British Journal of Radiology (2004) 77, 538
© 2004 British Institute of Radiology
doi:
Cognitive behaviour therapy for people with cancer. By S Moorey and S Greer, pp. xii + 208, 2002 (Oxford University Press, New York, NY), £24.95 ISBN 0 19 850866 2
A J Munro
Books written by experts fall into two main categories: tedious accounts of why that particular expert has always been right (and how the rest of the world is either totally wrong or catching up too slowly); balanced accounts of a field written from a wealth of personal experience and practical knowledge. This book is emphatically in the latter category. The first 50 pages deal succinctly with the psychological aspects of cancer and ask two questions. Can cognitive behaviour therapy improve quality of life? Answer: definitely yes. Can psychological therapy affect duration of survival? Answer: perhaps, but the verdict is not yet in. The remaining 150 pages concern some of the theory, and a lot of the practice, of cognitive behavioural therapy.
This is the second edition of a book originally published in 1989. There has been an interesting modulation of the title: from "Psychological therapy for patients with cancer" to "Cognitive behaviour therapy for people with cancer". The only two substantive words in common are therapy and cancer; the patients have become people.
The authors use clinical vignettes to illustrate their points and this grounding in reality greatly adds to the impact of the book. The authors do their best to dispel preconceptions concerning psychological interventions for patients with cancer: that such adjunctive treatment is only of relevance to middle-class women with breast cancer. Despite their careful choice of vignettes I am not entirely convinced. The simple fact is that the majority of the studies referred to in this account are of women with breast cancer and the demographic profile of patients attending the Royal Marsden Hospital is very different from that of patients attending the Beatson in Glasgow. What works in Surrey and Kensington may not play so well in Moss Side or Castlemilk. A woman on adjuvant tamoxifen for early breast cancer may have the time and energy to participate in a psychotherapy programme; this may not be true for a man undergoing intensive chemoradiotherapy for locally advanced lung cancer.
There are the usual idiosyncrasies: on page 6 we are told that radiotherapy "commonly causes nausea and fatigue" – and chemotherapy doesn't? The text-box on page 131 mentions "scott free", possibly an attempt to avoid an ethnic slur, possibly a simple misprint. The book is expensive, £25 for just over 200 pages is no bargain. These are minor cavils and in no way detract from the worth of this book.
This short and well-written book tells oncologists some of what they need to know about the psychological aspects of cancer. It also tells them in an interesting and vivid manner what happens within that mysterious group of therapeutic encounters known as cognitive behaviour therapy. Should I suggest to all my patients that they should undergo such therapy? I don't know. Would 10 mg of fluoxetine be cheaper, as effective, and more convenient? I don't know the answer to that one either.
