The last 30 years have seen little improvement in the age-adjusted mortality rates for most common types of cancer, and until we develop more effective and less damaging treatment modalities for these tumours, selection of each patient's treatment must depend on prognostic pointers. These lead to a calculated trade off between our estimate of likely benefit to the patient, as against cost in terms of quality of life. But changes have occurred recently in our understanding of the traditional prognostic pointers used for selecting such individualised treatment. First, it is increasingly recognised that the stage at which a tumour presents is more related to the chromo logical age of the tumour (how far it has progressed before diagnosis) than to its biological characteristics. While advanced chronological age of the tumour may predict a greater likelihood of early death, only biological criteria can predict the tumour growth rate, the likelihood of prolonged survival, the likely course of the disease after the first recurrence or the likehood of response to systemic therapy. Second, there is increasing use of failure analysis in relating the clinical and biological characteristics of tumours to their response to standard treatments. In the past, the relationship was interpreted mainly in terms of survival rate, but the site and timing of first recurrence and the pattern and timing of subsequent spread provide a better assessment of the control possible from local or systemic therapy.

M. K. Gospodarowicz, P. Hermanek, and D. E. Henson Attention to innovations in cancer treatment has tended to eclipse the importance of prognostic assessment. However, the recognition that prognostic factors often have a greater impact on outcome than available therapies and the proliferation of biochemical, molecular, and genetic markers have resulted in renewed interest in this field. The outcome in patients with cancer is determined by a combination of numerous factors. Presently, the most widely recognized are the extent of disease, histologic type of tumor, and treatment. It has been known for some time that additional factors also influence outcome. These include histologic grade, lymphatic or vascular invasion, mitotic index, performance status, symptoms, and most recently genetic and biochemical markers. It is the aim of this volume to compile those prognostic factors that have emerged as important determinants of outcome for tumors at various sites. This compilation represents the first phase of a more extensive process to integrate all prognostic factors in cancer to further enhance the prediction of outcome following treatment. Certain issues surround ing the assessment and reporting of prognostic factors are also considered. Importance of Prognostic Factors Prognostic factors in cancer often have an immense influence on outcome, while treatment often has a much weaker effect. For example, the influence of the presence of lymph node involvement on survival of patients with metastatic breast cancer is much greater than the effect of adjuvant treatment with tamoxifen in the same group of patients [5].

This book is comprised of extensive reviews and instructional chapters that discuss the quality of life in several aspects of cancer. The first six chapters deal with conceptual issues relating to measuring quality of life in adult and pediatric populations with cancer. The next five chapters provide practical information on how to select quality-of-life measures, the statistical analysis of trials, economic evaluations to be considered, and some possible abuses of quality-of-life measures. Five chapters review the results of studies using selected quality-of-life measures and provide recent information on their performance. These are followed by three chapters dealing with specific issues relating to nausea and vomiting associated with cancer therapy. Three chapters are devoted to the problems of assessing and controlling pain in patients who have cancer. There are also two chapters that deal with the quality of life in palliative care. Effect of Cancer on Quality of Life is intended for all who have an interest in measuring the quality of life in patients with cancer. This includes investigators who are just entering the field and can benefit from instructions on how to conduct quality-of-life research, as well as those who are experienced in conducting this kind of research.

Challenging a number of myths about living long term with or after cancer, this book offers new insights by delving into areas that are not usually spoken about. Written from a dual perspective- that of a psychologist who had breast cancer and who copes with the long-term effects of treatment - the book contests the assumption that the afflicted person will simply 'get better' or 'move through' to a better situation. Emotional and physical side-effects can worsen over time and people living beyond or with cancer often endure a mismatch between expectations and reality, because they have been told that life would be easier than it actually is. This can leave both those suffering longer term and those close to them confused and unprepared. Including testimonies with people who have had a cancer diagnosis and people in the medical profession, the book signposts ways that professionals may help and offers prompts for friends and relatives to have useful and open conversations with the person affected. It gives voice to many people who feel that their suffering is disputed and diminished by the prevailing narrative around recovery. Galgut includes discussion on relationships, work, trauma, fear of recurrence and the role of therapy. Giving an unflinchingly honest perspective, Living with the Long-Term Effects of Cancer sheds light on these struggles, in the belief that bringing this conversation to the forefront is key to improving life for those who are affected by cancer and who suffer longer term from its effects.

The focus of the 22nd Annual Detroit Cancer Symposium was the presentation and discussion of cytotoxic agents, with a significant portion of the symposium including the exciting frontiers of drug discovery being explored by the National Cooperative Drug Discovery Groups (NCDDG) Program. The symposium brought together a large number of investigators from government, universities and pharmaceutical companies involved in the discovery and development of new anticancer agents. Exciting new leads were presented and the status of others presently under development was discussed. Of particular significance has been the initiation of renewed efforts in the area of natural product drug discovery, where the discovery of new cytotoxics is very promising at the moment. A number of major changes have occurred during the last decade in research on drug discovery of cytotoxic agents. Critical reviews of a number of the models and concepts underlying drug discovery represented a continuous thread throughout the meeting, being constantly discussed in terms of their advantages, disadvantages and capabilities of discovering solid tumor active anticancer agents. A recent development which is to be much applauded and which portends to great discoveries is the new relationship formed between Government, University of Industry. The NCDDG mechanism which stimulates this interaction is an inexpensive manner to greatly magnify the drug discovery and development effort nationally. Cytotoxic Anticancer Drugs: Models and Concepts for Drug Discovery and Development represents a forum which will become the major mode for bringing together these three different components in the equation to regularly discuss new results and ideas.