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Am Fam Physician. 2000;62(7):1718-1720

Book Reviews

Current Therapy in Cancer

By John F. Foley, Julie M. Vose and James O. Armitage. Pp. 576. Price, $89.00. Saunders, The Curtis Center, Independence Sq. West, Philadelphia, PA 19106, 1999, 2d ed. Phone: 800-831-7799. ISBN: 0-721-67548-4.

As a hematologist-oncologist in clinical practice, I read the second edition of Current Therapy in Cancer anticipating an updated, succinct review of recent information on common and less common malignancies. As a member of the editorial advisory board of American Family Physician, I considered the usefulness of this text to a family physician.

The contributors to Current Therapy in Cancer are international experts in hematology-oncology and related fields who wrote 79 diverse chapters attempting to describe current knowledge in oncology. The title is a misnomer, however, because the editors allocate more than one third of the text to lymphomas, other hematologic malignancies and bone marrow transplantation treatments of hematologic malignancies.

The book is divided into two sections dealing with solid tumors and “liquid” or hematologic, malignancies, which include all lymphomas, acute and chronic leukemias, multiple myeloma, myelodsyplasia and bone marrow and stem cell transplantation of these neoplasms. A final section deals with complications of chemotherapy, radiation therapy and bone marrow transplantation, as well as advances in chemotherapy. The last chapter discusses targeted cancer therapy, including antisense therapy and monoclonal antibody-directed treatment.

The first section describes lung cancer with a well-written overview followed by a chapter on treatment and “details of therapy.” A chapter on the rare thymic cancers is followed by an excellent overview of head and neck cancers, followed by chapters on laryngeal, paranasal sinus and salivary gland tumors. The original chapter organization is not followed consistently.

A thorough discussion of gastrointestinal cancers is included, but the section on breast cancer is not current, which is surprising given the progress of breast cancer research in recent years. Little about genetic screening is included in the section on colorectal cancers or the one on breast cancer. A “current concept” textbook that does not consider bisphosphonate therapy with pamidronate for bone metastases of breast cancer, adjunctive taxane chemotherapy or herceptin immunotherapy for metastatic disease is behind the times.

The sections on gynecologic, genitourinary, endocrine and skin malignancies are complete, well written and balanced between common and uncommon cancers. Malignant melanoma is thoroughly discussed but without mention of sentinel node biopsy, which is rapidly becoming the preferred surgical staging procedure for melanoma and breast cancer.

The sarcoma section contains useful diagnostic, staging and treatment considerations. A chapter on desmoid tumors attempts to tie together a variety of benign fibromatoses; it is questionable that this topic belongs in an oncology book. Again, the neurologic malignancy section is definitive and includes meningiomas, metastatic brain tumors and central nervous system lymphomas, subjects that are often difficult to find in textbooks.

The lymphomas are divided between Hodgkin's and non-Hodgkin's lymphomas, and these are the best chapters in the book. An overview of modern lymphoma pathology updating readers on the current classification of non-Hodgkin's lymphomas would go a long way toward providing needed structure to the extensive descriptions. Organization of the lymphoma section becomes confusing, with the inclusion of a section and a separate chapter titled “NHL: Diffuse Aggressive.”

The chapter on hematologic malignancies contains the expected information on multiple myeloma and acute and chronic leukemias. Myelodysplasia, a unique topic in an oncology text, is also covered. There is an extensive section on bone marrow or stem cell transplantation techniques, which is not surprising, given the expertise of the editors.

A useful section on the complications of chemotherapy, radiation and bone marrow transplantations is worthwhile for the generalist as well as the specialist. The use of four different names for methotrexate on the same page, however, is confusing.

The last chapter, on targeted therapy, is ambitious but less useful because it does not highlight the two antibody therapies labeled for this use by the U.S. Food and Drug Administration.

It is also surprising, in the year 2000, not to find sections on supportive treatments in cancer management or palliative therapies (see Am Fam Physician 2000;61:755–70 for an article on managing pain in the dying patient, along with an editorial on palliative care).

While many of the chapters of this book are well written, current and documented with useful tables, the editing is inconsistent. I would have expected a greater emphasis on staging and therapy, and was disappointed to have to go to the oncology journals or the Internet to find the latest information. Current Therapy in Cancer contains useful sections and chapters, but other texts provide this information in a more consistent style.

