons for all of this are opaque to outsiders. 4 G Gatta, JM van der Zwan, PG Casali, Rare cancers are not so rare: the rare cancer burden in Europe, Eur J Cancer, Vol. 47, 2011, 2493-2511 5 Rare Cancers Europe, European Society of Pathology, Pathology in Rare Cancers Summary Report, 2012, (accessed May 27, 2017)...

Results of the Trastuzumab for Gastric Cancer (ToGA) study1 of chemotherapy for advanced upper gastrointestinal cancer in The Lancet today are interesting on many levels, including the implications of this type of commercially funded study for research into cancer treat ment and the political and moral consequences of the globalisation of research into cancer treatment. [...] results are generally true for cetuximab in cancers of the head and neck,2,3 bevacizumab in colorectal cancer,4 trastuzumab in breast cancer,5 and now, for trastuzumab in tumours of the upper gastrointestinal tract.

Background Since the introduction of serious illness as a potential traumatic stressor in the fourth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM‐IV), research on the prevalence and predictors of posttraumatic stress disorder (PTSD) after cancer diagnosis has proliferated. Studies have reported widely varying estimates of the number of people with PTSD after cancer. The aim of this review is to synthesize quantitative data from studies reporting the proportion of people with PTSD among groups of cancer survivors. Methods We undertook a diversified literature search strategy and identified 120 samples from 110 sources reporting a proportion of cancer survivors with PTSD. Of these, 11 studies, containing 12 samples, reported estimates of PTSD in cancer survivors compared to matched controls. Results A random effects meta‐analysis estimated the odds ratio as 1.66 (95% confidence interval (CI): 1.09–2.53) for PTSD in cancer survivors compared to controls, although some of this apparent increase may have arisen from publication bias. Factors influencing the reported proportion of a postcancer sample with PTSD included measurement type (clinical interview vs. self‐report instrument), type of cancer, type of treatment, geographic region, whether the term “posttraumatic stress” was in the title or , prior trauma, age, and time since diagnosis. Conclusions PTSD, diagnosed according to DSM‐IV criteria, is more common in survivors of cancer than it is in the general population. Estimates of the occurrence of PTSD in patients with a history of cancer depend upon clinical and demographic factors, as well as upon study design.

Background MDT (multidisciplinary team) meetings are considered an essential component of care for patients with cancer. However there is remarkably little direct evidence that such meetings improve outcomes. We assessed whether or not MDT (multidisciplinary team) processes influenced survival in a cohort of patients with colorectal cancer. Methods Observational study of a population-based cohort of 586 consecutive patients with colorectal cancer diagnosed in Tayside (Scotland) during 2006 and 2007. Results Recommendations from MDT meetings were implemented in 411/586 (70.1 %) of patients, the MDT+ group. The remaining175/586 (29.9 %) were either never discussed at an MDT, or recommendations were not implemented, MDT- group. The 5-year cause-specific survival (CSS) rates were 63.1 % (MDT+) and 48.2 % (MDT-), p  < 0.0001. In analysis confined to patients who survived >6 weeks after diagnosis, the rates were 63.2 % (MDT+) and 57.7 % (MDT-), p  = 0.064. The adjusted hazard rate (HR) for death from colorectal cancer was 0.73 (0.53 to 1.00, p  = 0.047) in the MDT+ group compared to the MDT- group, in patients surviving >6 weeks the adjusted HR was 1.00 (0.70 to 1.42, p  = 0.987). Any benefit from the MDT process was largely confined to patients with advanced disease: adjusted HR (early) 1.32 (0.69 to 2.49, p  = 0.401); adjusted HR (advanced) 0.65 (0.45 to 0.96, p  = 0.031). Conclusions Adequate MDT processes are associated with improved survival for patients with colorectal cancer. However, some of this effect may be more apparent than real – simply reflecting selection bias. The MDT process predominantly benefits the 40 % of patients who present with advanced disease and conveys little demonstrable advantage to patients with early tumours. These results call into question the current belief that all new patients with colorectal cancer should be discussed at an MDT meeting.