Comprehensive Geriatric Oncology [Hardcover]

Lodovico Balducci (Author), William B. Ershler (Author), Gary H. Lyman (Author)

Book Description

Publication Date: December 1, 1997

Cancer is the most common cause of death and morbidity in the elderly. This book provides an extensive review of the effects of age on tolerance of cancer treatments, prevention, and treatment strategies and the influence of age on treatment choice. The authors analyse major clinical trials and highlight emerging issues in geriatric oncology as well as pain control, supportive care, and rehabilitation. It is an exhaustive reference that will enable the practitioner to optimize management of the elderly cancer patient while at the same time providing a state-of-the-art review on the epidemiology, pathology, and biological interaction of ageing and cancer.

Editorial Reviews

From The New England Journal of Medicine

Justification for a book with the title Comprehensive Geriatric Oncology lies in two demographic trends. The first is the aging of the population. We are in the midst of a serious demographic shift toward an increasing number of older persons in this country and, indeed, around the world. The number of people over the age of 65 will more than double over the next 50 years, and the number over the age of 85 will almost quadruple. The other trend is that the incidence of and mortality from cancer increase with age. Sixty percent of all cases of cancer are diagnosed in patients over the age of 65, and the percentage of deaths attributed to cancer is even larger in this group. Moreover, recent work on many fronts has suggested biologic relations between the processes of neoplasia and aging. With the growth of geriatrics, there is increasing recognition that although older people are a heterogeneous group, they differ in a number of ways from younger ones, suggesting that caring for older people with cancer requires a special approach.

Over the past several years, the editors of this textbook and several other authors have made the importance of these issues increasingly clear and have advocated incorporating the principles of geriatrics into oncology practice. Several educational efforts have been launched toward this end, including the Geriatrics Education Retreat in Oncology supported by the Hartford Foundation and the American Geriatrics Society, as well as subsequent approaches to joint geriatric-oncology training. For these reasons, a textbook that comprehensively summarizes these issues and lays out a framework for meeting these objectives is highly desirable. This book represents a largely successful attempt to meet that need, but as might be expected for such an ambitious effort, it has some gaps and areas for improvement. The authors see their primary audience as medical oncologists, with a secondary audience of other practitioners such as geriatricians and a tertiary audience of basic biologists and social scientists.

The book consists of 60 chapters in 8 sections by multiple authors. The sections address the key issues at the interface of geriatrics and oncology: epidemiology, biology, prevention, general management, and the management of specific tumors. Throughout, the book emphasizes age-specific approaches and information, without attempting to be a general oncology textbook. This strategy avoids redundancy for the oncologist and provides enough basic oncologic information for the non-oncologist. This very useful compendium of information will serve as a resource for clinicians who care for older patients with cancer and will alert clinicians to many of the critical issues.

The authors are among the national and international leaders in this emerging field. Probably as a result, there is considerable diversity in the organization and style of the various chapters, which reduces the readability of the book. Moreover, the book seems disjointed, with chapters of similar importance varying considerably in length. For example, the chapter on international perspectives is excessively detailed. Contributing to this feeling of a lack of direction is the idiosyncratic nature of many of the chapters, which seem to be position pieces or descriptions of a particular program or research effort, rather than attempts to present a balanced overview of a topic. It is not clear why particular chapters address a very narrow topic, whereas others are much broader in scope. For instance, there is a chapter on the endoscopic approach to gastrointestinal cancers, yet no separate discussion of pancreatic cancer is offered. Other chapters have enigmatic titles that fail to convey what the chapter is about: "Morbid Anatomy of Aging" really addresses gross pathology and histopathology, and "Assessing Needs and Providing Comfort to Geriatric Cancer Patients and Their Families" really deals with the emotional needs of patients and their families.

Another problem is the considerable redundancy in a number of areas and the absence of attention to others. The physiology of aging is described in an excellent chapter, but this description is then repeated a number of times in the introductions of other chapters. Since a number of these chapters differ considerably in style, the approach to this repeated information is not always uniform, which may be confusing. Likewise, material relating to geriatric assessment is scattered among a number of chapters. The book could benefit from a single strong chapter on geriatric-assessment principles in general and in patients with cancer. There are too many idiosyncratic descriptions of individual approaches. In a number of cases two chapters, such as those dealing with surgery, breast cancer, and bone marrow function, could have been replaced by one strong, integrated chapter. It is also disappointing not to see a really substantial chapter on palliative care, including the management of symptoms (in addition to the very nice chapter on pain management). There is a notable lack of discussion of death and dying, managing the dying process, bereavement, and ethical issues in the care of older patients with cancer.

Despite these limitations, I view this book as a very useful contribution to the field and, much like the discipline of geriatric oncology itself, as a work in progress. I hope it will be improved in the future, with continued refinements. It is a book well worth having in the case of oncologists and generalists alike.

Reviewed by Harvey Jay Cohen, M.D.
Copyright © 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

Product Details

• Hardcover: 832 pages
• Publisher: Taylor & Francis; 1 edition (December 1, 1997)
• Language: English
• ISBN-10: 9057022257
• ISBN-13: 978-9057022258
• Product Dimensions: 11.4 x 8.6 x 2.1 inches
• Shipping Weight: 5.2 pounds
• Amazon Best Sellers Rank: #7,666,643 in Books (See Top 100 in Books)