Abstract
I said I would kill myself if another person asked me to give blood. No one asked any more questions, and before I knew it I had a psychiatrist at the end of my bed.
Such searing real-life insights punctuate Clinical Psychologist Dr. Toni Lindsay's new book for clinicians. 1 Lindsay has worked with adolescents and young adults (AYAs) with cancer for over a decade, and has rightly earned the well-respected status as one of the leading AYA specialists in the clinical psychology sphere.
This easy-to-read book aims to upskill psychosocial clinicians—particularly psychologists—in the unique therapeutic skill set required to work effectively with AYA cancer patients across the care trajectory. Lindsay draws from several evidence-based therapeutic approaches—cognitive-behavioral therapy (CBT), acceptance and commitment therapy (ACT), and existential psychotherapies—to address a broad range of AYA-relevant psychological concerns, with a strong emphasis throughout on establishing effective therapeutic engagement.
Lindsay reasonably anticipates a few distinct readerships who may benefit from her book. There is plenty of educational content around cancer and its treatment for a psychologist adept in AYA work in other contexts to extend his or her practice sideways into oncology, and navigate the unique challenges that occur when adolescence and cancer collide. For clinicians in this category, the early medically focused chapters provide a succinct overview of the “nuts and bolts” of cancer treatment, and the (oftentimes normal) psychological reactions these can evoke in AYA patients. This will be essential reading for a clinician preparing to work with AYAs undergoing active treatment in hospital settings. For example, less-experienced clinicians may not anticipate the mood and motivation “crash” patients often encounter by the third to fourth cycle of chemotherapy (once the novelty of treatment has passed and initial groundswells of support have subsided). Later chapters on Relationships, Fertility and Sexuality, Drugs and Alcohol, and Body Image provide an excellent insight into the developmentally unique impact of cancer on each of these areas. The later chapter on Competency will also undoubtedly be of interest to clinicians who have not previously worked with minors/adolescents. In each, Lindsay guides the reader to understand key intervention targets, and choices around clinical language that can be used to open doors to address these issues.
This book will also be valuable to psychosocial clinicians already working on oncology, with different/older age groups. Clinicians will be able to “dip in” to read specific chapters on different points of the cancer trajectory. In one chapter, Lindsay explores how the phenomenon of “scan anxiety” (or “scanxiety” as it is increasingly coined) during and after treatment can be addressed cognitively and behaviorally; in another, she addresses the psychological challenges of survivorship and the attendant fear of cancer recurrence that can emerge. There are useful chapters on managing depression and anxiety in the cancer context, where Lindsay outlines in concrete, practical terms how clinicians can differentiate between transient distress and “red flag” symptoms more likely to indicate severe/chronic psychopathology. There is a level of nuance that will assist clinicians to assess how they can translate and tailor their existing skills in ACT, CBT, and other existential approaches to the clinical scenarios presented.
Lindsay's extensive grounding in AYA clinical practice is clear throughout; difficult clinical issues are brought to life through numerous case examples and quotes. This allows her to gently guide the clinician through some of the most challenging terrain: for example, suicide and risk assessment, cancer recurrence, and the “pointy end” of end-of-life and legacy making. As these are the areas that most often provoke fear in the hearts of the multidisciplinary team (and trigger psychology referrals), they are important to understand in-depth.
Cancer, Sex, Drugs and Death has a calm matter-of-fact way of unpacking complex and anxiety-provoking clinical scenarios. Lindsay's writing is to the point, and avoids dry or overly jargonistic language that can obscure psychosocial professionals' understanding of the medical aspects of patients' care. The book's conversational style leaves the reader feeling as though they have been sitting across from a colleague, engaged in clinical supervision. Lindsay takes an important “360-degree view” of the clinician's role, emphasizing the impact of AYA work on the clinician, including the relevance of self-care, and boundary setting, throughout. One criticism that could be made is that the book rarely cites formal evidence (although research on the frameworks discussed is easily located). As a clinical guide, however, this book achieves exactly what it sets out to do. As AYA psycho-oncology research flourishes, Cancer, Sex, Drugs and Death fills an important gap in broadening the reach of psychosocial practice tailored to the needs of this group.