A Practitioner's Guide

Abstract

By Theresa A. Veach, Donald R. Nicholas, and Marci A. Barton Published by Brunner-Routledge, New York, 2002 255 pages, $34.95 (Hardcover) Cancer and the Family Life Cycle is a nicely organized work that integrates six phases of the family life cycle with six defined stages of cancer treatment. The authors have created narratives for the single young adult, newly forming couple, the family with adolescents, the family launching children and the family in later life as they move through diagnosis, treatment, rehabilitation, survival, recurrence/advanced disease and end of life care. This guide is written for practitioners who work with cancer patients and their families in settings such as hospitals, nursing homes and hospice, as well as private practice settings. The book reinforces the importance of early psychosocial assessment and interventions along the continuum of illness and provides a framework for conceptualizing the impact of cancer on the family system and individual family members. Chapter 1, “Introduction and Purpose,” provides interesting history on the perception of cancer since the 1800's. The evolution of the illness is explored as it changed from a shameful, hopeless diagnosis to a treatable disease impacting multidimensional aspects of patient and family life. This ongoing evolution is reflected in some of the complex constructs and language presented in this guide. For example, phrases such as “cancer as a new family member” (p. 23), “married couples who have had cancer” (p. 159), “cancer to be kept in its place” (p.135) are woven through the text and seem to represent the ongoing struggles to establish a language and conceptual framework that set boundaries around the illness and its influences. This same evolving language impacts the perception of family who are alternately described as “part of the team” and as the “unit of treatment.” How we see the role of family influences the therapeutic formulation and interventions. This book does a fine job of discussing the implications of boundaries and rules of communication within families; it misses an opportunity to do the same in the area of our language as clinicians. Each chapter of this guide is similarly organized. There is an overview of medical, treatment, existential and psychosocial aspects and case examples for each life cycle phase. The case examples integrate genograms, diagnostic interview, assessment and interventions. Tables help coordinate life cycle stage with the following factors: life cycle tasks, cancer's potential disruption to the system, psychosocial interventions and specific topics of communication. Figures describe the emotional process of transitions as families are asked to adjust and adapt boundaries, rules, roles and communication patterns consequent to diagnosis and treatment realities. The case examples are rich with suggested interventions ranging from speaker/listener communication techniques; rituals; and structural, problem solving, group, behavioral and mind-body interventions. Cultural and diversity aspects of the patient/family experiences are not discussed; instead, clinicians will need to integrate this aspect of assessment into the valuable constructs that are provided. This practitioner guide is a useful clinical tool. It represents an ideal wherein patients and families are afforded an initial biopsychosocial assessment, ongoing interventions, options for home care and end-of-life care. The guide can empower clinicians to intervene with patients and families, and encourage specific advocacy efforts to enhance the quality and availability of these important services.