Book Review

Textbook of Medical Oncology

N Engl J Med 1997; 337:717-718September 4, 1997

Article

Textbook of Medical Oncology
Edited by Franco Cavalli, Heine H. Hansen, and Stanley B. Kaye. 516 pp., illustrated. St. Louis, Mosby, 1997. $120. ISBN: 1-85317-290-1

Medical oncology is a relatively new field of medicine in Europe. I remember going on rounds in a large Dutch hospital in the late 1970s with an attending physician from the United States, who suggested obtaining a consultation with a medical oncologist; we did not know whom to ask. Many of us who later became medical oncologists found our education and training in the very few specialized European hospitals or in the big American cancer centers. Only in the 1980s did medical oncology establish its place among the respected medical specialties in Europe. The European Society for Medical Oncology was founded in 1982 mainly through efforts in France, but its meetings have become truly European only since 1988, and the society's journal, Annals of Oncology, was started in 1990. From this perspective, the publication of the Textbook of Medical Oncology may be considered a landmark. The book's editors, who include the editor-in-chief of Annals of Oncology and the current president of the European Society for Medical Oncology, state that their aim was “to provide an up-to-date synopsis of the specialty of medical oncology in the Europe of the nineties.” Have they achieved this goal?

The book starts with a chapter on the molecular biology of cancer and contains information on epidemiology, pathology, surgery, and radiotherapy in each of the 13 disease-oriented chapters, but the emphasis is on medical oncology. For instance, in the chapter on gastrointestinal cancers, six of the seven pages on colorectal cancer are devoted to chemotherapy. In contrast, in the chapter on breast cancer, 13 of the 29 pages deal with prevention, diagnosis, and local treatment. Both chapters present a European view. As examples, protracted venous infusion of fluorouracil, rather than use of the so-called Mayo Clinic schedule, is considered the treatment of choice for metastatic colorectal cancer, and a trial of endocrine treatment is recommended for some patients with estrogen-receptor–negative metastatic breast cancer. For readers who are interested in a balanced, European view of the systemic treatment of cancer, this book is an excellent buy.

The final chapters of the book are devoted to the control of symptoms. Excellent reviews of the treatment of pain, hypercalcemia, infection, and vomiting and a good introductory discussion of the measurement of quality of life are followed by a disappointing final chapter on palliative treatment of terminal cancer. One could argue with the notion that in Britain, “palliative care is very well developed” merely because it is a recognized medical specialty — a notion that may serve to illustrate the British orientation of this chapter. More seriously, the chapter hardly gives textbook-level information on how to deal with the well-known conditions associated with terminal cancer, such as the anorexia–cachexia syndrome, depression, and fatigue. In my view, it is hard to understand why, in a European textbook on medical oncology, the paragraph on what the oncologist can offer the dying patient does not discuss physician-assisted suicide, euthanasia, and other decisions concerning the end of life.

This textbook has authors from nine European countries with a total of six native languages. The book is truly European in its occasional imbalances, but more important, it offers excellent and up-to-date information for those who provide systemic treatment of cancer and others working in the field of oncology.

Geert H. Blijham, M.D.
Utrecht University Hospital, 3508 GA Utrecht, the Netherlands