The development by WHO-CCCE of a textbook for Cancer in General Practice

 

The reason to develop a multidisciplinary approached textbook for cancer in general practice

Background

Cancer is often considered to be a difficult and complex field of medicine. That is understandable, because cancer encompasses over one hundred different malignant diseases, each of which may present in an early or late stage, and with different tumour characteristics. Furthermore, each patient with a malignant tumour differs in tumour-host relationship; and also the localization of the tumour may vary. In addition: oncology is a multidisciplinary area of medicine, which means that several medical disciplines are involved in the diagnosis, staging and treatment of individual patients with cancer. This multidisciplinary approach is reflected in cancer education. For example: in most medical curricula lung cancer is a topic that is taught by the general practitioner, the pulmonologist, the pathologist, the surgeon, the radiation oncologist and the internist. The problem is that a particular topic, such as lung cancer, is usually taught in different curriculum years, and mostly without any consultation and coordination between the lecturers. Such a structure harbours the danger of unnecessary duplications and unnoticed omissions, and is frequently complicated by the use of a variable and ambiguous terminology. Cancer education practice reveals that this danger is not an imaginary one. It goes without saying that this results in a fragmented and confusing offer of knowledge to medical students.

Development

"Essential Oncology for Health Professionals" tries to avoid the above mentioned problems in current cancer education. The book is a result of a four-year s project (1987-1991) at Groningen University Faculty of Medicine, aiming at developing a multidisciplinary cancer curriculum, integrated throughout the medical curriculum, and aiming at general cancer knowledge for every physician who will see patients with cancer.

 

Coordinated multidisciplinary approach – avoiding ambiguity

By means of a coordinated multidisciplinary approach, and by avoiding ambiguity through the use of uniform terminology, the different aspects of the many malignant diseases could be reduced to a more general subject matter, relevant for the general physician.

 

Restricted to general insight and knowledge

This book is restricted as much as possible to general insight and knowledge. Going deeply into a subject matter was not our goal. The reader with specific interest is referred to the hereafter-mentioned literature, to lectures, and in general to continuing medical education activities.

 

Educational research through continuous evaluation

During the development of this book, the content and the design were evaluated by students, residents and family physicians. The evaluation disclosed that the book indeed provided basic clinical knowledge and insight. As to the design: several options related to the insertion of educational objectives were investigated. The current design was experienced as the most appealing form. According to medical students, the objectives provide:

• an overall picture of required knowledge and skills
• a means for self-assessment.

Evaluation

As of 1991/1992 a first draft of this book was evaluated by over 300 lecturers in oncology of Groningen University Faculty of Medicine, senior medical students, interns, residents and other physicians. The authors have gratefully accepted many critical remarks, which have been taken into account in the first Dutch edition of this book ("Oncologie voor de Medicus Practicus", Van Gorcum, Assen, 1992).

'Essential Oncology for Health Professionals' is subdivided into four parts:

1. Introduction to the general clinical aspects of oncology.
2. Site specific tumours.
3. Global insights into cancer pain management, nutrition in oncology, and aspects of psychosocial care
4. Patient problems, mainly centred around the first visit of a patient with cancer to an oncologist.

It cannot be overemphasized that Part A provides the fundamental background to comprehension and insight in general clinical oncology for general practice.

Part B can only be understood in connection with understanding the principles of the foregoing part. Attention throughout the book is focused on the crucial questions of:

• when do I have to be on the alert for a malignant disease?

• what can I see?

• how do I have to examine the patient?

• which relevant investigations are required?

• what are the do’s and don’ts ?

• what should be my pattern of referral?

• what is going to happen to the patient, and why?

• how to take care of the patient at home?

Further reading (textbook 1994)

As mentioned above: this book comprises general clinical knowledge for every physician who will see patients with cancer. Those who want to study particular topics more in depth, are referred to the following books.

• Anonymus: Cancer Pain Relief. Geneva: World Health Organization, 1992, 74 pp.
• DeVita Jr VT, Hellman S, Rosenberg SA (editors): Cancer. Principles and Practice of Oncology, JB Lippincott Company,1993, pp 2928
• Goldberg R, Tull RM: The psychosocial dimensions of cancer. New York: The Free Press/Macmillan, Inc., 1983, 280 pp.
• Hermanek P, Sobin LH (editors): TNM Classification of Malignant Tumours. UICC, Berlin: Springer Verlag, 1992, 217 pp.
• O'Donnel JF, Coughlin CT, LeMarbre PJ: Oncology for the House Officer. Baltimore: Williams and Wilkins, 1992, 336pp. 
• Osteen RT, Cady B, Rosenthal PE (editors): Cancer Manual. Massachusetts: American Cancer Society Division, Inc., 1990, 576 pp.
• Weissman DE, Burchman SL, Dinndorf PA, Dahl JL: Handbook of Cancer Pain Management. Wisconsin Cancer Pain Initiative, 1992, 36 pp.
• WHO Technical Report Series, 804: Cancer Pain Relief and Palliative Care. Report of a WHO Expert Committee. Geneva: WHO, 1990, 76 pp.
• Wollard JJ (editor): Nutritional Management of the Cancer Patient. New York, Raven Press, 1979, 204 pp.

Translations

Haagedoorn EML, Oldhoff J, Bender W, Clarke WD, Sleijfer DTh . PRINCIPI DE ONCOLOGIA. Faenza (RA), Italia, Edizione C.E.L.I., Gruppo Editoriale Faenza Editrice S.p.A., 1995. 405 pg. ISBN 88-8138-023-4

Haagedoorn EML, Oldhoff J, Bender W, Clarke WD, Sleijfer DTh . BASISWISSEN ONKOLOGIE. Deutsche Ausgabe herausgegeben von Franz Porzsolt. Berlin/Wiesbaden, Deutschland: Ullstein Mosby GmbH & Co. KG, 1996. 485 pg. ISBN 3-86126-125-1

Haagedoorn EML, Oldhoff J, Bender W, Clarke WD, Sleijfer DTh. ONKOLOOGIA PEREARSTILE. Tôlkija: Rait Labotkin. Tallinn, Estonia, Kirjastus MEDICINA, 1996. 386 pg. ISBN 9985-829107

Haagedoorn EML, Oldhoff J, Bender W, Clarke WD, Sleijfer DTh . ΒΑΣΙΚΕΣΓΝΩΣΕΙΣΟΓΚΟΛΟΓΙΑΣ. ΒασικέςΓυώσειςΟγκολο ү ί а ς. Αποκλειστικότητα ү ιατηνελληνική ү λώσσα. І ατρικέςΕκδόσεις“ΖΗΤΑ”. Μικράς Ασίας 76 - 115 27 Αθήνα . 1997. 395 pg. ISBN 90-232-2905-3 

Haagedoorn EML, Oldhoff J, Bender W, Clarke WD, Sleijfer DTh. ONCOLOGIA BÁSICA PARA PROFISSIONAIS DE SAÚDE. Associação Paulista de Medicina. São Paulo – SP, Brazil. Indices para catálogo sistemático: 1. Oncologia : Medicina 616.922. Impresso no Brasil 2000.