Geriatrics Review Syllabus

The American Geriatrics Society. Price, $395.00. American Geriatrics Society, 9 Hallmark Dr., New York City, NY 10956, 1999, 4th ed. Phone: 914-634-3209. ISBN: 0-962-43972-X.

The Geriatrics Review Syllabus is a study and teaching guide for primary care physicians, including geriatricians. The fourth edition gives an updated overview of evidence-based care for geriatrics patients in a concise, informative manner. It outlines the unique characteristics and special needs (physical, medical, psychosocial and spiritual) of this older population. It reviews the different aspects of geriatric medicine in various settings (outpatient, inpatient, nursing home and home care) with major emphasis on preventive measures and maintaining healthy elderly patients in the community.

The material is organized into five major sections: general principles of aging, approach to the elderly patient, geriatric syndromes, geriatric psychiatry and common geriatric diseases. Each of these sections gives current and clinically relevant information, supplemented by references and various appendices. The textbook accomplishes its purpose by enabling physicians to understand the basic principles of geriatric medicine, address the patient's psychosocial issues, diagnose and manage most of the geriatric syndromes and prepare for the geriatrics board examination.

The syllabus provides a great resource for self-study, especially for fellows. Several tables and a figure are especially useful in outlining principles of clinical management. The new chapters, in particular the ones on palliative care, dysphagia/tube feeding, dizziness and hormone replacement therapy, and the color atlas of dermatology contribute well to further learning in geriatric medicine. The syllabus could be improved if future editions included the following: (1) an objective tool to assess caregiver burden during a comprehensive geriatric assessment, (2) more emphasis on ethnogeriatrics, because ethnicity is an increasingly important factor in U.S. population, (3) emphasis on reimbursement for geriatric assessment and various aspects of home care to promote adequate care and create incentives for physicians, (4) more information on home visits, such as may be found in a recent publication, “The Home Visit” (American Family Physician 1999;60: 1481-8), (5) expanded comparison of rehabilitation approaches (subacute care, acute care, inpatient care), (6) comments on the usefulness of chest radiographs in asymptomatic elderly patients with positive purified protein derivative (PPD) tests, (7) a more complete table on the treatment of Alzheimer's disease to include dosages of medications and the frequency of side effects, (8) a table comparing dementia, delirium and depression, (9) a discussion of osteoporosis in men, (10) a flowchart mentioning use of different bed types for treatment of specific pressure ulcers, because this topic affects a patient's care and Medicare reimbursement, (11) pictures of different gait impairments, (12) the addition of the “CAGE Questionnaire” to assess for alcoholism, (13) the addition of “Medical Care of Nursing Home Patients—What Physicians Need to Know,” (Besdine WR, American College of Physicians, 1996) as a reference in the Community-Based Care section and (14) clarifying a discrepancy about the “get-up-and-go test”: it's listed as 10 feet on page 77 and as 20 feet on page 349.

Also Received

Diabetes Mellitus in the Elderly

Edited by James W. Cooper. Pp. 84. Price, $39.95. Pharmaceutical Products Press, 10 Alice St., Binghamton, NY 13904-1580, 1999. Phone: 800-429-6784. ISBN: 0-7890-0682-0.

Health Care Finance: Basic Tools for Nonfinancial Managers

By Judith Baker and R.W. Baker. Pp. 263. Price, $59.00. Aspen Publishers, 200 Orchard Ridge Dr., Gaithersburg, MD 20878, 2000. Phone: 800-638-8437. ISBN: 0-834-21206-4.

Infectious Diseases and Arthropods

By Jerome Goddard. Pp. 240. Price, $ 75.00. Humana Press, 999 Riverview Dr., Ste. 208, Totowa, NJ 07512, 1999. Phone: 973-256-1699. ISBN: 0-8960-3825-4.

The Meditation Sourcebook

By Holly Sumner, Ph.D. Pp. 320. Price, $15.95. NTC Contemporary Publishing Group, 4255 W. Touhy Ave., Lincolnwood, IL 60646-1975, 2000. Phone: 847-679-5500. ISBN: 0-7373-0396-4.

Homeopathic Medicine in Primary Care

By Sidney E. Skinner. Pp. 464. Price, $49.00. Aspen Publishers, Inc., 200 Orchard Ridge Dr., Gaithersburg, MD 20878. Phone: 800-234-1660. ISBN: 0-8342-1676-0.

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