CANCER: THE NEED TO KNOW

Breast Cancer Care have made available the following reviews which will be published in a shorter version in the Spring Edition of the Breast Cancer Care Newsletter.

Cancer: a positive approach
Dr Hilary Thomas and Professor Karol Sikora
Thorsons, 1995, 238 pages, £8.99

Cancer: What every patient needs to know
Dr. Jeffrey Tobias
Bloomsbury 1995, 304 pages, £6.99

These two books have much the same aim of providing an up-to-date authoritative guide to cancer and its treatments for the lay person, whether patient, supporter or friend. They cover roughly the same material and both are written by well-known cancer experts. But the feel of the books is different.

To start with, one is £2 cheaper than the other and the quality reflects the price. Tobias' book has more pages but some useful information provided by Thomas and Sikora is not provided: a glossary, a list of books for further reading and addresses of complementary treatment centres. The value attributed to complementary therapies by Thomas and Sikora is denied, even denigrated, by Tobias. The mere title of his chapter 'Alternative therapies and their limitations' illustrates his viewpoint, which he himself acknowledges is prejudiced on this topic.

Both books have an introductory section explaining the nature of cancer (Thomas and Sikora do this particularly well, with clear diagrams) and chapters on the various treatments: surgery, chemotherapy, radiotherapy and hormone therapy. Both have similar passages on the misleading nature of media hype about 'breakthroughs' in treatment, and both speculate about future developments. Both have passages about clinical trials - Tobias claiming they are 'good for you' and taking a somewhat cavalier attitude to informed consent, while Thomas and Sikora put a more balanced view. Tobias in addition gives separate chapters about the various major groups of cancers, which accounts for his extra pages. He also gives case histories to illustrate each cancer, which make interesting reading, but he does not acknowledge permission from the patients to use them. Thomas and Sikora give only two case histories, but again, with no acknowledgement.

As far as breast cancer is concerned, Tobias is again rather more inclined to put forward his personal views of treatment options than to state uncertainties, which Thomas and Sikora are not afraid to do. Tobias would use Tamoxifen routinely for all patients with breast cancer, regardless of age or menopausal status. Thomas and Sikora acknowledge that 'not all patients respond to hormonal tratment.' They give an excellent section on breast self examination, a helpful table of drug side-effects, and checklists of points to note or remember at each stage of the cancer journey.

When it comes to controversies about radiotherapy, Thomas and Sikora are prepared to state that 'small frequent fractions...tend to result in fewer long-term side effects and better cosmetic results' (that is, every day is better than five times a fortnight). Tobias asserts 'there doesn't seem to be any clear evidence that patients undergoing a rapid, three-week treatment course have more to fear from long-term side effects than those who are treated at a slower rate over six weeks.' Since Karol Sikora has been a champion of RAGE women and one of the first to take their concerns seriously and undertake research on their behalf, I would be more inclined to accept his advice on this point. The problem for women, of course, is to find a centre that can offer the best treatment when their nearest centre may still be lagging behind, sometimes for logistical reasons over which they have little control.

The difference in approach betwen these two books is illustrated by their titles. Tobias' book seems to be about what he thinks every patient needs to know. Although apparently open and very free with information, the book is till coloured by his own opinions, and on nearly every page we have phrases like: 'In my view...'. At least we know where we are, this is what Tobias thinks. Thomas and Sikora are both more inclusive of others' views and more modest, acknowledging where there are uncertainties, especially with breast cancer threatment, and pointing to further sources of information. Their attitiude is one of partnership with the patient. Their final paragraph sums up their stance:

'Progress is not simply about proposals, it is also about a cultural change in the attitude of doctors and paramedical staff. As a result, there should be an understanding of the need for unbiased information, greater sensitivity to patients' quality of life, and perhaps above all, the right to be involved in decisions about their management. We hope that this book will empower them in that process.'

Tobias too in his last paragraph wants to encourage patients to regain control, but seems to put the onus on them to achieve this: that is, be ready with your questions so as to use the busy specialist's time in the best possible way.

Both these books will be useful additions to the volunteer's library, but if you have to choose between them you might do well to fork out the extra £2.

Heather Goodare
Heather Goodare was treated for breast cancer in 1986. She now works as a counsellor.

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