The Psychoimmunology of Cancer (2nd edn) Edited By C. E. Lewis, R. M. O'Brien & J. Barraclough. Oxford: Oxford University Press. 2002. 274 pp.£45.00 (hb). ISBN 0 19 263060 1

When the first edition of this book was published in 1994 the psychoimmunology of cancer was very much in its infancy. A second edition is timely, as there has been a vast literature published in this area over the past decade and I had hoped (unrealistically, of course) that, nearly 10 years on, many of the questions posed in the first edition could be answered.

Three main pathways are investigated in the psychoimmunology of cancer. The first is the effect of health behaviours (e.g. smoking, delay in presentation and compliance with drug therapy) on the initiation and spread of cancer. Next, there are the effects of cancer on the mental state (e.g. depression and anxiety disorders). The third, and perhaps more intellectually stimulating, although speculative, pathway is the effect of cognitions and emotions on cancer: is a ‘fighting spirit’ coping style associated with longer survival times, or social support associated with lower mortality? However, these types of pathways are now considered too simple and misleading. Immune surveillance seems to be less important in the development of most types of solid tumours than previously thought, although the immune system is still thought to be very important in limiting tumour development and late-stage metastatic spread. The authors suggest that future researchers will need to develop new hypotheses for specific types of cancer. Therefore, despite an increase in our understanding of the bidirectional communications between the mind, the nervous system, the endocrine system, the immune system and the cancer, there seems to be more caution in linking psychological interventions to reductions in cancer mortality.

The important message of this book is that the mind is clearly important for cancer patients (as for all patients) and in the past few years psycho—oncology as a clinical discipline has grown and is increasingly seen as very relevant to clinical care. There is clear evidence that psychological interventions improve the quality of life for cancer patients, but the jury is still out on whether a better quality of life can lead to living longer. The book would have benefited from much more editing — the few psychological intervention studies testing the latter hypothesis were repeated too often and in too much detail. The critical reviews in each chapter provide useful summaries and this book would be much thumbed in a specialist library.