In this issue, Simon Noble and Miriam Johnson's thoughtful review of the management of cancer associated thrombosis focuses on challenging clinical situations faced by palliative care teams looking after patients with advanced disease. Indications and contraindications abound, often leaving clinicians with difficult decisions in the absence of good empirical data.

In her editorial, Jane Maher suggests that the late effects of treatment in cancer survivors will present an increasing challenge for supportive care services in the 21st century. As time goes by and therapy changes, different presentations emerge with new challenges in symptom control and rehabilitation. Another problem associated with medical advances is the subject of Stephen Pettit and colleagues' feature on implantable cardioverter defibrillators (ICDs) in patients with chronic heart failure. Despite consensus that ICD deactivation should be routinely discussed, this rarely occurs in clinical practice for many reasons including uncertainty …