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Competing Interests: The Ending Discrimination against Cancer Survivors research project is grateful for the support received from FOCA (Fonds Cancer, ASBL, Belgium). ML is supported by funding from Health Data Research UK. ML has received honoraria from Bayer, Novartis, and Roche, unrelated to this work. GS and FM declare no competing interests.

Existing evidence often indicates higher cancer incidence and mortality rates, later diagnosis, lower screening uptake and poorer long-term survival for people living in rural compared to more urbanised areas. Despite wide inequities and variation in cancer care and outcomes across Europe, much of the scientific literature explicitly exploring the impact of rurality on cancer continues to come from Australia and North America. The European Code of Cancer Practice or "The Code" is a citizen and patient-centred statement of the most salient requirements for good clinical cancer practice and has been extensively co-produced by cancer patients, cancer professionals and patient advocates. It contains 10 key overarching Rights that a cancer patient should expect from their healthcare system, regardless of where they live and has been strongly endorsed by professional and patient cancer organisations as well as the European Commission. In this article, we use these 10 fundamental Rights as a framework to argue that (i) the issues and needs identified in The Code are generally more profound for rural people with cancer; (ii) addressing these issues is also more challenging in rural contexts; (iii) interventions and support must explicitly account for the unique needs of rural residents living with and affected by cancer and (iv) new innovative approaches are urgently required to successfully overcome the challenges faced by rural people with cancer and their caregivers. Despite equitable healthcare being a key European policy focus, the needs of rural people living with cancer have largely been neglected., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aim: Cancer is one of Europe's key research missions, with gender equity a major policy pillar. To benchmark how well European countries perform for gender balance in cancer research, high quality intelligence is required., Methods: For cancer research papers in Europe (EUR31; the 28 EU Member States plus Iceland, Norway and Switzerland) from two specific years (2009 and 2019), we evaluated the numbers of female authors overall and then the female last-author presence, as a proxy of female cancer research leadership., Results: Overall, female authorship increased from 42% to 49%. In 2009, females represented 50% or more of cancer research authors in only five EUR31 countries. By 2019, that number had risen to 17. In Eastern European (EE) countries, females were more likely to be in the majority. The presence of female cancer research authors in the last (senior) author position increased from 24% to 34%. Five of the top six countries for female authorship in 2019 were from EE, whereas disappointingly four central European countries (Austria (AT), Czechia (CZ), Germany (DE) and Switzerland (CH)) were below the 25th percentile. A number of European powerhouses of cancer research (UK, DE, CH) underperformed in terms of female cancer research leadership. However, when cancer researchers from these countries worked abroad (e.g. Scandinavia, USA) the percentage of females was similar to that of their host countries. A factor potentially influencing female cancer research participation was availability and relative cost of child-care, which is more favourable in Scandinavia and EE than in central/western Europe., Conclusion: Our data show that Horizon Europe's Cancer Mission must ensure gender equity in its future research programmes and support the enhancement of female cancer research leadership opportunities., Competing Interests: Declaration of Competing Interest ML declares honoraria for presentations unrelated to this work from Bayer, Carnall Farrar, EMD Serono, Novartis, Pfizer and Roche. No other authors declare DOI., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

European cancer research stakeholders met in October 2022 in Heidelberg, Germany, at the 5 th Gago conference on European Cancer Policy, to discuss the current cancer research and cancer care policy landscape in Europe. Meeting participants highlighted gaps in the existing European programmes focusing on cancer research, including Europe's Beating Cancer Plan (EBCP), the Mission on Cancer (MoC), Understanding Cancer (UNCAN.eu), and the joint action CRANE, and put forward the next priorities, in the form of the Heidelberg Manifesto for cancer research. This meeting report presents all discussions that shed light on how infrastructures can be effectively shaped for translational, prevention, clinical and outcomes cancer research, with a focus on implementation and sustainability and while engaging patients and the public. In addition, we summarize recommendations on how to introduce frameworks for the digitalization of European cancer research. Finally, we discuss what structures, commitment, and resources are needed to establish a collaborative cancer research environment in Europe to achieve the scale required for innovation., (© 2023 The Authors. Molecular Oncology published by John Wiley & Sons Ltd on behalf of Federation of European Biochemical Societies.)

