THE DAMOCLES SYNDROME

An important, original study of what happens to children who survive cancer--physically, emotionally, psychologically--with a view to making their treatment responsive to their needs. The very focus is new. It's only recently, we're reminded, that childhood cancer has come to be seen ""as a life-threatening, chronic illness,"" not ""an acute, almost invariably fatal disease."" To fill the reader in, Koocher and O'Malley--both affiliated with Harvard Medical School--first review the literature on childhood cancer, with attention to issues affecting both patients and families. They then report the findings of their own project, carried on at Boston's Sidney Farber Cancer Institute. Medically, though survivors can live ""normal"" lives, they are 20 times more likely than the general population to develop tumors--either by the recurrence of old ones or the appearance of new ones; emotionally, 47 percent of the survivors seem to have suffered some impairment of mental health. (Best off were those whose cancer was discovered in infancy or early childhood, whose treatment was short, who didn't have relapses, and whose families were supportive and communicated openly.) Other findings illumine how the illness, and coping with it, affects family relationships and such social concerns as marriage and employment. Health-care professionals, the authors conclude, should keep in mind the need for long-term follow-up care, with special attention to mental health. Public policy makers should be mindful, in turn, of the need for both public information programs and financial support for affected families. And, for researchers, further avenues of study are indicated. Though addressed chiefly to these groups (and somewhat clinical in tone), the book is not beyond the ken of those personally involved--who, directly or indirectly, stand to benefit mightily from it.