Book Review

Survivors of Childhood and Adolescent Cancer: A Multidisciplinary Approach

N Engl J Med 2005; 353:1076-1077September 8, 2005

Article

Survivors of Childhood and Adolescent Cancer: A Multidisciplinary Approach
Second edition. Edited by Cindy L. Schwartz, Wendy L. Hobbie, Louis S. Constine, and Kathleen S. Ruccione. 348 pp., illustrated. Berlin, Springer-Verlag, 2005. $129. ISBN: 3-540-40840-1

The five-year survival rate among children and adolescents with cancer has improved steadily over the past three decades, from 55 percent in the 1970s to 78 percent in the 1990s. This success has increased the population of survivors of pediatric cancer to nearly 300,000 in the United States alone. By one estimate, approximately 1 of every 450 young adults in the year 2010 will be a cancer survivor. This statistic translates into a harsh reality: many survivors have an increased risk of early death due to therapy-related second cancers or severe cardiac or pulmonary disease. Overall, nearly two thirds of these survivors have at least one chronic disorder as a complication, and one third have serious or debilitating sequelae. As this high-risk population ages, its medical problems will only worsen, posing a growing challenge not only to oncologists but also to primary care physicians, adult and pediatric medical specialists, nurses, psychologists, and physical therapists — not to mention social workers and teachers.

The study of childhood cancer survivors can yield enormous dividends. The knowledge gained often translates into improved health care for the survivors and may suggest methods of improving the treatment of future patients. Various aspects of the late effects of cancer treatment on survivors of childhood and adolescent cancer have been admirably covered in numerous journal articles, but few comprehensive monographs are available on this topic. Schwartz and her associates are to be commended for producing an excellent second edition that does much to fill this gap.

To the editors' credit, this edition is considerably more comprehensive than the first edition, and it certainly exceeds the coverage of other textbooks in the field. These editors, like others before them, chose to review the late adverse effects of therapy according to organ system and type of treatment but not according to the type of primary cancer, although one chapter does provide algorithms of late effects for specific malignant diseases. This approach will clearly benefit clinical investigators who are charged with designing treatment protocols, because the same sets of complications may occur in patients who have different types of tumors, assuming that these patients received the same antineoplastic agents at the same doses. However, health care providers or cancer survivors who are seeking information on specific tumors will be disappointed. This lack is compounded by an oversimplified subject index. Although the book has 22 chapters, its index carries a mere 343 primary subject headings, only 4 of which refer to specific cancers. Common cancers such as acute myeloid leukemia, non-Hodgkin's lymphoma, neuroblastoma, Ewing's sarcoma, rhabdomyosarcoma, osteosarcoma, and germ-cell tumor are not even listed.

Five chapters that are especially informative and that I would recommend to any reader are those on neuroendocrine complications of cancer therapy, ocular complications due to cancer treatment, adverse effects of cancer treatment on hearing, cardiovascular effects of cancer therapy, and late gastrointestinal and hepatic effects. Most of the chapters are divided into sections on pathophysiology, clinical manifestations, detection and screening, and management of established problems. Some readers might think that detailed coverage of pathophysiology is not essential to comprehending the multidisciplinary approach to the care of survivors of childhood cancer, but I found these sections both refreshing and highly complementary to the purely clinical aspects of each chapter.

Even though this book is the most comprehensive of its type published to date, future editions could be improved by adding chapters on the common cancers of children and adolescents, such as leukemia, brain tumor, lymphoma, neuroblastoma, and bone cancer — all of which require intensive chemotherapy, with or without irradiation. It would also be helpful to have a chapter on pharmacogenetics, because the vast majority of treatment complications are related to this host factor, which has been the focus of intense study in recent years.

Schwartz and her associates should be congratulated for compiling and editing this much-needed book. It will undoubtedly serve as a primary resource for clinicians charged with the care of cancer survivors and pediatric oncologists charged with the task of developing therapeutic protocols.

Ching-Hon Pui, M.D.
St. Jude Children's Research Hospital, Memphis, TN 38105
ching-hon.pui@stjude.org