BACKGROUND:Frail patients with cancer (Ca) have worse survival. Current methods of assessment of fitness (performance status) for cancer treatment, such as chemotherapy, are time -consuming and often not used by practicing oncologists. The electronic frailty index (SCARF) is derived from a cumulative deficit frailty model and provides a measure of frailty alongside pre-existing conditions. We used this methodology to investigate whether it can predict outcomes of chemotherapy in patients with Ca. METHODS:The study conducted data analysis of Ca patients treated with chemotherapy in England, years 2015-2018; stage II-III breast Ca, stage III colon Ca and stage IIIB-IV non-small-cell lung Ca. The data was linked with hospital admissions to calculate 30-day chemotherapy mortality, overall survival and SCARF. RESULTS:The SCARF was calculated for 78,799 patients. The risk of dying within 30 days of chemotherapy in severely frail patients with colorectal cancer ≥70 y.o. was twice that of the <70 y.o. (OR 2.04 -95% CI 1.58-2.64, mild frailty 1.07-95% CI 0.78-1.45); and 6 times higher in breast cancer (OR 5.73-95% CI 2.66-12.32, mild frailty OR 1.45 95% CI 0.78-2.71). CONCLUSION:The SCARF index predicts poor outcomes from SACT, particularly in breast and colon cancer, and it requires further evaluation.

PURPOSE:Rural populations comprise around 27% of Europeans and face persistent challenges across the cancer pathway. Although rurality is recognised as a contributor to cancer inequalities, most evidence has historically been generated outside Europe. No comprehensive mapping of European rural cancer research exists and understanding where evidence is concentrated or absent is important for informing equitable cancer-policy planning. We mapped rural cancer research activity across Europe, including publication trends, geographical distribution, collaboration patterns, and thematic focus. METHODS:We conducted a bibliometric review in accordance with the BIBLIO Guidelines for Reporting Bibliometric Reviews of the Biomedical Literature. Data were retrieved from Scopus and Web of Science (1940-2025), processed in R (4.5.1), and analysed using the bibliometrix package. Analyses included annual output, citation metrics, country and institutional productivity, collaboration networks, thematic mapping, and Multiple Correspondence Analysis. RESULTS:A total of 2050 publications were analysed. Annual output increased at a growth rate of 6.04%. Research activity was unevenly distributed, with the UK, France, Germany, Poland, and Italy as the most productive countries. Collaboration networks were strong, especially among Western European nations. Thematic analysis showed a focus on screening, epidemiology, and specific tumour types, with limited research on treatment, survivorship, and service delivery-patterns relevant for European cancer policy. CONCLUSIONS:Rural cancer research in Europe is uneven and thematically narrow. Integrating rurality into cancer-inequality monitoring, incorporating rural indicators into EU policy frameworks, and strengthening research capacity in under-represented countries are timely, achievable steps to support more equitable cancer policy and planning.

The European Code of Cancer Practice (ECCP) is a patient-centred framework for good clinical cancer practice, to improve outcomes for all of Europe’s patients [1]. Given challenges with applications to rural regions, the study aimed to explore the barriers and facilitators to implementing the ECCP in a rural, coastal, and urban context. We conducted semi-structured individual and group interviews with nine acute cancer professionals; nine non-clinical professionals; and four people with lived experience of cancer. Interviews were analysed using reflexive thematic analysis, underpinned by a constructivist approach. Three themes were developed across all groups. 1) ‘Fragmented communication pathways limits access’ to information-sharing between services, and about support and research, linked to workforce challenges. 2) ‘Geographic and infrastructural disparities between urban, rural, and coastal areas’ highlight barriers to accessing and delivering care, including transport issues, alongside place-specific facilitators to wellbeing. 3) ‘Unmet needs for living well during and after treatment’ denotes financial, work-related, and psychological challenges through treatment and survivorship. These barriers transcended across all ECCP domains. Workforce challenges that limit information-sharing about support and research, and gaps in post-treatment support, must be addressed to meet the ECCP aim to ensure equitable cancer care across geographical locations.

