Much work on psychosocial sequelae of breast cancer has been guided by the assumption that body image and partner reaction issues are focal. In a tri-ethnic sample of 223 women treated for early-stage breast cancer within the prior year, the authors assessed a wider range of concerns and relations to well-being. Strongest concerns were recurrence, pain, death, harm from adjuvant treatment, and bills. Body-image concerns were moderate; concern about rejection was minimal. Younger women had stronger sexual and partner-related concerns than older women. Hispanic women had many stronger concerns and more disruption than other women. Life and pain concerns and sexuality concerns contributed uniquely to predicting emotional and psychosexual disruption; life and pain concerns and rejection concerns contributed to predicting social disruption. In sum, adaptation to breast cancer is a process bearing on several aspects of the patient's life space.

This review evaluated the association between time-to-chemotherapy (TTC) and survival in six priority cancers. A systematic review of the literature was undertaken for papers indexed in the MEDLINE and Cochrane Library databases from the earliest index until April 2014. The methodology used has been published in a separate paper (Guidelines for timely initiation of chemotherapy: a proposed framework for access to medical oncology and haematology cancer clinics and chemotherapy services). The optimal timing of chemotherapy in breast cancer is unclear as available studies are of low quality, report inconsistent results and are limited to the adjuvant setting. However, increased TTC may have a negative prognostic impact, and delays beyond 4 weeks should be avoided. Studies suggest that the optimal timing for initiation of adjuvant chemotherapy for surgically resected colorectal cancer is 4-8 weeks post-surgery. Timing of chemotherapy for metastatic colorectal cancer does not influence survival. There is a paucity of studies to guide the timing of chemotherapy for the treatment of lymphoma and myeloma; no definitive conclusions can be drawn, and clinician discretion should be applied. The optimal timing of chemotherapy in lung cancer is unclear; however, rapid tumour growth and poor disease prognosis suggest that delays should be avoided wherever possible. The optimal timing of chemotherapy in ovarian cancer is unclear as available studies are of low level, report inconsistent results and are limited to the post-surgery setting; however, increased TTC may have a negative prognostic impact; therefore, delays beyond 4 weeks should be avoided.

Patient delay in seeking care for cancer symptoms is common and well documented by research studies. Fear and denial, lack of information about cancer, and financial considerations all contribute to this delay. Patient education may be an important factor in decreasing the length of delay and thereby improving treatment outcome. By making good use of opportunities for patient education, primary care physicians may positively influence the prognosis of several types of cancer, particularly breast cancer and malignant melanoma of the skin.

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A 6‐year experience of providing mammograms to the socioeconomically disadvantaged in Dade County, Florida, through Primary Health Care Centers has defined a breast cancer control program that minimizes the barriers to early breast cancer detection for these women. First, an education and recruitment phase that reaches into the community to solicit the target group: Recruitment is needed more than education. Second, a low‐cost mammography service that also reaches into the community and makes it available, accessible, and acceptable. Third, a one‐stop breast center that minimizes the barriers to diagnostic evaluation. Finally, a multidisciplinary evaluation and treatment planning program offers optimum treatment options to the patient with newly diagnosed breast cancer and an opportunity for bonding between her and the staff. A research overlay has allowed data to be collected continuously and provides an evaluation of the effectiveness of the program. This program has saved lives by reducing the projected mortality rate and has saved money by reducing the cost of treatment through earlier diagnosis. All four components are essential to a breast cancer control program for the socioeconomically disadvantaged.