Clinical Oncology (1997) 9:198 © 1997 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.

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Accidental Administration of Vineristine into the Brachial Artery

S~R - We wish to report an adverse event connected with the administration of vincristine, which may be of interest.

A 20-year-old man with acute lympho- blastic leukaemia who was on maintenance therapy was injected, in the right ante- cubital fossa, with 2 mg of vincristine over 2 minutes. At the end of the procedure, it was suspected that the injection had been given accidentally into the brachial artery instead of the median cephalic vein because pulsation was noted in the blood coming back into the syringe. There was no immediate reaction, but over the next 2 days the patient developed severe pain and moderate swelling of the whole of the lower tight arm. He was managed by elevation of the limb and administration of analgesics. The swelling subsided over the next 2 weeks, but a mild weakness of the forearm and hand muscles developed without signs of sensory neuropathy. The skin peeled to a

certain extent. The arm returned to normal, with complete resolution of the weakness within 2 months, and intravenous vincris- tine was continued monthly.

At the time of this unfortunate occur- rence, we were unable to find any report in the literature, from the Committee on Safety of Medicines, or from the pharma- ceutical companies, to reassure us of a favourable outcome. However, vincristine has been infused intentionally via the intra- arterial route to treat certain tumours, mainly in the head and neck or the pelvis [1,2]. Local tissue inflammation and neuro- pathy are mentioned as occasional side effects [I].

To avoid this type of accident, clearly one should ensure that the vessel cannu- lated for the infusion of vincristine is non- pulsatile. It is recommended not to use the antecubital fossa at all if possible, in order to avoid damaging the median nerve should any of the drug extravasate [3].

This accident produced an unpleasant,

but completely reversible, local reaction. We report this case to reassure those who, in the future, might accidentally infuse vincristine into a brachial artery.

References

l. Claudio F, Cacace F, Commella G, et al. Intraarterial chemotherapy through carotid transposition in advanced head and neck cancer. Cancer 1990;65:1465-71.

2. Park SY, Kim B-G, Kim J-H, et al. Phase I/II study of neoadjuvant intraarterial chemother- apy with mitomycin C, vincristine, and cisplatin in patients with stage IIB bulky cervical carcinoma. Cancer 1995;76:814--23.

3. Tish Knobf MK. Nursing management of patients receiving systemic cancer therapy. In: Bonnadonna G, Robustelli della Cuna G, editors. Handbook of medical oncology. 3rd ed. Chicago: Year Book, 1988;305-6.

N. JACKSON Hospital Universiti Sains Malaysia

N. B. HASSAN Kelantan, Malaysia

Book Review Cancer and the Family. Edited by L. Baider, C. L. Cooper and A. K. De-Nour. Wiley, Chichester, 1996. Pages: 414; Price: £60.00. Hard cover. ISBN 0-471-95890-5.

As Jamie Holland points out in her foreword to the book, it is a widely acknowledged fact that cancer is not just a problem for the individual sufferer but it also has consequences for important others, particularly family members. This book is unique, taking as its starting point the family affected by cancer and providing a helpful compilation of an impressively broad range of research in the area.

The editors have marshalled together a substantial number of the world 's best researchers in psycho-oncology, all of whom have produced readable, accessible accounts of different aspects of cancer and the family, which should satisfy both the academic and the clinician searching for some deeper understanding of the wider impact of diagnosis and treatment.

The book is divided into six sections coveting theoretical aspects, children and adolescents, the effect of diagnosis on partners, breast cancer, sexual issues, and the ethics of communication and medical care. As with any multiauthored book, there are some irritating inconsistencies of style and some overlap of content, although the editors seem to have kept this down to a tolerable level.

All chapters have their merits, but worthy of particular mention were those by Siegel et al. on patterns of communication with children when a parent has cancer, Keller et al. 's review of the spouses of cancer patients, and the two chapters on communication and ethics by Blanchard et al. and Surbonne.

This book deserves wide dissemination among all health care professionals dealing with cancer, not just the social scientists.

L. J. FALLOWFIELD University College London Medical School

London