Medical decisions in the selection of therapy for the child with cancer

This paper discusses the treatment development that has taken place for children with cancer. It is argued that the physician is a coequal partner with other members of the total care team of the child. The factors that demand individualization of therapy will be discussed, and the stages in medical decision making will be reviewed. The physician is not a member of the team as a researcher, but as a medical care giver. The physician also has special knowledge. The expertise that is brought to the team by a physician must ultimately be an understanding of the pathophysiology of the disease. Once therapy is designed on pathophysiological understanding, cancer can become just another disease among the possible diseases of childhood, and medical decision making can be done rationally and eventually, to a large degree, in the hometown community.