Providing care beyond medical treatment, the multidisciplinary field of psychosocial oncology addresses the psychological, social, and emotional health of the patient with cancer. On an occasional basis, The ASCO Post will explore the realm of psychosocial oncology with a column guest edited by Jimmie Holland, MD, Wayne E. Chapman Chair in Psychiatric Oncology at Memorial Sloan-Kettering Cancer Center, New York.
For the past few years, we have been running an Aging and Cancer Group at Memorial Sloan-Kettering Cancer Center, to help the fastest growing group of cancer survivors—ie, the elderly—cope with the double whammy of aging and cancer. In some ways, these are opposite problems: Cancer crystallizes the fear of dying, whereas aging often crystallizes the fear of growing older and more infirm as the years go by. One challenge both issues have in common, though, is the sense of isolation they can engender.
Search for Solutions
We have tried different approaches to these issues, based on various psychological models, particularly the work of Erik and Joan Erikson on development throughout the life cycle. We convened two “expert panels” of elders to help us pilot our ideas. Not surprisingly, when talk of theories and models of development came up, eyes routinely glazed over. And so we learned to keep theory out of it and stick to everyday life experiences.
Then an amazing thing happened, based not on theory, research, or any kind of science, but, instead, on the love between a grandmother and granddaughter. My (JH) granddaughter and I decided to start a grandmother/granddaughter book club, to read and discuss the Harvard Classics during her gap year before college. We so enjoyed the exchange of ideas across the generations. But when college finally started and my young partner became too busy, she suggested I start a new book club for elders interested in tackling the great books of western civilization. Which is exactly what I did.
The new group, which we integrated into the Aging and Cancer Group, was called the Vintage Readers Book Club. We devoted one meeting a month to discussing passages from the classics; keeping in mind the age of our readers, we selected texts from antiquity to the modern era, starting with writings by Ben Franklin and Cicero’s essay, “On Old Age.”
If those choices sound dry to you, they were anything but. Whereas the regular group meetings averaged two to four members, the book club meetings sometimes had close to a dozen attendees. We could barely squeeze into the same room. Discussions were the most animated since the inception of the group. Clearly, the book club touched something very visceral for its members, who ranged in age from their mid-60s to mid-90s.
Reasons for Success
What was it about the Vintage Readers Book Club that was so inspiring to its members? And why was it so much more popular than the Aging and Cancer Group from which it had sprung?
We have some theories. One possibility is a cohort effect. People of a certain age aren’t comfortable with talking about themselves in a therapeutic situation—there’s a stigma to anything associated with psychiatry. But they can talk about books. Ironically, in talking about books, the conversations regularly come back to ourselves—what we think of what the author wrote and how it relates to our own experiences, including but not limited to our experience of aging and/or dealing with cancer.
Which brings us to another possible reason. One of the ways we cope with aging and cancer is simply to live our lives the best we can, and set goals on which to focus. Having a concrete external goal—to discuss Ben Franklin’s ideas of what makes us happy, for example—sounds a lot more fun than just generally discussing our problems, even if both discussions end up leading us to the same place!
Cicero’s essay on old age was illuminating in another way, too. His description of ageism thousands of years ago could have popped out of today’s New York Times. And what better way to feel connected to the world than to feel connected across boundaries of time and culture. ■
For further information about the Vintage Readers Book Club, e-mail Dr. Holland at hollandj@mskcc.org.
Disclosure: Drs. Holland, Greenstein, and Nelson reported no potential conflicts of interest.
Dr. Holland is Wayne E. Chapman Chair in Psychiatric Oncology and Attending Psychiatrist, Dr. Greenstein is a former chief clinical fellow in the Department of Psychiatry, and Dr. Nelson is a clinical psychologist at Memorial Sloan-Kettering Cancer Center, New York.