In order to tailor treatment to their needs, cancer patients are encouraged to be more active and engaged in their care decisions and to be autonomous yet collaborative with their healthcare professionals when it comes to aspects of their treatment in order to get better results. However, this can only happen after providing them with accurate information about cancer and the different treatment alternatives and their potential side effects. However, sharing robust data-based information is often hindered by exposure to misleading information through different media and online platform, where patients might come across unscientifically founded health practices. Increasing health literacy and cancer-specific literacy is essential to fight this negative trend. The idea is that more knowledgeable patients will be able to debunk more easily misinformation they encounter. This is also related to inequalities among cancer patients. Not only levels of cancer literacy within Europe are uneven across and within countries, but there are social groups that, due to specific social determinants, are systematically less informed and skilled regarding cancer care. In this paper an overview of gaps in addressing literacy issues, and the importance of health literacy to empower patients in their journey through treatment is delineated, concluding with some recommendations to improve cancer literacy in Europe., (Copyright © 2022. Published by Elsevier Ltd.)

The purpose of this study was to provide an evidence base for colorectal cancer research activity that might influence policy, mainly at the national level. Improvements in healthcare delivery have lengthened life expectancy, but within a situation of increased cancer incidence. The disease burden of CRC has risen significantly, particularly in Africa, Asia and Latin America. Research is key to its control and reduction, but few studies have delineated the volume and funding of global research on CRC. We identified research papers in the Web of Science (WoS) from 2007 to 2021, and determined the contributions of the leading countries, the research domains studied, and their sources of funding. We identified 62 716 papers, representing 5.7% of all cancer papers. This percentage was somewhat disproportionate to the disease burden (7.7% in 2015), especially in Eastern Europe. International collaboration increased over the time period in almost all countries except in China. Genetics, surgery and prognosis were the leading research domains. However, research on palliative care and quality-of-life in CRC was lacking. In Western Europe, the main funding source was the charity sector, particularly in the UK, but in most other countries government played the leading role, especially in China and the USA. There was little support from industry. Several Asian countries provided minimal contestable funding, which may have reduced the impact of their CRC research. Certain countries must perform more CRC research overall, especially in domains such as screening, palliative care and quality-of-life. The private-non-profit sector should be an alternative source of support., (© 2022 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.)

Cancer research is a crucial pillar for countries to deliver more affordable, higher quality, and more equitable cancer care. Patients treated in research-active hospitals have better outcomes than patients who are not treated in these settings. However, cancer in Europe is at a crossroads. Cancer was already a leading cause of premature death before the COVID-19 pandemic, and the disastrous effects of the pandemic on early diagnosis and treatment will probably set back cancer outcomes in Europe by almost a decade. Recognising the pivotal importance of research not just to mitigate the pandemic today, but to build better European cancer services and systems for patients tomorrow, the Lancet Oncology European Groundshot Commission on cancer research brings together a wide range of experts, together with detailed new data on cancer research activity across Europe during the past 12 years. We have deployed this knowledge to help inform Europe's Beating Cancer Plan and the EU Cancer Mission, and to set out an evidence-driven, patient-centred cancer research roadmap for Europe. The high-resolution cancer research data we have generated show current activities, captured through different metrics, including by region, disease burden, research domain, and effect on outcomes. We have