2013; Volume 14, No 4, April
IAHPC book reviews
by Dr. Roger Woodruff
Palliative Care book of the month
PRINCIPLES AND PRACTICE OF PALLIATIVE CARE AND SUPPORTIVE ONCOLOGY. 4eAnn Berger, John Shuster and Jamie Von Roenn (Eds)
Lippincott, Williams and Wilkins, 2013
942 pp
ISBN 978- 1-4511-2127-8
RRP $US212.00 £138.00
I have chosen this as my Book of the Month, but not without a few caveats. Shifting the principles of palliative care upstream, applying them at a much earlier stage in the course of the patient’s disease, is praiseworthy. But I would have liked a little scene-setting. Is supportive oncology just about the principles and practices of palliative care or is it more effective if it involves palliative care personnel? The presence of the latter has been known to irritate oncologists but may smooth the transition to palliative care at a later stage. What models of care have been developed? How well do they work? Better treatment of pain and physical symptoms is good, but how often does supportive oncology incorporate the psychosocial and spiritual concerns? In other words, where are we at in providing comprehensive (interdisciplinary) care for patients with both early- and late-stage disease, and what should we be aiming for? After all, what patients and their families really need is a seamless transition between the oncology and palliative medicine services.
The first section of the book is about pain and Chapter 1 jumps straight in—Difficult Pain Syndromes. Surely if this is an inclusive textbook, written for (amongst others) the next generation of doctors and nurses coming into oncology, you would look for some description and classification of the types of pains cancer patients may suffer; their frequency; how you assess them, including in cognitively impaired patients; and something about the approach to management (which might be a good place to start emphasizing interdisciplinary teamwork). Difficult pain should be the last chapter in the section. Yes, I want to know the results of recent trials for difficult and refractory pains, but first I want to read about the state-of-the-art management of the much more frequent ‘ordinary’ pains that my patients have. And while we are on the research stuff, I would like to know the results of the trials of inhaled cannabis for neuropathic pain, but I am just told that the results were ‘convergent’, ‘comparable to current therapies’, and that the McGill studies were ‘favorable’.
There are other inconsistencies that are annoying. Table 1.3 is about equianalgesic doses of opioid drugs and it states that morphine 10 mg IM is equivalent to morphine 60 mg PO, with a footnote that IM, IV and SC are considered equivalent. But in table 2.2, morphine 10 mg IV/SC is equivalent to morphine 30 mg PO (with which most people would agree).
The bulk of the book is a system-by-system review (some 37 chapters) of the treatment of symptoms and symptom complexes. Most of the chapters that I browsed were well set out, but there was a definite leaning toward supportive oncology and away from the palliative care of end-stage disease. For example, the chapter on liver metastases provides a good review of chemotherapy, arterial infusions, embolization and surgical resection, but says very little about providing optimal symptomatic and supportive palliative care for the patient dying with extensive metastases. I was left wondering what this chapter (and a number of others) would have been like if they were co-authored by two experts—one in supportive oncology and the other in palliative medicine. I shall leave the editors to ponder that, but it might be another way to help build the bridge.
There is then a section of 14 chapters on issues in palliative care, including Glare on prognostication, Twaddle on hospice, Tulsky and Arnold on communication, Rousseau on the actively dying patient, and Christina Puchalski on spirituality. As good as some of the chapters were, one couldn’t feel they were set aside and not as important. The message here to oncologists (or at least their trainees) should be that these topics are compulsory and form an integral part of supportive oncology (which is not just pain and symptom control while you treat their cancer).
The first three editions of this book have done an enormous amount to raise the standard of supportive oncology, and the 4e doesn’t disappoint. It should be required reading for trainees in medical and radiation oncology and it certainly belongs on the oncology department bookshelf. Whether it will make oncologists more understanding and accepting of palliative care is a more difficult question; if they read the palliative care chapters, perhaps it will. If you work in palliative care and a lot of your patients have end-stage cancer, this book will be useful as a resource for symptom control but probably won’t teach you much about palliative care.
