H Wallace and D Green (eds)
Published by Arnold
ISBN: 0-3408-0803-9. 401 pages plus index.
Late Effects of Childhood Cancer has been edited by two of the true experts in the area. Dr Daniel Green, a paediatric oncologist in Buffalo, New York, organises a superb conference on Late Effects every two years. He assembles a stellar cast of speakers of whom co-editor Hamish Wallace (paediatric oncologist based in Edinburgh) is often both a guest speaker and lively commentator.
One in 900 20-year-olds today is a survivor of childhood malignancy. Significant long-term health and psychological effects occur in around 30% of these young people and clinicians in a wide variety of practice can expect to see such a patient.
This book is well set out, with sections dealing with each organ system, as well as chapters on quality of life and healthy lifestyle issues.
Each chapter is written by a specialist in a particular organ system and though some of the more severe late effects, as pointed out in the foreword, will no longer be seen because of changes in treatment, discussion of these problems is important in a historical context, serving to emphasise the importance of long-term follow-up of any of our medical treatments.
The section on neurological consequences is disappointing as it focuses predominantly on acute rather than long-term effects of treatment. Our own work reveals some significant problems following radiotherapy, eg epilepsy and stroke of which clinicians need be aware. There is further discussion of radiation effect on cerebral vessels in a later chapter.
The chapters on other organ systems are very comprehensive and extremely readable by both a general physician as well as those more used to reading oncology publications. Each chapter has simple graphs and tables to indicate site and effects of specific treatments. There is also a column of key points highlighting the important messages for the body system.
Chapters on testicular, ovarian function and fertility are very well written by authors at the forefront of research and clinical practice. The foremost concern of many of long-term survivors is future fertility potential. Each of these chapters gives an overview of basic physiology, effects of the various treatment modalities, suggested investigations and research aimed at preserving fertile potential in young cancer patients undergoing treatment. There is also discussion of ethical and legal issues and options for family formation.
There is a detailed chapter addressing late effects following bone marrow transplantation (BMT), important as BMT rates increase in developed countries. This chapter is also important to aid discussion with children and families contemplating BMT, so as to try to ensure realistic expectations of this modality of treatment.
Finally, the chapters on second malignancy, quality of life, healthy lifestyle and prevention strategies are vital for clinicians caring for the long-term survivors of childhood malignancy, so as to maximise good outcomes and ensure that the complication rate does not rise in parallel with cure rates.
I would strongly commend this book to any clinician interested or involved in the care of young people including general practitioners, paediatrician and general physicians, as well as specialists in the many systems affected by treatment of malignancy. Oncology nurses, a highly specialised and competent group who often have the primary contact for long- term survivors, as well as allied health professionals with an interest in childhood cancer, will find this book an excellent resource.