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Depression and Cancer
Int. J. Radiation Oncology Biol. Phys., Vol. 81, No. 1, p. 313, 2011 Copyright Ó 2011 Elsevier Inc. Printed in the USA. All rights reserved 0360-3016/$ - see front matter
doi:10.1016/j.ijrobp.2011.03.055
BOOK REVIEW
Depression and Cancer
larly the cost, sensitivity, and resultant questionnaire fatigue that can complicate symptom inventories. Chapter 5 is an excellent and comprehensive look at why adherence to cancer therapy is important and what factors contribute to noncompliance. The authors also demonstrate how compliance is impacted by depression in three broad ways: cognitive, motivational, and behavior regarding resource utilization. In addition, they suggest an approach for the clinician to improve outcomes of both depression management and adherence to cancer therapy. Specifically, they stress that depression may lead to nonadherence and that nonadherence itself may be a sign that the clinician should screen for depression. The second half of the book provides an overview of treatment. Of particular note are the chapters on suicide and psychotherapy. These are two areas least familiar to oncologists and give helpful approaches to these vexing topics. The risk factors for suicide and desire for hastened death, including the characteristics and demographics of those at risk and the multitude of reasons cancer patients are at higher risk is particularly enlightening. In addition, a cogent, concise and thoughtful approach to dealing with suicide and desire for hastened death is included in accessible table format. The section on psychotherapy gives the clinician an overview as to the various options and situations where they may be of benefit in the cancer patient. Because this is an area most oncologists have little experience, it is particularly helpful. Pharmacotherapy is the topic of one chapter and is discussed in a succinct manner with tables to provide necessary detail. The final chapter is an interesting discussion of the role of culture and social disparities in the genesis of depression. Depression and Cancer would be of use to most radiation, medical, and surgical oncologists as well as general practitioners dealing with oncologic patients. The first half of the book may also be of use to nurses and other health care workers given the importance of all team members in caring for the depressed cancer patient.
David W. Kissane, Mario Maj, Norman Sartorius, editors Hoboken, NJ, Wiley, 2011 258 pages, ISBN 978-0-470-68966-0 $49.50, paperback. The role of depression in cancer is still relatively poorly studied because cancer patients are often excluded from clinical trials examining depression treatment. Depression and Cancer is the third book in a series by the World Psychiatric Association linking depression with various physical diseases. This is a timely and important topic for oncologists generally and radiation oncologists specifically. This book, written by leaders in the field of psychooncology, does an excellent job of defining the problem and offers a series of chapters on approaches to treatment. It consists of nine chapters dealing with etiology, diagnosis, biology, and treatment. As with any multiauthored text there is redundancy in the introductions of many of the chapters. Still, new information is presented in a concise and clear manner with reasonably complete bibliographies. The text flows from one chapter to the next with increasing ease as one reads through the book. It fills the niche of a handbook on depression for the physician treating cancer patients. The first two chapters offer a nice overview of the topic of depression richly imbued with tables of relevant literature. Specifically discussed are a breakdown of the three types of depression that may occur in cancer patients (and others), including the importance of differentiating anhedonic depression, demoralization and grief in individual patients. The section on biology of depression is particularly informative as an excellent introduction to the field of cytokines and other inflammatory mediators and their relationship and contribution to depression. Of particular note, the discussion of sickness behavior mimicking anhedonic depression is lucid and important. This chapter is richly referenced and discusses the major pathways of immune contributions to neurobehavioral symptoms. One of the most problematic situations confronting the oncologic clinician is differentiating depression from side effects of cancer therapy. Chapter 4 discusses the difficulties in diagnosing depression in cancer patients because of the confounding somatic complaints of weight loss, anorexia, fatigue, and sleep disturbances common to depression and cancer and its treatment. This chapter stresses the fact that clinicians are not adept at diagnosis. Also, that many patients with depression are under or not treated at all. It addresses the difficulties inherent in screening for depression, particu-
William M. Lydiatt, M.D. Professor and Division Chief, Head and Neck Surgical Oncology Department of Otolaryngology-Head and Neck Surgery University of Nebraska Medical Center and Nebraska Methodist Hospital 9881225 Nebraska Medical Center Omaha, NE 68198-1225
