Book ReviewsCancer in the Elderly: A Nursing and Medical Perspective Robert StuartMD Robert Stuart Search for more papers by this author Published Online:1 May 1998https://doi.org/10.5144/0256-4947.1998.278aSectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionFor the last dozen years, Fellows in my Hematology-Oncology training program have asked me, “If I want to have an academic career, what area of Hematology/Oncology should I emphasize?” And for at least ten years, my unhesitating and invariable answer has been: “Geriatric Oncology.” This reply has never failed to elicit surprise and cries for explanation, but regrettably it has not yet succeeded in convincing a Fellow to follow my advice.Cancer in the elderly, the topic of this second monograph in a new series from the European School of Oncology (ESO), is the next great frontier in oncology research. As this 98-page booklet concisely summarizes, cancer in the elderly is a demographic brush fire driven by the twin winds of decreasing cardiovascular mortality and rapid population increase in the over-70 age group. And, at least in North America, we are not well prepared for the demands that will be made on the health care system by a large cohort of otherwise healthy oldsters with newly diagnosed malignant neoplasms.Why are we not prepared? In North America the traditional practice in the design of cancer therapy clinical trials has been to exclude individuals over 70 years of age. Some aggressive chemotherapy trials have used upper age limits of 65 (breast cancer), 60 (acute leukemia), or even 40-50 (marrow transplantation). While these restrictions were motivated by genuine concerns about the marrow therapeutic ratios of some cytotoxic chemotherapy regimens, the result has been the systematic exclusion of potential new knowledge about cancer therapy in older patients. Only recently (perhaps as oncologists themselves began to approach old age?) has this deficiency been recognized and clinical trials without upper age limits initiated.Cancer in the Elderly: A Nursing and Medical Perspective represents the results of a study group or task force sponsored by ESO, wherein “leading experts exchange views on the state of the art of a given field, discuss controversies and new developments, and give opinions on future directions.” In seven well-chosen chapters, the seven multidisciplinary and multinational authors provide an overview of the problem with emphasis on patient care and cancer treatment in the elderly. (Interestingly, the editors do not list the specific authors of the individual chapters, a way of emphasizing the collaborative nature of the book.) Both medical and nursing care are emphasized, reflecting the disciplines of the authors, three of whom are nurses.The strength of the booklet lies in its readability—at 98 pages, it can be read in an evening—and in the timeliness of its subject matter. Its principal weakness is the lack of hard data in the field.Repeatedly, the authors are forced to temper their conclusions due to a lack of prospective studies, a limited amount of information, or a lack of evidence that certain data apply to the elderly as well as to the younger population. This is not a flaw of the book, but a fault of investigators worldwide.Who should buy this book? I should buy this book so that I can lend it to the next Fellow who seeks career advice. It also deserves a place on the shelves of physician and nurse educators and in medical libraries. Previous article FiguresReferencesRelatedDetails Volume 18, Issue 3May 1998 Metrics History Published online1 May 1998 InformationCopyright © 1998, Annals of Saudi MedicinePDF download