A substantial gap persists in our understanding of specific cancer prevention, diagnosis and care needs of coastal communities. Despite growing policy attention to coastal inequalities, the current evidence-base is limited, with insufficient explanation of how and why cancer-related needs and outcomes vary across coastal geographies. Treating coastal areas as homogenous, or subsuming them within broader rural or urban categories, risks obscuring place-specific mechanisms that may contribute to inequalities, while also overlooking opportunities for targeted, place-sensitive interventions to improve cancer outcomes. This gap is increasingly salient considering recent policy developments. The new National Cancer Plan for England recognises that patients from deprived areas, particularly those in coastal and rural locations, distant from large academic centres, are less likely to be offered certain cancer-related care opportunities. The plan also commits to rebalancing cancer diagnostic and medical training places towards remote, rural and coastal areas, targeting investment in cancer nurse specialists and medical specialists in areas with greater need, and adopting more holistic approaches that involve non-clinical interventions to tackle inequalities. However, these ambitions have yet to be underpinned by a robust, conceptually grounded evidence-base specific to coastal cancer care. In response to the National Cancer Plan, our multidisciplinary team propose a conceptual framework for "coastal cancer care" relevant to both the UK and internationally. We identify key domains where a coastal context may influence cancer prevention, diagnosis, care, and survivorship, and present guiding principles to stimulate debate and inform future research and policy aimed at understanding and reducing inequalities in coastal settings.

DFS amongst Leibovich risk groups stratified by genomic classifier

Somatic mutations detected in 12 interrogated genes for cohorts C1-C3

Hypophosphatasia (HPP) is a rare disease caused by deficient tissue–non-specific alkaline phosphatase (ALP) activity. Asfotase alfa is a tissue–non-specific ALP enzyme-replacement therapy which was reimbursed in the UK under a Managed Access Agreement (MAA). This analysis assessed safety and effectiveness of asfotase alfa in adults with HPP. This prospective, observational data collection included adults with paediatric-onset HPP enroled in the MAA and treated with asfotase alfa for ≥ 6 months to 5 years. Assessments included mobility, pain, and health-related quality of life (HRQoL), each reported at regular intervals through year 3. Analgesic use, fractures, and events of interest (EOIs) were each reported continuously throughout follow-up. Of 28 enroled treated adults, 24 were assessed for effectiveness. Distance walked in the 6-Minute Walk Test was median (min, max) 172.5 m (0.0, 380.0; n = 24) at baseline and improved by 157.3 m (− 171.0, 479.5; n = 16) at month 6; results were sustained throughout follow-up. Median (min, max) Bleck score was 6.0 (2.0, 9.0; n = 24) at baseline and increased to 6.5 (5.0, 9.0; n = 10) at month 36. Median (min, max) aggregate Brief Pain Inventory Short Form severity score was 8.0 (4.3, 10.0; n = 24) at baseline and improved to 4.4 (1.0, 7.8; n = 10) at month 36. During follow-up, 8 participants (33.3

DFS by tumor stage stratified by genomic classifier

Supplementary Tables S3-S13

BACKGROUND:The United Kingdom's (UK) diverse geography means many people live in rural and coastal areas, where cancer outcomes are often poorer than in urban settings. Devolution means that the four nations of the UK have distinct approaches to cancer care. Scotland, Wales, and Northern Ireland have recently published national cancer strategies, while England's new plan is expected later in 2025. This study examined UK cancer policy documents, to identify, how, and to what extent, rural or coastal issues were considered. METHODS:UK cancer policy documents from 2000 to 2024 were sourced via The International Cancer Control Partnership (ICCP) website (https://iccp-portal.org/), UK government sites and Google. Documents were searched for rural and coastal related terms. RESULTS:Fifty-five documents were included (England n = 17; Northern Ireland n = 10; Scotland n = 21; Wales n = 7). No recent policies included a specific section or explicit recommendations for rural or coastal cancer care. Across the policies, contextual analysis highlighted that terms to promote rural or coastal equity rarely appeared within recommendations. Northern Ireland gave more attention to rural issues than other nations, as evidenced by a rural needs impact assessment and supporting documents to inform Northern Ireland's Cancer Strategy 2022-2032. CONCLUSION:Despite sizeable rural and coastal populations facing specific health challenges across the UK, national cancer policies excepting Northern Ireland gave minimal guidance for delivering cancer care tailored to these communities. Other UK nations should consider adopting more rural-centric approaches like Northern Ireland. POLICY SUMMARY:Coastal and rural health issues have received policy attention via the Chief Medical Officer for England's annual reports (2021; 2023) and more recently in the UK Government's 10 Year Health Plan for England (July 2025). However, when it comes to high-level cancer policy across the UK, the needs of rural and coastal people with cancer are not being adequately or specifically recognised.

