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Supportive Care of Children with Cancer,
  1. Paediatric Oncologist

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Supportive Care of Children with Cancer, 2nd ed. Edited by Ablin AR. (Pp 327; paperback £25.00.) The Johns Hopkins University Press, 1998. ISBN 0 801 85727 9 .

The proportion of children being cured of cancer continues its inexorable rise. The cohort treated by UKCCSG centres in 1991–94 is approaching a plateau on the survival curve at about 70%. If survival continues to rise as in previous cohorts, there is every expectation that by the year 2000 around 80% of children will be cured. This improvement reflects not only the development of better primary treatment, but also the great advances in supportive care that have permitted the delivery of increasingly toxic chemotherapy regimens. This useful little book represents the efforts of the North American Children’s Cancer Group to codify and rationalise their supportive care regimens, not only to ensure a high standard of care but also to control what has become one of the greatest variables in clinical trials of cancer treatment.

The overall organisation and layout of the book is reminiscent of the American Academy of Pediatrics “red book” on infectious diseases. A total of 21 chapters cover every conceivable aspect of supportive care. The first part has the sections that one might conventionally expect in such a book and covers the problems of immunity, infection, blood component treatment, haemopoietic growth factors, problems with the administration of chemotherapy and radiotherapy, and control of pain. There is a very useful chapter on oncological emergencies and a selection of very useful chapters on subjects that perhaps could use more of our attention, such as nutritional support and the management of the sexually mature patient with cancer. No doubt many British paediatricians will wonder why the latter chapter is included, but there are increasing numbers of adolescent patients being treated by paediatric oncologists in the UK, and these patients represent an age group of which many paediatric trainees will have little experience.

The latter part of the book includes interesting chapters on psychosocial care, alternative medicine, home care, and palliative care. I particularly enjoyed the “quick quack check” in the section on alternative medicine. The chapters are well organised and designed for dipping into rather than reading through. One might not completely agree with all of the recommendations, but as the authors themselves frequently say, their suggestions are reasonable. Where data are inconclusive or suggest that an intervention is inappropriate there is a clear statement to that effect.

Having worked in the USA I tend to be more tolerant of books originating there than most UK reviewers seem to be. There are differences in practice and emphasis, but who are we to say that our view is correct? In this book too, there are some areas where UK practice differs. There are very few instances where the differences are of any significance, but where they exist it is usually a consequence of drug licensing. Inevitably there are a few areas of deficiency or where one might seriously differ with the suggestions made by the authors. For example, in the section on hyperkalaemia I was surprised that there was no mention of the problem of factitious results. Failure to mention the use of salbutamol in the treatment of hyperkalaemia probably reflects availability and licensing. The other irritation is the use throughout the book of non-SI units. Surely it is not difficult to include SI units in a book with an intended market that extends beyond the US?

All of the regional children’s cancer centres will have their own written guidelines for supportive care, so who would buy this book? I doubt that many units’ guidelines will have the comprehensive coverage that this book gives and for that reason alone it ought to be available on the notes trolley in all centres worthy of the name. In addition, it is a useful textbook for junior staff beginning a rotation in oncology. Having read through a number of chapters I lent the book to the team’s senior house officer, eventually prising it out of her grasp some weeks later; it is now chained to the notes trolley until it is replaced by the third edition.