Breast Cancer Book review

Susan C. Hedlund, MSWOncology Social Worker

Faculty School of Medicine and Graduate School of Social Work

Oregon Health Sciences University

Portland, Oregon

This book is a unique collaborative venture of 10 women psychologists. One of whom died of breast cancer during the project and to whom the volume is dedicated. It was originally published by the Division of Independent Practice, American Psychological Association. The book is unique, in part, because it is the result of a collaboration, which the authors acknowledge was an extraordinary process because of their interrelatedness as women drawn together by the importance of the topic.

The book adds to an increasingly rich collection of literature that addresses breast cancer. It is estimated that at the end of the 1990s, two million women in the United States will have had a diagnosis of breast cancer during the decade and that 460,000 of them will have died of the disease. Between 1950 and 1989, the incidence of breast cancer increased by 53%. Its magnitude and its constant increase over time continue to keep the disease in the foreground as a rele-vant concern for all women and for the health care system as a whole.

The authors address the emotional responses of patients, families, and caretakers and examine the psychological factors that may influence morbidity and mortality. The book is intended for use as a manual and includes many charts, highlighted quotations, and reference guides.

The book begins with an excellent overview of medical aspects of breast cancer, including clear definitions of terms, descriptions of procedures, and an excellent review of treatment options. Also included are photographs of patients before and after breast recon-struction. Chapter 2 acknowledges the importance of the patient-physician relationship and acknowledges the important role that a mental health professional can play throughout the process of deci-sion making with regard to treatment decisions. The chapter also addresses the professional's role in helping the patient communicate and manage anxiety throughout the diagnosis, treatment, and recovery periods.

Section 2 (Chapters 3-5) addresses the stages of breast cancer and patients' experiences with and psychological reactions to each stage. Patients' psychological reactions to the phases of diagnosis, treatment, posttreatment, recurrence, and terminal illness are thoroughly addressed. The authors do a nice job of "normalizing" the range of these reactions along the continuum of care. The important issues of trust, need for accurate information, and responsibility are addressed succinctly and in language that is easy to understand.

Section 3 (Chapters 6-9) addresses psychotherapy and the breast cancer patient. The authors stress that to help their patients most effectively, mental health professionals must possess basic knowl-edge about the disease, its treatment, side effects, and pain assessment. The authors also acknowledge the difficulty of working with women who have a life-threatening illness and the importance of knowing one's own limits. However, I was disappointed to note in this section and throughout the book for that matter that the text refers only to the psychologist-patient relationship; it does not attempt to acknowledge the range of other mental health profession-als who may work with breast cancer patients. I was also bit alienated because the text failed to acknowledge the extraordinarily rich contributions to psychooncology made by oncology social workers over the last 20 years. Nonetheless, the section provides a good review of crisis theory, the use of short-term treatment models, and interventions that utilize a "strengths" perspective. Chapter 7 provides an interesting description of basic "how-to's" regarding the development and facilitation of support groups. Of particular interest is Chapter 8, in which the authors describe the needs of special populations at high risk for developing breast cancer: les-bian women, older women, and women who live in poverty or have ethnic or cultural concerns. This excellent chapter addresses issues that are not treated in such a comprehensive way in other texts. The section concludes with a well-done chapter on countertransference.

Section 4 (Chapters 10-1l) addresses family issues from the perspective of illness as a crisis that disrupts normal family func-tioning and adds to any preexisting stress that the family has already experienced. Role changes and role negotiations are acknowledged. Chapter 11 provides a particularly useful discussion about the impact of cancer on children, including an excellent description of chil-dren's developmental stages and concerns.

The final section (Chapters 12-15) describes specific models and therapeutic interventions that will serve as an excellent resource for mental health practitioners. Chapter 13 addresses the current research on the effectiveness of psychological interventions for women with breast cancer. It includes findings from recent studies and acknowl-edges the strengths and weaknesses of these studies. Chapter 14 contains an excellent list of resources and an annotated bibliography, and Chapter 15 contains a comprehensive medical glossary.

Overall, the book is well done. However, because each page includes several boxes, quotations, case examples, and other data, the layout proved to be a bit distracting, although the information was useful.

As was mentioned earlier, the authors unfortunately limited their audience to other psychologists. Given that the book was published first through their professional organization, this may have been difficult to avoid. As a result, however, the authors missed some important contributions of other disciplines to the field and the literature. The limitations of this scope are also evident in the lack of a "team" approach to treatment. Although the authors acknowl-edge the importance of communicating with the treating physician "at least once," they do not stress the value of the mental health professional as an integral member of the treatment team. Working side by side on a daily basis with oncologists, nurses, rehabilitation staff, pharmacists. and other health professionals. In my opinion, this limits the authors' perspective to some extent.

Finally, the book is worth reading and having in one's library. If readers can get past the exclusionary language, the principles the authors address are sound and easily generalized to a variety of settings and professional orientations. Again, it is a nice tribute to the authors' colleague.