Rural communities frequently experience inequalities in cancer care compared to urban counterparts. Despite growing academic interest, there has been no global bibliometric analysis of rural cancer publications. Increasingly, global policies focus on place-based health inequalities; it is critical to understand the current state and emerging trends of rural cancer research. This analysis focuses on publication trends, including authors, citations, geography, collaboration (extent and patterns) and target journals. Web of Science and Scopus were searched from inception to 25th February 2025. Bibliometric methodology examined citation counts, authorship and publication sources. Results were converted into bibliographic data frames using the bibliometrix R package. All analysis and visual illustrations were in R 4.4.2. Fifteen thousand seven hundred and twenty two documents were analysed (mean age, 10.6 years; average, 25.5 citations per document (2.2 per year)). Annual publication growth was 4.6

Background The UN General Assembly (UNGA) stated that the right-to-water entitles everyone to accessible and affordable water. People living with cancer (PLWC) need water for numerous reasons including hydration, personal hygiene and infection control. In 2023, reports emerged of PLWC in Lincolnshire (UK) disconnecting their water supply from cost fears. We report on innovative ways to ease financial burden and provide equitable and affordable access to clean water for PLWC in rural and coastal settings. Methods Quantitative data from secondary care and qualitative data from community-practitioners investigating PLWC’s difficulties in accessing a clean and safe water supply were synthesised. A review of existing financial support identified no services directly addressing water. The Lincolnshire Living with Cancer Team approached water provider, Anglian Water sharing concerns, identifying common values, and confirming shared aims. A formal partnership was established to address these inequalities. Results Initial data reviews showed completion of 25,858 Extra Care Assessments between Jan-Sept 2023 (12 % increase on previous year). This has enabled over 30,000 people with long-term conditions, including PLWC, to access clean and affordable water, a personalised support package for their water bill, including income maximisation, debt management, payment breaks, and bill reductions. Conclusion Impacts of cancer extend beyond physical health, with many PLWC reporting financial distress. Some PLWC have taken extreme measures to reduce their water consumption when they actually need increased water volumes. A partnership approach between health, voluntary and community sectors with a water provider can help address these inequalities. Policy summary The study addresses national policy (NHS Long Term Plan 2019) by demonstrating how personalisation can be achieved for PLWC in a rural and coastal county. Internationally, it aligns to The European Code of Cancer Practice and seeks to contribute to its implementation UNGA Resolution 64/292, the universal human right to water and sanitation.

Purpose To synthesize the qualitative literature exploring the experiences of people living with lung cancer in rural areas. Methods Searches were performed in MEDLINE, CINAHL, and PsycINFO. Articles were screened independently by two reviewers against pre-determined eligibility criteria. Data were synthesized using Thomas and Harden’s framework for the thematic synthesis of qualitative research. The CASP qualitative checklist was used for quality assessment and the review was reported in accordance with the ENTREQ and PRISMA checklists. Results Nine articles were included, from which five themes were identified: (1) diagnosis and treatment pathways, (2) travel and financial burden, (3) communication and information, (4) experiences of interacting with healthcare professionals, (5) symptoms and health-seeking behaviors. Lung cancer diagnosis was unexpected for some with several reporting treatment delays and long wait times regarding diagnosis and treatment. Accessing treatment was perceived as challenging and time-consuming due to distance and financial stress. Inadequate communication of information from healthcare professionals was a common concern expressed by rural people living with lung cancer who also conveyed dissatisfaction with their healthcare professionals. Some were reluctant to seek help due to geographical distance and sociocultural factors whilst others found it challenging to identify symptoms due to comorbidities. Conclusions This review provides a deeper understanding of the challenges faced by people with lung cancer in rural settings, through which future researchers can begin to develop tailored support to address the existing disparities that affect this population.

Leadership as a key building block of a health system plays a crucial role in achieving high performance and helps deliver change and shape the policy agenda and its implementation. Echoing the emerging need for effective leaders in Oncology, the "Improving Cancer Outcomes and Leadership Course" was developed jointly by the European School of Oncology (ESO), the European Cancer Organization (ECO) and Sharing Progress in Cancer Care (SPCC). The course was offered as a hybrid event online and in Warsaw in June 2022. It aimed to introduce early and mid-career cancer healthcare professionals of all disciplines and professions to the expertise required to develop strategic plans, support and collaborate in relevant applied health research, develop implementation approaches and acquire the skill sets required to support leadership and change management within their countries and regions. A total of 47 participants, mainly from Europe, participated and prepared 'case discussions' of organisational challenges or projects aiming to improve health care in their regions. These were deliberated and further developed in 3 break out groups. A qualitative evaluation of the course impact performed 2 years after the course showed that most participants remained in contact with each other, the majority had implemented learnings from the course to help improve cancer outcomes, 87 % had further developed their projects that were presented during the breakout sessions and of those 89 % felt that the discussions that were held during course had actively helped them to develop and potentially apply these projects. Finally, 77 % have thought of or initiated a different project than the one they discussed during the course, based on ideas coming from the discussions during or after the course. Here we describe the course, give three examples of topics discussed in Warsaw and present plans for the future.