Cancer in Primary Care

Abstract

Edited by a general practitioner and a cancer specialist, Cancer in Primary Care aims to provide a single reference point for primary healthcare team members to access basic information necessary for holistic cancer care. Most of the text is directed to specific types of cancer, with each chapter dealing with a specific site and providing concise descriptions of incidence, pathology, diagnosis and staging and management. HIV-associated cancer is dealt with in a separate chapter. The data are up-to-date for a 2003 publication and for the most part presented in colourful and graphic format. The chapter on children's cancer is particularly helpful because the conditions are rare and usually managed in regional centres. The five-year actuarial survival curves provide an encouraging visual representation of the progress made in the treatment of childhood leukaemias and I found the table relating to common presenting signs and symptoms of childhood malignancy, with associated differential diagnoses, a useful aide-memoire. The introductory section of the book deals with organizing a cancer service and does not appear immediately relevant to a busy health professional with a specific question. I liked the chapter on managing side effects of cancer therapy, compressing a lot of data into a short readable essay. The book finishes with a comprehensive listing of information and support sources for cancer patients, which provides general national and disease-specific information with web addresses. A subject now fraught with difficulties for the general practitioner is prostate cancer—especially with regard to the place of prostate specific antigen (PSA) estimation. I took issue with the statement that ‘men who present with prostatism should be assessed initially with digital rectal examination and PSA estimation’. This is not the consensus in the UK and such a policy, if followed blindly, can lead to a series of further investigations not necessarily in the patient's best interest. That point aside, the prostate chapter does offer a balanced discussion of the treatment options of localized and metastatic prostate cancer with recent trial results presented in an accessible manner which clarified some issues for me. Does a book of this sort serve a useful purpose in an age of rapid change in screening technology, imaging and treatment options? Will the text be ‘dipped into’ by the primary healthcare team as the authors hope, or will the internet and nationally agreed statements be the preferred route. The long-term future, I suspect, is for such texts to be available electronically with regular updates.