Cancer and the Adolescent
CMAJ 1997;156:1048
Edited by Peter Selby and Clifford Bailey. 298 pp. Illust. BMJ Publishing Group, London. 1996. Distributed in Canada by the Canadian Medical Association, Ottawa. $84.95 ($70.95 CMA members). ISBN 0-7279-0893-6
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| Overall rating: |
Good |
| Strengths: |
Includes the point of view of adolescents |
| Weaknesses: |
The definition of adolescence, some aspects of epidemiology and the assessment of quality of life are poor |
| Audience: |
Members of multidisciplinary teams caring for young patients with cancer |
This British book addresses, in large measure, the special challenges of treating adolescents with cancer. Much of the material is of considerable value for health care professionals involved in the management of cancer in these young patients.
However, it is a pity that the age range of adolescence is defined differently in different chapters, especially in the first 3 chapters, which focus on epidemiologic aspects. As a result, the reader has difficulty determining which matters are of particular relevance to adolescents, rather than to younger children. This flaw is compounded by the overlapping age ranges given for childhood and adolescence in the opening chapter.
The first chapter sets considerable store by data from Canada, although the predominantly passive cancer-registration process in this country leads to systematic overestimation of the incidence of cancer in Canadian children. The authors of this chapter also fail to deal with the increasing evidence that EpsteinBarr virus plays an important role in Hodgkin disease. It is disappointing that an epidemiologist as distinguished as Sir Richard Doll attributes the marked increase in the reported incidence of thyroid cancer in children in Eastern Europe after the Chernobyl nuclear disaster to intensive case finding. If Doll visited the Children's Cancer Hospital in Minsk, Belorussia, as I have, he would be quickly disabused of such a notion.
The chapter on lymphoma is generally sound but does not mention the exemplary German studies of children with Hodgkin disease. The chapters covering soft-tissue sarcomas and bone tumours are excellent. Chapter 9, which is devoted to psychologic and psychiatric effects, is a treasure trove of common sense from an experienced author. Likewise, chapters 10 and 12 are outstanding. A weaker chapter on "Quality of life in Hodgkin's disease and lymphomas" (sic) takes an almost exclusively descriptive approach and is based on anecdotal experience. This chapter makes no attempt to deal with the measurement of global health, relevant measurement instruments or the measurement of the severity of morbidity.
Chapter 16 deals with an important issue -- "Where should patients be treated?" -- but leaves the reader dissatisfied. The discussion is based largely on the personal experience of the author. By contrast, the following chapters, entitled "Interacting with teenagers with cancer," by Margaret Evans, and "The impact of treatment: adolescents' views," by Dr. Christine Eiser, are simply superb. It is almost worth buying this book for these 2 contributions alone.
The highly variable quality of the chapters in this book should not be a disincentive to those who have an interest in the care of adolescents with cancer. The book contains many "pearls" that make it worth recommending. It should be required reading for those working in pediatric oncology.
Ronald D. Barr, MB, ChB, MD
Professor of Pediatrics,
Pathology and Medicine
Chief of Service
Pediatric Hematology/Oncology
McMaster University
Hamilton, Ont.
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