Children with cancer: the quality of life Christine Eiser. Lawrence Erlbaum Associates, Mahwah NJ, 2004. pp. 304, $79.95/£52.95 (hardback). 080583544X

Abstract

Major advances in cancer treatment over the past two decades have dramatically improved survival rates for paediatric oncology patients. Cancer in children is no longer a deadly disease but a chronic illness. Thus, the quality of life (QOL) for children who have cancer is an important issue for those who are currently suffering and those who have completed treatment. Some consensus about the definition of quality of life has been reached; that it is subjective and multidimensional. When children assess their own quality of life, the first problem encountered is how to measure the subjective perspective of QOL when children have limited cognitive ability or are too sick to use measurement tools. This is the first book that addresses the issues of quality of life for children with cancer including conceptual/theoretical issues, measurement, and how the QOL is affected throughout treatment, from diagnosis to long-term survival. The book has seventeen chapters, with findings based on research by the authors and which are clearly documented. The author indicates that this book is written as in two major themes: ‘to increase public awareness of the progress that has been made in treating childhood cancer’ and to what extent ‘treatment for cancer affects the child's QOL’ (p. 3). In order to present both comprehensive and substantial context, the author has organized this book into five major parts. The first part emphasizes the importance of holistic care of children. The next chapters deals with an overview of medical care for childhood cancer, the history and consequent development of psychosocial care, the theoretical and methodological assumptions of QOL, and emotional, social and behavioural outcomes for children with cancer. Medical treatment discussed includes an overview of treatment, prognosis and long term survival. Psychosocial care is also described in chronological order (from diagnosis to long term survival). There are pragmatic discussions of theories and methods in assessing QOL, which are very informative. However, there is one important theoretical framework—Hinds and Haase's work on ‘substantive models for quality of life in paediatric oncology patients’—which is not included (Hinds and Haase, 1998). Part II covers a variety of effects of treatment for paediatric cancer and includes chapters on effects of diagnosis of cancer in children at different ages and different approaches to communicating with paediatric oncology patients. It also includes outcomes used to measure behaviour and adjustment of the patients, such as depression, anxiety, self-esteem, body image, and coping. The issues of validity between parental proxy and patient report are also discussed in describing children's behaviour and adjustment. The normality of going back to school is also important for long term survivorship. The chapter also covers the child's school behaviour and social relationships, as well as interventions to promote the child's reintegration after she/he returns to school Part III covers the importance of family cancer care, by considering how cancer treatment affects children, parents and healthy siblings. The responses of the family to diagnosis, treatment, and long term physical and psychological effects are described. Psychological interventions and follow up clinics for survivors and parents are needed to promote a healthy lifestyle. Gender differences (between mothers and fathers) are also discussed. Part IV describes the long term consequences of surviving paediatric oncology in terms of later physiological and psychological effects. Paediatric oncology patients are highly vulnerable to some lifestyles related to the risk of cancer (such as smoking and sexual activity). The author states ‘it is not enough to give people health information but they need also to understand how themselves can improve their health’ (p.213). Interventions to promote a healthy lifestyle are suggested and a recommendation is made that children should be examined in clinics on a regular basis for continuous care. Part V covers the need for assessing quality of life as an outcome indicator for paediatric oncology. This differs from adult oncology in that the treatment protocol for paediatric oncology is more aggressive in aiming to cure the disease, and survivors are at risk for later physical and psychological effects. Different measures of quality of life, both parent-completed and children's self-reports, are discussed in terms of concepts, and psychometric properties, both for paediatric oncology patients currently undergoing treatment and long term survivors. This book will help multidisciplinary health care professionals in dealing with the complex and difficult problems of paediatric oncology patients, their parents and healthy siblings. This is the only recent comprehensive book on physical and psychological care, as well as quality of life in survivors. An important part of this book is its overview of physical and psychological care from diagnosis to long term survival. This is a very practical work for all health care professionals, including the paediatric oncologists, paediatricians, nurses, psychologists and social workers who care for these patients. I highly recommend this book to my colleagues in the field of paediatric oncology.