Book Review

Cancer Patient Follow-up

N Engl J Med 1998; 338:1081April 9, 1998

Article

Cancer Patient Follow-up
Edited by Frank E. Johnson and Katherine S. Virgo, with five others. 554 pp. St. Louis, Mosby, 1997. $69. ISBN: 0-8151-4925-5

Clinical follow-up is a neglected field in oncology. Although attention is focused on detecting and treating primary cancers and cancer recurrence, follow-up strategies all too frequently do not receive the same attention. Many of these strategies are based on one's best guess and consensus rather than on objective evidence. This is lamentable, given that in the United States an estimated 1 million to 2 million new cases of cancer will be seen in 1998. Fortunately, the majority will be treated with curative intent and then followed. However, the type of follow-up is inconsistent. For example, factors such as the centers where clinicians were residents often determine the type of follow-up recommended, with little questioning of the effect on quality of life or survival. The cost of follow-up strategies is likely to be substantial, but although so many patients have cancer, only limited research has documented these costs. Questions remain about the types of tests patients with cancer should undergo to identify recurrence when they are seemingly well, the role of patient choice in follow-up, the defensive maneuvers physicians use to avoid legal repercussions in the event of recurrence or new primary cancers, and the cost effectiveness of various approaches to follow-up.

Cancer Patient Follow-up comprehensively deals with these challenging issues and provides an insightful review of follow-up strategies for patients who have received treatment for cancer and are apparently well. To deal adequately with this topic, current follow-up strategies are reviewed in 19 chapters devoted to specific organs. Follow-up recommendations are provided by international experts and are summarized throughout in clearly identifiable tables. Each chapter addresses future follow-up strategies, with the various authors giving their ideas of how follow-up care will change in the next decade and beyond. Here, it is clear that molecular genetics is at the forefront. This book is not a simple prescriptive textbook; opposing views of international cancer experts are presented in each chapter. These debates sometimes provide intriguing perspectives and highlight key issues in the follow-up of patients with cancer.

This book makes clear the need to tackle many unresolved issues in the follow-up of these patients. The very detailed and careful presentation of data by over 100 contributing authors illustrates just how important the stakes are in terms of the length, quality, and cost of human life. Because it provides a well-informed and thoroughly debated evaluation of follow-up strategies, this book is essential reading for all who deal with patients with cancer.

Andrew Bottomley, Ph.D.
Cancer Support Centre, Bradford BD9 6RN, United Kingdom