also included granular data on research collaboration, gender of researchers, and research funding. The inclusion of granular data has facilitated the identification of areas that are perhaps overemphasised in current cancer research in Europe, while also highlighting domains that are underserved. Our detailed data emphasise the need for more information-driven and data-driven cancer research strategies and planning going forward. A particular focus must be on central and eastern Europe, because our findings emphasise the widening gap in cancer research activity, and capacity and outcomes, compared with the rest of Europe. Citizens and patients, no matter where they are, must benefit from advances in cancer research. This Commission also highlights that the narrow focus on discovery science and biopharmaceutical research in Europe needs to be widened to include such areas as prevention and early diagnosis; treatment modalities such as radiotherapy and surgery; and a larger concentration on developing a research and innovation strategy for the 20 million Europeans living beyond a cancer diagnosis. Our data highlight the important role of comprehensive cancer centres in driving the European cancer research agenda. Crucial to a functioning cancer research strategy and its translation into patient benefit is the need for a greater emphasis on health policy and systems research, including implementation science, so that the innovative technological outputs from cancer research have a clear pathway to delivery. This European cancer research Commission has identified 12 key recommendations within a call to action to reimagine cancer research and its implementation in Europe. We hope this call to action will help to achieve our ambitious 70:35 target: 70% average 10-year survival for all European cancer patients by 2035., Competing Interests: Declaration of interests ML declares honoraria from Bayer, Carnall Farrar, EMD Serono, Novartis, Pfizer, and Roche unrelated to this work and membership of the board of the European Cancer Organisation (ECO). AA declares Advanced NIH Fellowship unrelated to this work. AMB declares honorarium from Roche unrelated to this work and Presidency of Lung Cancer Europe. MC declares membership of the board of ECO and the European Society of Oncology Pharmacy. FC declares consultancy and advisory board membership of Amgen, Astellas/Medivation, AstraZeneca, Celgene, Daiichi-Sankyo, Eisai, GE Oncology, Genentech, Gilead, GlaxoSmithKline, Iqvia, Macrogenics, Medscape, Merck-Sharp, Merus, Mylan, Mundipharma, Novartis, Pfizer, PierreFabre, prIME Oncology, Roche, Sanofi, Samsung Bioepis, Seagen, Teva, and Touchime unrelated to this work. TC declares honoraria from AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Roche, Merck Sharpe & Dohme, Pfizer, and Takeda unrelated to this work. LD declares consultancy from the International Cancer Research Partnership unrelated to this work. FDN declares grants from the AIRC Foundation for Cancer Research, Associazione Italiana per la Ricerca sul Cancro, and Fondazione Piemontese per la Ricerca sul Cancro-ONLUS, and consultancy from Pierre Fabre unrelated to this work. JJ declares consultancy from AstraZeneca, Exact Sciences, and Merck Sharpe & Dohme unrelated to this work. DK declares honoraria from Merck Sharpe & Dohme unrelated to this work. TKo declares grants from Ipsen, AAA Pharma, Novartis, Isotope Technologies Munich, Victory Net Foundation, and Camulus, and honoraria or support from Cor2Ed, Ipsen, ECO, International Cancer Genome Consortium unrelated to this work. CLV received support from AIRC Foundation. YL is chair of the HERO VBHC and member of the European Society for Radiotherapy and Oncology (ESTRO) Scientific Committee, the Belgian College of Oncology, and a personal investigator on the European Organization for Research and Treatment of Cancer/ESTRO E2-RADIATE project. PS declares support from ECO and the European School of Oncology. SO, KO, AS, CA, PN, KA, MA, AC, MPC, ACo, CLD, AE, SE, MG, BJo, OK, TKu, GL, FM, JP, TP, RP, BR, ITR, MJS, GSB, JVH, EV, WW, UW, and RS declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Competing Interests: Competing Interests: ML has received honorararia from Pfizer, EMD Serono, Roche, and Carnall Farrar unrelated to this work. ML has received an unrestricted educational grant from Pfizer unrelated to this work. MC has no competing interests to declare. Provenance and peer review: not commissioned; not peer reviewed.

