Clinical governance in a changing NHS

The managment of metastatic neuroblastoma brings out extremes of view in paediatric oncologists. There is black pessimism from those who feel that little if any progress has been made and question the value of more than gestural or palliative treatment. This is in contrast to the excessive zeal and optimism of others who enthusiastically publish premature reports of 'advances' in survival. Screening infants for urine catecholamine elevation may detect some early stage patients (Draper, 1988) but whether it is a practical or effective system to reduce the incidence of metastatic disease remains to be proven. Until then chemotherapy remains the most important component of management. But has any progress been made in the past decade? Between 1970 and 1977, 61 patients with stage III (large unresectable primary)