The financial sustainability of cancer services as part of national health systems is a major challenge;1 oncology consumes up to 30% of total hospital expenditure and the amount spent on expensive cancer drugs is rising fast.2 In view of the pipeline of new drugs, these costs are likely to continue to grow.3 Apart from the risk of unequal access between European countries, burdening health systems with fast-growing costs for these drugs means that the sustainability of cancer care could be compromised. Some respondents referred to sensitivity around research funding; the centres that treat most patients with cancer are often cooperating closely with the pharmaceutical industry in undertaking translational drug research, and are at the same time confronted with the drug cost issue. ...we noted substantial price differences in the prices of cancer drugs in this illustrative example from 15 European countries. Lithuania Spain (n=2) France (n=2) The Netherlands (n=3) GDP per person 12 400 22 800 32 200 39 300 One 420 mg vial pertuzumab* Actual price N/A 2590·18 2891·10 3000·00 List or official price N/A 2910·58 2891·10 3000·00 One 100 mg vial rituximab* Actual price N/A 210·56 266·44 271·13 List or official price N/A 238·06 266·44 279·27 One 50 mg vial ipilimumab* Actual...