313
doi:10.1016/j.ijrobp.2011.03.055
BOOK REVIEW
Depression and Cancer
larly the cost, sensitivity, and resultant questionnaire fatigue that can complicate symptom inventories. Chapter 5 is an excellent and comprehensive look at why adherence to cancer therapy is important and what factors contribute to noncompliance. The authors also demonstrate how compliance is impacted by depression in three broad ways: cognitive, motivational, and behavior regarding resource utilization. In addition, they suggest an approach for the clinician to improve outcomes of both depression management and adherence to cancer therapy. Specifically, they stress that depression may lead to nonadherence and that nonadherence itself may be a sign that the clinician should screen for depression. The second half of the book provides an overview of treatment. Of particular note are the chapters on suicide and psychotherapy. These are two areas least familiar to oncologists and give helpful approaches to these vexing topics. The risk factors for suicide and desire for hastened death, including the characteristics and demographics of those at risk and the multitude of reasons cancer patients are at higher risk is particularly enlightening. In addition, a cogent, concise and thoughtful approach to dealing with suicide and desire for hastened death is included in accessible table format. The section on psychotherapy gives the clinician an overview as to the various options and situations where they may be of benefit in the cancer patient. Because this is an area most oncologists have little experience, it is particularly helpful. Pharmacotherapy is the topic of one chapter and is discussed in a succinct manner with tables to provide necessary detail. The final chapter is an interesting discussion of the role of culture and social disparities in the genesis of depression. Depression and Cancer would be of use to most radiation, medical, and surgical oncologists as well as general practitioners dealing with oncologic patients. The first half of the book may also be of use to nurses and other health care workers given the importance of all team members in caring for the depressed cancer patient.
David W. Kissane, Mario Maj, Norman Sartorius, editors Hoboken, NJ, Wiley, 2011 258 pages, ISBN 978-0-470-68966-0 $49.50, paperback. The role of depression in cancer is still relatively poorly studied because cancer patients are often excluded from clinical trials examining depression treatment. Depression and Cancer is the third book in a series by the World Psychiatric Association linking depression with various physical diseases. This is a timely and important topic for oncologists generally and radiation oncologists specifically. This book, written by leaders in the field of psychooncology, does an excellent job of defining the problem and offers a series of chapters on approaches to treatment. It consists of nine chapters dealing with etiology, diagnosis, biology, and treatment. As with any multiauthored text there is redundancy in the introductions of many of the chapters. Still, new information is presented in a concise and clear manner with reasonably complete bibliographies. The text flows from one chapter to the next with increasing ease as one reads through the book. It fills the niche of a handbook on depression for the physician treating cancer patients. The first two chapters offer a nice overview of the topic of depression richly imbued with tables of relevant literature. Specifically discussed are a breakdown of the three types of depression that may occur in cancer patients (and others), including the importance of differentiating anhedonic depression, demoralization and grief in individual patients. The section on biology of depression is particularly informative as an excellent introduction to the field of cytokines and other inflammatory mediators and their relationship and contribution to depression. Of particular note, the discussion of sickness behavior mimicking anhedonic depression is lucid and important. This chapter is richly referenced and discusses the major pathways of immune contributions to neurobehavioral symptoms. One of the most problematic situations confronting the oncologic clinician is differentiating depression from side effects of cancer therapy. Chapter 4 discusses the difficulties in diagnosing depression in cancer patients because of the confounding somatic complaints of weight loss, anorexia, fatigue, and sleep disturbances common to depression and cancer and its treatment. This chapter stresses the fact that clinicians are not adept at diagnosis. Also, that many patients with depression are under or not treated at all. It addresses the difficulties inherent in screening for depression, particu-
William M. Lydiatt, M.D. Professor and Division Chief, Head and Neck Surgical Oncology Department of Otolaryngology-Head and Neck Surgery University of Nebraska Medical Center and Nebraska Methodist Hospital 9881225 Nebraska Medical Center Omaha, NE 68198-1225
313