Other Reviews
COMMUNICATION IN PALLIATIVE NURSING
Elaine Wittenberg-Lyles, Joy Goldsmith, Betty Ferrell and Sandra Ragan
Oxford University Press, 2013
286 pp
ISBN 978-0-19-979682-3
RRP $US39.95 £27.50
This book is written for nurses but the messages are relevant to all the healthcare professionals who work in palliative care. Written by an expert in palliative care nursing (BF) and experts in communication (the others), it underlines the importance of communication and that it can be learned.
It outlines a holistic communication model—COMFORT—an acronym for seven principles designed to be taught and implemented in palliative care communication. C for communicate, O for orientation and opportunity, M for mindful presence, F for family, O for openings, R for relating, and T for team. The text has numerous Practice Examples and descriptions of Communication Behaviors. The chapters finish with a Summary, a list of Discussion Questions, as well as practical Exercises.
I liked this book because it took time to explain what is good about one way of communicating and what is bad about another, both for verbal and non-verbal communication. It left me asking me why we are not exposing our medical students, interns and residents to this type of training in good communication, particularly for patients with advanced disease and their families?
I did not like the cover. Depressed faces that would discourage anyone from picking it up or opening the book. But as my mother told me, you mustn’t judge a book by its cover… and this is a good book.
PAIN COMORBIDITIES
Understanding and Treating the Complex Patient
Maria Adele Giamberardino and Troels Staehelin Jensen (Eds)
IASP (International Association for the Study of Pain) Press, 2012
507 pp
ISBN 978-0-931092-92-3
RRP $US85.00
This book sets out to offer an in-depth analysis of complex clinical situations involving multiple concurrent diseases. As with most other clinical entities, pain rarely presents on its own, but is clouded by multiple other diagnoses. The first section of the book describes the epidemiological relation between pain and non-pain comorbidities and the possible genetic, hormonal, immunological and psychological links. The second section explores the interaction between pain and conditions such as hypertension, obesity, diabetes, and a range of other visceral disorders. The last section discusses implications for treatment and management. The importance of a multidisciplinary approach is emphasized, and includes pharmacological, physical and psychological therapies. This book will be of use and interest to those specializing in the management of chronic pain.
Christina Staudt and Marcelline Block (Eds)
Cambridge Scholars Publishing, 2012
248 pp
ISBN 978-1-4438-3792-7
RRP $US59.99, £39.99
The contributions to this book are edited versions of papers presented at a conference, Unequal Before Death, at Columbia University in 2010. When I picked it up, I thought the chapter headings were uninviting and I thought it was going to be a dry, scholarly treatise. But I was pleasantly surprised. The opening chapters provide a predictable overview of the factors involved in inequalities in mortality, followed by a comparison of the mortality patterns over time in New York City, the United States, and globally. Then there is a chapter on hospice care for racial, ethnic and sexual minorities and the changes needed in hospice care to better accommodate them. There is a chapter on the importance of advanced care planning and documentation, discussed in the context of real patients in the ICU. The chapter on palliative care services asks whether hospitals under pressure are providing only fragments of palliative medicine and not a full (interdisciplinary) program, and discusses the many and serious implications. In addition, there are a number of chapters covering a range of topics including death cults, the social and religious background to martyrdom in Palestine, a documentation of the inequities dealt to women in the course of the HIV epidemic, and the institutionalization of the death of soldiers, all of which I found interesting. Not being a regular follower of the celebrity columns, I was most interested in the chapter on dying/dead celebrities and learned that Michael Jackson’s moonwalk was thought to have come from Marcel Marceau’s Bip the Clown. The contributions to this book ask some very important practical questions about where we are with the delivery of palliative care and also provide some interesting reading.
Palliative Care Classics
Simone de Beauvoir
Pantheon Books
106 pp
ISBN 978-0-394-72899-5
RRP $US11.95; £7.47
Roger Woodruff, MD (Australia)
March 2013
Dr. Woodruff is a Lifetime Member of the IAHPC Board and Past Chair. His bio may be found here.
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Dr Roger Woodruff
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AUSTRALIA
Note: Review copies become property of IAHPC and are not returned to the author. Only palliative care related books which are previously approved will be reviewed. Due to the large number of requests, we can't provide exact dates of when books will be reviewed.