Evolution and development of hospice and specialist palliative care services

Clinical Oncology (1998) 10:347 © 1998 The Royal College of Radiologists

Clinical Oncology

Correspondence Letters are published at the discretion of the Editor. Opinions expressed by correspondents are not necessarily those of the Editor. Unduly long letters may be returned to the authors for shortening. Letters in response to a paper may be sent to the author of the paper so that the reply can be published in the same issue. Letters should be typed double spaced and should be signed by all authors personally. References should be given in the style specified in the Instructions to Authors which appear in each issue of the Journal.

Imaging Investigation Childhood Cancer

Protocols

for

StR - Thirty-six children with childhood cancer presented over a 3-year period. We reviewed their imaging investigations at diagnosis to see how they complied with those laid down in the United Kingdom Children's Cancer Study Group-approved protocols. Eleven treatment and investigation protocols were reviewed. Adherence to the protocol as determined by imaging modality ranged from 91% for ultrasound to 56% for MRI. Limited resources in the case of MRI are no doubt largely accountable for this discrepancy. Of further interest, however, is the ~verlap of diagnostic information obtained by various investigations. Six of 11 protoCols stipulated frontal and lateral chest !adiographs. Four of these six also required a CT scan of the thorax, a more sensitive but less specific examination for pulmonary nodules, which, in older patients, are likely to be benign [1], although the granulomata bften seen in older adults are less common in children. A study carried out in children With Wilms' tumour suggests that pulmonary nodules seen on a CT scan but not on a chest radiograph often represent metastatic disease [2]. The radiation dose from a CT examination of the chest is considerable, but the small additional radiation burden of frontal and lateral chest radiographs, parti:cularly in children who are likely to need longterm radiological surveillance, cannot be disregarded. A rational review of the radiological investigations and a consensus on which is the best route to diagnostic accuracy, while minimizing radiation dose, geems appropriate. Radiological input at an

early stage of protocol planning would be the best way to achieve this.

References

1. Chalmers N, Best JJK. The significance of pulmonary nodules detected by CT but not by chest radiography in tumour staging. Clin Radiol 1991;44:410-2. 2. Wilimas JA, Douglass EC, Magill HL, et al. Significance of pulmonary computed tomography at diagnosis in Wilms' tumour. J Clin Oncol 1988;6:1144-6.

With good judgement (for example, of the extent of the surgery or the amount of radiation), combined with technical skill and good psychological support, much was achieved and there were many grateful patients. Reference

1. Ford G. Evolution and development of hospice and specialist palliative care services. Clin Oncol 1998;10:50-5. T. BREWIN

S. E. HEGARTY J. J. FAIRHURST

Southampton University Hospitals NHS Trust Southampton, UK

Pegasus Grange Oxford, UK

The author replies as follows: Evolution and Development of Hospice and Specialist Palliative Care Services

SIR - I have been an admirer of Cicely Sannders and of the hospice movement since its earliest days, but I feel that Gillian Ford, in an otherwise excellent review [11, somewhat overstates the previous lack of interest in palliation and quality of life, especially before the stage of terminal care. For example, for at least 50 years before this time, the standard practice of every surgeon or radiotherapist, when faced with a cancer patient, was to decide whether to advise radical treatment, hoping for a cure, or instead aim for palliation. Throughout this period, the sole aim of many kinds of surgery and radiotherapy was not to prolong life, but to relieve symptoms and give the best possible quality of life. This is well documented in contemporary textbooks.

SIR - Dr Brewin's helpful comment on the palliative direction of the treatment approach of surgeons and radiotherapists in the earlier years of this century adds an interesting historical perspective. But it also raises the question of why recent decades of research in chemotherapy-based treatment of late-stage disease failed to include and/or record palliative objectives such as quality of life and symptom control [1]. Reference

1. MacDonald N. The interface between oncology and palliative medicine. In: Doyle D, Hanks GW, MacDonaId N, editors. Oxford textbook of palliative medicine. Oxford: Oxford University Press, 1993. G. FORD

Ryecotes Mead Dulwich, London, UK