Background: Colorectal cancer is one of the leading causes of cancer morbidity and mortality in Europe. We aimed to ascertain the economic burden of colorectal cancer across Europe using a population-based cost-of-illness approach., Methods: In this population-based cost-of-illness study, we obtained 2015 activity and costing data for colorectal cancer in 33 European countries (EUR-33) from global and national sources. Country-specific aggregate data were acquired for health-care, mortality, morbidity, and informal care costs. We calculated primary, outpatient, emergency, and hospital care, and systemic anti-cancer therapy (SACT) costs, as well as the costs of premature death, temporary and permanent absence from work, and unpaid informal care due to colorectal cancer. Colorectal cancer health-care costs per case were compared with colorectal cancer survival and colorectal cancer personnel, equipment, and resources across EUR-33 using univariable and multivariable regression. We also compared hospital care and SACT costs against 2009 data for the 27 EU countries., Findings: The economic burden of colorectal cancer across Europe in 2015 was €19·1 billion. The total non-health-care cost of €11·6 billion (60·6% of total economic burden) consisted of loss of productivity due to disability (€6·3 billion [33·0%]), premature death (€3·0 billion [15·9%]), and opportunity costs for informal carers (€2·2 billion [11·6%]). The €7·5 billion (39·4% of total economic burden) of direct health-care costs consisted of hospital care (€3·3 billion [43·4%] of health-care costs), SACT (€1·9 billion [25·6%]), and outpatient care (€1·3 billion [17·7%]), primary care (€0·7 billion [9·3%]), and emergency care (€0·3 billion [3·9%]). The mean cost for managing a patient with colorectal cancer varied widely between countries (€259-36 295). Hospital-care costs as a proportion of health-care costs varied considerably (24·1-84·8%), with a decrease of 21·2% from 2009 to 2015 in the EU. Overall, hospital care was the largest proportion (43·4%) of health-care expenditure, but pharmaceutical expenditure was far higher than hospital-care expenditure in some countries. Countries with similar gross domestic product per capita had widely varying health-care costs. In the EU, overall expenditure on pharmaceuticals increased by 213·7% from 2009 to 2015., Interpretation: Although the data analysed include non-homogenous sources from some countries and should be interpreted with caution, this study is the most comprehensive analysis to date of the economic burden of colorectal cancer in Europe. Overall spend on health care in some countries did not seem to correspond with patient outcomes. Spending on improving outcomes must be appropriately matched to the challenges in each country, to ensure tangible benefits. Our results have major implications for guiding policy and improving outcomes for this common malignancy., Funding: Department for Employment and Learning of Northern Ireland, Medical Research Council, Cancer Research UK, Health Data Research UK, and DATA-CAN., Competing Interests: Declaration of interests RHH is an employee at Diaceutics. RA reports grants from AstraZeneca and MSD; consulting fees from AstraZeneca, Merck, and Bayer; speaker fees from Amgen, Merck, and Servier; and support for attending meetings from Amgen, Bristol Myers Squibb, and Merck. TM reports consulting fees from AstraZeneca; participation on a Pierre Fabre Independent Data Monitoring Committee and a Pfizer steering committee; and receipt of material from Almac Diagnostics, Indica labs and Psioxus. EM reports support from Cancer Focus Northern Ireland and has given advice to the Royal College of Nursing. ML reports support from MRC, Cancer Research UK, and HDRUK; an unrestricted educational grant from Pfizer; and honoraria from Pfizer, EMD Serono, and Roche unrelated to the work. All other authors declare no competing interests., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

We have reached a watershed moment in Europe in our efforts to ensure increased survival and better outcomes for cancer patients. The EU Cancer Mission and the European Beating Cancer Plan together provide an unrivalled opportunity to make significant inroads into a disease that kills over 1.7 million European citizens annually. Harnessing these twin pillars of cancer research and cancer control can be transformative for the European cancer community and in particular for the European cancer patient. However, from a research perspective, in order to fully realise these benefits, we need to ensure that all aspects of the cancer continuum are addressed. Previous research efforts have focussed more on the diagnosis and treatment of cancer, whereas cancer survivorship, to date, has been overlooked. Here, we aim to redress this balance, by identifying the key challenges in cancer survivorship research that need to be addressed and proposing a series of recommended solutions, which, if acted upon, would deliver significant benefits for the nearly 20 million cancer survivors in Europe. To achieve this, we propose the development of a clearly articulated and sustainably funded European Cancer Survivorship Research and Innovation Plan. Embedding this plan within the framework of the EU Cancer Mission would be transformative for cancer survivors and society., (© 2021 The Authors. Molecular Oncology published by John Wiley & Sons Ltd on behalf of Federation of European Biochemical Societies.)

