MD Anderson Manual of Medical Oncology

It is an unusual oncologist in the United States who has not had a patient receive a second opinion at the M. D. Anderson Cancer Center (MDA). Long a respected and well-known force in cancer research and patient care, MDA has exerted significant national and international influence not only with scientific publications but also through its training programs and large clinical operation. This book will add to that influence with concise disease-oriented chapters covering the patient population a medical oncologist will see in practice. The MD Anderson Manual of Medical Oncology is not a small handbook. Rather, it is a hardbound text of more than 1,000 pages authored by nearly 100 MDA clinicians.

The 13 sections contain a total of 44 chapters generally organized by disease category, much as clinical activities are designed at large cancer centers. The book is physically structured so as to be easy to read. First-year fellows, for example, could easily digest a chapter a day early in their training and receive a solid perspective on treatment trends and controversies. There are two columns of text per page, and each chapter contains multiple illustrations, figures, tables, treatment flow diagrams, or decision algorithms. Some of the algorithms are complex with opportunity for error. For example, in one for metastatic breast cancer, a label for "previously used taxane treatment" is missing, causing some confusion for the reader. The color photographs of pathologic specimens, endoscopy pictures, or histology examples are generally of excellent quality. Radiologic images are also put to good use, highlighting key points in the text.

Most of the chapters do indeed capture the sense of "How we do it at MDA," which is what this manual is all about. The chapter on colorectal cancer has an interesting section titled, "The MDACC Approach to Patients with Metastatic Disease." Here, the authors describe broad principles that drive their treatment recommendations. Not all readers will agree with some of their approaches, but the authors are clear in the rationale for treatment of metastatic disease in asymptomatic patients, and it is refreshing to see such commentary in print. Some more encyclopedic cancer texts can overwhelm the reader with data and references but come up short in terms of clinical advice. In that sense, this book is more of a manual than a comprehensive text, and oncology fellows should not mistake reading a chapter as being exposed to the basic science, treatment development history, and multidisciplinary approaches that are essential in oncology training.

The audience for this book would include a variety of clinicians. As mentioned, it is a nice reference for fellows as they rotate through the different clinics. In many large cancer programs, attending clinicians devote their efforts to one disease. It is easy to become outdated in the other diseases, and this book will provide a nice review. Likewise, this would be a good reference for family practitioners or general internists who may be involved in helping to counsel a patient being treated for cancer. Too often, generalists can shy away from helping patients in the decision-making process. This book is a nice resource for them to get a relatively quick sense of treatment strategies and controversies.

An important chapter called "Adult Long-Term Follow-Up" is placed near the end of the book. In future editions, it might be better to place it near the beginning since the importance of this topic will only grow. Cancer survivorship research will need to expand, and oncologists will need to work with primary care clinicians to develop strategies that will enhance high-quality long-term survivorship. The authors are to be commended for including this chapter.

The references for each chapter are quite current for a hardbound book. Many chapters include 2005 references. The editors have done an excellent job in maintaining reasonable uniformity of style across chapters without diminishing author/clinic individuality. It will be a challenge to keep the manual current, as treatment strategies for many diseases change fairly rapidly.

In summary, this book is clearly an MDA product, and from my experience, the authors do in fact preach what they practice. No book can replace a real second opinion with doctor-patient face-to-face discussion, but it does provide a look at what your patient might hear if they visit MDA. It is not a comprehensive textbook of all elements of cancer biology and multidisciplinary care. Rather, the manual provides a readable review of medical treatment approaches to cancers treated with chemotherapy. As a manual should, it provides concise treatment descriptions in a volume that should be readily available for reference. With this focus, this text is a unique and valuable addition to clinically oriented oncology books.