		BOOK REVIEW BREAST CANCER- A PSYCHOLOGICAL TREATMENT MANUAL. edited by Sandra Haber. Contributors: Catherine Acuff, Lauren Ayers, Esther Lerman Freeman, Carol Goodheart. Christine C. Kieffer. Louise B. Lubin, Susan G. Mikesell, Michele Siegel, Barbara R. Wainrib, New York: Springer Publishing Company, 138 pages. $27.95. From the Journal of Psychosocial Oncology, Vol. 14(2) 1996. ©1996 by The Haworth Press, Inc. Susan C. Hedlund, MSWOncology Social Worker Faculty School of Medicine and Graduate School of Social Work Oregon Health Sciences University Portland, Oregon This book is a unique collaborative venture of 10 women psychologists. One of whom died of breast cancer during the project and to whom the volume is dedicated. It was originally published by the Division of Independent Practice, American Psychological Association. The book is unique, in part, because it is the result of a collaboration, which the authors acknowledge was an extraordinary process because of their interrelatedness as women drawn together by the importance of the topic. The book adds to an increasingly rich collection of literature that addresses breast cancer. It is estimated that at the end of the 1990s, two million women in the United States will have had a diagnosis of breast cancer during the decade and that 460,000 of them will have died of the disease. Between 1950 and 1989, the incidence of breast cancer increased by 53%. Its magnitude and its constant increase over time continue to keep the disease in the foreground as a rele-vant concern for all women and for the health care system as a whole. The authors address the emotional responses of patients, families, and caretakers and examine the psychological factors that may influence morbidity and mortality. The book is intended for use as a manual and includes many charts, highlighted quotations, and reference guides. The book begins with an excellent overview of medical aspects of breast cancer, including clear definitions of terms, descriptions of procedures, and an excellent review of treatment options. Also included are photographs of patients before and after breast recon-struction. Chapter 2 acknowledges the importance of the patient-physician relationship and acknowledges the important role that a mental health professional can play throughout the process of deci-sion making with regard to treatment decisions. The chapter also addresses the professional's role in helping the patient communicate and manage anxiety throughout the diagnosis, treatment, and recovery periods. Section 2 (Chapters 3-5) addresses the stages of breast cancer and patients' experiences with and psychological reactions to each stage. Patients' psychological reactions to the phases of diagnosis, treatment, posttreatment, recurrence, and terminal illness are thoroughly addressed. The authors do a nice job of "normalizing" the range of these reactions along the continuum of care. The important issues of trust, need for accurate information, and responsibility are addressed succinctly and in language that is easy to understand. Section 3 (Chapters 6-9) addresses psychotherapy and the breast cancer patient. The authors stress that to help their patients most effectively, mental health professionals must possess basic knowl-edge about the disease, its treatment, side effects, and pain assessment. The authors also acknowledge the difficulty of working with women who have a life-threatening illness and the importance of knowing one's own limits. However, I was disappointed to note in this section and throughout the book for that matter that the text refers only to the psychologist-patient relationship; it does not attempt to acknowledge the range of other mental health profession-als who may work with breast cancer patients. I was also bit alienated because the text failed to acknowledge the extraordinarily rich contributions to psychooncology made by oncology social workers over the last 20 years. Nonetheless, the section provides a good review of crisis theory, the use of short-term treatment models, and interventions that utilize a "strengths" perspective. Chapter 7 provides an interesting description of basic "how-to's" regarding the development and facilitation of support groups. Of particular interest is Chapter 8, in which the authors describe the needs of special populations at high risk for developing breast cancer: les-bian women, older women, and women who live in poverty or have ethnic or cultural concerns. This excellent chapter addresses issues that are not treated in such a comprehensive way in other texts. The section concludes with a well-done chapter on countertransference. Section 4 (Chapters 10-1l) addresses family issues from the perspective of illness as a crisis that disrupts normal family func-tioning and adds to any preexisting stress that the family has already experienced. Role changes and role negotiations are acknowledged. Chapter 11 provides a particularly useful discussion about the impact of cancer on children, including an excellent description of chil-dren's developmental stages and concerns. The final section (Chapters 12-15) describes specific models and therapeutic interventions that will serve as an excellent resource for mental health practitioners. Chapter 13 addresses the current research on the effectiveness of psychological interventions for women with breast cancer. It includes findings from recent studies and acknowl-edges the strengths and weaknesses of these studies. Chapter 14 contains an excellent list of resources and an annotated bibliography, and Chapter 15 contains a comprehensive medical glossary. Overall, the book is well done. However, because each page includes several boxes, quotations, case examples, and other data, the layout proved to be a bit distracting, although the information was useful. As was mentioned earlier, the authors unfortunately limited their audience to other psychologists. Given that the book was published first through their professional organization, this may have been difficult to avoid. As a result, however, the authors missed some important contributions of other disciplines to the field and the literature. The limitations of this scope are also evident in the lack of a "team" approach to treatment. Although the authors acknowl-edge the importance of communicating with the treating physician "at least once," they do not stress the value of the mental health professional as an integral member of the treatment team. Working side by side on a daily basis with oncologists, nurses, rehabilitation staff, pharmacists. and other health professionals. In my opinion, this limits the authors' perspective to some extent. Finally, the book is worth reading and having in one's library. If readers can get past the exclusionary language, the principles the authors address are sound and easily generalized to a variety of settings and professional orientations. Again, it is a nice tribute to the authors' colleague.