In the management of the child with cancer, the modern pediatrician and pediatrie oncologist are able to see possibilities where their predecessors saw only doom. The steady improvement in the overall survival rate of these children has dispelled the previous pessimism and has given birth to a new era of cautious optimism. This improved outlook cannot be attributed to any single "wonder drug." Rather, the improved prognosis is the result of a carefully integrated and methodically carried out mult idisciplinary approach that fully utilizes the special expertise of the oncologist, radiotherapist, and surgeon. In addition, the success of specialized centers, well equipped to care for the child with cancer, is enhanced by the increased awareness and early diagnosis of cancer by the primary physician or pediatrician. The rewards of the multidisciplinary approach to management of the child with cancer are exemplified by the improved prognosis that is now possible for children with bone tumors, Burkitt's tumor, and reticuloendotheliosis. These are discussed in this issue.
Recent success in the treatment of children with cancer has also done a great deal to establish the science of pediatrie chemotherapy. Attempts to better understand the rational basis for chemotherapy have led us to enter the fascinating realm of cell kinetics, pharmacokinetics, the action of various drugs, and the nature of experimental and human tumors. The modern pediatrie chemotherapist must have a good background in cancer biology to determine effective chemo therapeutic regimens for his patients.
The striking success in chemotherapy of Burkitt's tumor has raised the hope that other malignant solid tumors in children may be attacked chemotherapeutically with similar success.
With improvement in prognosis by the use of chemotherapy and radiotherapy, the side effects of these techniques assume greater importance. Many children with cancer will live to adulthood. Relatively little is known about the late effects of chemotherapy and radiotherapy with respect to growth retardation, sterility, and the risk of secondary tumors.
The prolonged survival and sometimes "cure" of children with cancer has led to the emergence of new needs in the psychological counseling of parents of children with cancer. These families need continued support and understanding of their special emotional needs when their children survive for longer periods. There is a need to avoid psychological maiming of children with cancer by overprotectiveness, permissiveness, and oversolicitude. Supportive psychotherapy by nonpsychiatrists engaged in the child's care and group therapy sessions for patients and hospital persons responsible for the care of children with cancer have been found to be of great value.
The articles in this issue indicate that more and more is being done for the child with cancer, and new needs are emerging that require the pediatrician's attention. These needs reaffirm the central and vital role that the pediatrician can play in the overall management of the child with cancer.