Cancer research is an essential part of national cancer control programmes, and the emerging economies of Central and Eastern Europe (CEE) and the Russian Federation and Central Asia (R-CA) (Commonwealth of Independent States) remain relatively understudied. Here, we map the cancer research activity from the 29 countries across these regions over a 10-year period (2007-2016), using a standard scientometric approach. Research activity was compared with the countries' wealth and with the disease burden from different cancers, and analyses were also performed by the research domain (e.g. fundamental cancer biology, surgery). We found that although there was a correlation between outputs and national wealth, there were many outliers; the CEE countries publishing relatively more, and the R-CA, less. Outputs reflected cancer burdens, but there was a relative paucity of research on lung, colorectal, gastric and pancreatic cancer, as well as research domains such as screening and palliative care. Clinical trials accounted for only 3% of all research outputs from all countries, and were very international, with on average 1.5 CEE countries and 8.0 others involved in each article, and they were heavily cited (on average, 84 times in 5 years). Poland was by far the most research-active country, but significant needs and opportunities have been identified to expand the cancer research activity in all CEE and R-CA countries to enhance national cancer control planning., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Cancer research is among the most active biomedical research domains for the European Union (EU). However, little quantitative empirical evidence is available to guide the decisions on the choice of disease site to study, specific research domain focus or allocation of research resources. To inform national/supranational cancer research policy, high-resolution intelligence is needed., Methods: We performed a bibliometric analysis of European cancer research papers in the Web of Science from 2002 to 2013 to quantify research activity in each of the 28 EU Member States, along with Iceland, Norway and Switzerland (EUR31), which cancer sites/research domains they addressed, and their sources of financial support (2009-2013)., Findings: Cancer research papers from EUR31 correlated well with national Gross Domestic Products (r 2  = 0.94). However, certain cancer sites (lung, oesophagus and pancreas) were under-researched relative to their disease burden, whereas central nervous system and blood cancers were more generously supported than their burden would warrant. An analysis of research domains indicated a paucity of research on radiotherapy (5%), palliative care (1.2%) and quality of life (0.5%). European cancer research funding in 2012-2013 amounted to ∼€7.6 billion and came from diverse sources, especially in western Europe/Scandinavia, where in nine countries the charitable sector outspent the government but not in Eastern Europe where charitable research funding barely exists., Interpretation: Several countries need to increase their cancer research outputs substantially, and/or alter their research portfolios to better match their growing (and changing) cancer burden. More co-ordination among funding agencies is required, so that resources can be attuned to align activities to research gaps and perceived clinical needs. In Eastern Europe, the charitable funding sector needs to be developed, so that both public and patient advocacy can have an active role in research., (Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Hematopoietic stem cell transplantation is becoming an increasingly important approach to treatment of different malignant and non-malignant disorders. There is thus growing demand for diagnostic assays permitting the surveillance of donor/recipient chimerism posttransplant. Current techniques are heterogeneous, rendering uniform evaluation and comparison of diagnostic results between centers difficult. Leading laboratories from 10 European countries have therefore performed a collaborative study supported by a European grant, the EuroChimerism Concerted Action, with the aim to develop a standardized diagnostic methodology for the detection and monitoring of chimerism in patients undergoing allogeneic stem cell transplantation. Following extensive analysis of a large set of microsatellite/short tandem repeat (STR) loci, the EuroChimerism (EUC) panel comprising 13 STR markers was established with the aim to optimally meet the specific requirements of quantitative chimerism analysis. Based on highly stringent selection criteria, the EUC panel provides multiple informative markers in any transplant setting. The standardized STR-PCR tests permit detection of donor- or recipient-derived cells at a sensitivity ranging between 0.8 and 1.6%. Moreover, the EUC assay facilitates accurate and reproducible quantification of donor and recipient hematopoietic cells. Wide use of the European-harmonized protocol for chimerism analysis presented will provide a basis for optimal diagnostic support and timely treatment decisions.