Depression and cancer.

The editors of Depression and Cancer, from New York, Italy, and Switzerland, have chosen authors from around the world who demonstrate a deep understanding of and thoughtfulness about their subjects. The book presents a biopsychosocial framework, discussing the biological association between depression and cancer and treatment, the psychological factors and treatment, and social issues and interventions for depression in cancer. The authors make the book interesting by going beyond summaries of the data. They discuss the implications in a relevant and thought-provoking way without straying from the data. For example, in chapter 1, “The Prevalence of Depression in People With Cancer,” the epidemiologic data are presented concisely and are followed by a fascinating description of the difference between demoralization and depression. This idea is further expanded in chapter 3, with the addition of the concept of the sickness behavior syndrome. These psychological factors are seamlessly integrated into the presentation of biological factors. The possible biological contributors to depression by various cancers and their cytokines are discussed in detail. The interaction between various chemotherapies and antidepressants is also presented. The adaptation of the suicide risk assessment to people with cancer is presented in chapter 6, which addresses the difficult controversies around hastened death, suicide, and physician-assisted suicide. Such discussions could center on the ethical issues, but this chapter is well-grounded in the data, with a focus on the identification and treatment of depression. Another fascinating presentation in the last chapter focuses on the association between socioeconomic status and depression in cancer. The authors present their research from the Danish registry of the effect on outcomes of full access to health care available in that country, with surprising results. These results supplement the data presented in previous chapters on the association between depression in cancer and health-related behaviors and education. Treatment of depression and demoralization in cancer is thoroughly covered. The effectiveness of antidepressants is presented. Several psychotherapies have been adapted for depression in cancer in various settings delivered by medical or psychiatric professionals, and these therapies and the outcome research are reviewed. Screening tools are also reviewed. Much practical information is provided in this little book. Depression and Cancer provides a comprehensive biopsychosocial review and a thought-provoking discussion of the profound questions raised by the association of depression and cancer. One clear message is that depression in cancer is underdiagnosed and undertreated. The data indicating that professionals consider clinical depression to be normal in the setting of cancer, and therefore provide little intervention, are convincing. Furthermore, the data indicating that depression has a negative effect on outcomes of cancer treatment are presented. The need to reverse these trends should make this book indispensable to consult-liaison psychiatry and oncology services.