Book Review

Oncology: A multidisciplinary textbook

N Engl J Med 1996; 334:198-199January 18, 1996

Article

Oncology: A multidisciplinary textbook
Edited by Alan Horwich. 703 pp., illustrated. New York, Chapman & Hall Medical, 1995. $99.95. ISBN: 0-412-55250-7

Over 1 million people are given a diagnosis of cancer in the United States each year. Given the high cost of aggressive treatment of cancer and the increasing prevalence of managed-care and capitated insurance programs, oncologists are coming under intense pressure to reexamine and modify their algorithms for care within the context of medical cost containment. Oncology: A Multidisciplinary Textbook will interest practicing American oncologists for its view of the care of patients with cancer under the cost-containing influence of the British medical system. Residents and fellows will enjoy its refreshingly brief presentation of the basics of oncology.

This textbook presents an introduction to the multidisciplinary management of cancer as it is practiced at the Royal Marsden Hospital in London. Contributors to the book are mostly staff members of the hospital and of the affiliated Institute of Cancer Research. Sadly, the book lacks a description or even a brief history of these distinguished institutions. The book is organized in two parts; the first addresses general principles and the second specific diseases. The first section includes 17 chapters and begins with brief introductions to the applications of epidemiology, cell biology, immunology, molecular biology, pathology, and radiology to practical oncology. Other chapters are devoted to the principles of surgical, radiologic, and medical cancer therapy and to related areas such as supportive and palliative care, treatment-related toxicity, and the development of new therapies. The second section provides generally clear and concise chapters on each of the major types of cancer. Although the organization and content are appropriate to an introductory textbook, there is room for improvement. For example, there are no sections dealing with oncologic emergencies or metastatic cancer of unknown primary site, and the index contains too many inaccuracies and not enough cross-references.

The book's style is that of a compilation of lectures addressed to the student oncologist, a feature that distinguishes it from the encyclopedic approach of most oncology and hematology textbooks. Most chapters are written by single authors with clarity and authority. Redundancies and inconsistencies are rare, and the material is presented for the most part in a well-organized and very concise fashion. Although the book's subtitle suggests a particular emphasis on multidisciplinary care, I did not find striking evidence of this in the individual presentations. Throughout my reading I found that I was first being presented with an introduction to the topic at hand and then provided with the author's view of the current state of the art in areas of controversy. Readers will need to look elsewhere for in-depth reviews and analyses of controversial issues if they wish to be exposed to more than a single point of view. Although figures and tables are presented in some chapters, there are relatively few, and those provided are limited in their usefulness and visual appeal. Each chapter has a focused selection of references that are generally current through 1993. As might be expected with any new work, a substantial number of typographic errors can be found throughout the book. In summary, this is a nicely done introductory textbook of clinical oncology that differs in style and content from comprehensive reference works.

What insight did I gain into cost-effective oncologic practice? First, I was struck by the degree of common ground between the American and British approaches to cancer treatment, despite our different health insurance systems. Nonetheless, my reading suggested that British management strategies were likely to require less use of expensive tests (such as computed tomographic scans in patients with lung cancer, lymphoma, and other diseases) and that the threshold for recommending aggressive treatment in Britain tended to be more conservative, especially with regard to treatments for which preliminary results are promising but definitive proof of benefit is not yet available. In the final analysis, however, I suspect that these issues are not nearly as important in determining differences in the costs and benefits of cancer care between Britain and the United States as are differences in access to care by oncologists. For example, a report on the front page of The New York Times (June 26, 1994) indicated that fewer than 40 percent of patients with cancer in the United Kingdom are ever referred to oncologists and that this low rate of access may be responsible for the higher rates of death from cancer in the United Kingdom than in the United States.

To whom would I recommend this book? Medical students and residents interested in a focused introduction to oncology will find this a useful resource, but oncology fellows and practitioners will probably require a more encyclopedic book for reference purposes. American oncologists interested in the British view of practice will find more similarities and parallels than differences and divergences.

Frederick R. Aronson, M.D.
Maine Center for Cancer Medicine, Portland, ME 04102