Oxford Textbook of Palliative Medicine

Geoffrey Hanks graduated from University College London with a BSc in anatomy and qualified in medicine in 1970. He has been working in palliative medicine since 1979, initially as a research fellow with Robert Twycross in Oxford. For almost 10 years he was consultant physician in charge of the palliative care units at the Royal Marsden Hospitals, London and Sutton, and honorary senior lecturer at the Institute of Cancer Research, University of London, and St Bartholomew's Hospital Department of Clinical Pharmacology. He was appointed to the first Chair of Palliative Medicine in the UK in the United Medical and Dental Schools of Guys and St Thomas' Hospitals, University of London, and was appointed Professor of Palliative Medicine in the University of Bristol in 1993. Positions held include Chairman of the Palliative Care Clinical Studies Development Group of the National Cancer Research Institute in the UK and Chairman of the National NHS Cancer Research & Development Commissioning Group Nathan Cherny is an Australian born, Israeli oncologist and palliative medicine physician. He holds the Norman Levan Chair of Humanistic Medicine at Shaare Zedek Medical Center in Jerusalem Israel. Prof Cherny graduated in medicine at Monash University Medical School in 1983 and then completed a Fellowship of the Royal Australian College of Physicians attaining specialist recognition in both Oncology and Palliative Medicine. He subsequently completed a fellowship in Cancer Pain and Palliative Medicine at Memorial Sloan Kettering Cancer Center. In 1994 Dr Cherny moved to Israel where he helped establish the Oncology and Palliative Medicine Unit at the Shaare Zedek Hospital in Jerusalem. He continues to head that Cancer Pain and Palliative Medicine Service, and, in addition, he continues to practice general oncology. Since 2008 he has been the chairman or the ESMO Palliative Care Working Group. Stein Kaasa is considered to be the leading figure in European palliative care. He is a specialist in medical oncology, radiotherapy, and palliative medicine. Since 1993, he has been the Director of the Palliative Medicine Unit at Trondheim University Hospital, Norway, and Professor of Palliative medicine at the Faculty of Medicine, Norwegian University of Science and Technology (NTNU). He is also chairman of the Unit for Applied Clinical Research and the Institute of Environmental Medicine at NTNU, and Chairman of the Program for Research on Alternative Medicine of the Norwegian Research Council. He was responsible for the development of the core curriculum at the medical school of the NTNU. He is the current President of the European Association for Palliative Care (EAPC) and serves on the editorial board of several journals including Progress in Palliative Care, Palliative Medicine, and the Journal of Pain and Symptom Management. Russell Portenoy is Chairman of the Department of Pain Medicine and Palliative Care, and the Gerald J. and Dorothy R. Friedman Chair in Pain Medicine and Palliative Care at Beth Israel Medical Center in New York. He is Chief Medical Officer of Beth Israel's Continuum Hospice Care/The Jacob Perlow Hospice, and Professor of Neurology and Anesthesiology at the Albert Einstein College of Medicine. Dr. Portenoy is president of the American Academy of Hospice and Palliative Medicine and a past president of the American Pain Society. He is the recipient of the Wilbert Fordyce Award for Lifetime Excellence in Clinical Investigation and the Distinguished Service Award from the American Pain Society, the Founder's Award from the American Academy of Pain Medicine, and the Bonica Award from the Eastern Pain Association. He serves on the Board of Directors of the American Pain Foundation and chairs various other forums and committees. Nicholas A. Christakis is an internist and social scientist who conducts research on social factors that affect health, health care, and longevity. He is a Professor of Medical Sociology in the Department of Health Care Policy at Harvard Medical School; Professor of Sociology in the Department of Sociology in the Harvard Faculty of Arts and Sciences; and an Attending Physician in the Department of Medicine at the Harvard-affiliated Mt. Auburn Hospital. Dr. Christakis received his BS from Yale University in 1984, his MD from Harvard Medical School and his MPH from the Harvard School of Public Health in 1989, and his PhD from the University of Pennsylvania in 1995. He was elected to the Institute of Medicine of the National Academy of Sciences in 2006. His current research focuses on health and social networks, and specifically how ill health, disability, health behavior, health care, and death in one person can influence the same phenomena in others in a person's social network. Marie Fallon completed her Palliative Medicine Higher Specialist Training at St Thomas' Hospital London and in Bristol and was appointed to the St Columba's Hospice Chair of Palliative Medicine at the University of Edinburgh in 2006. She is based in the Edinburgh Cancer Research Centre and the Western General Hospital, Edinburgh. Her research background is in opioid analgesia, complex cancer pain and barriers to symptom control. She is a founder member of the University of Edinburgh's Translational Research in Pain Group, which has a particular interest in cancer-induced bone pain. She is the Chief Investigator on a portfolio of Cancer Research UK funded multi-centre trials investigating various aspects of cancer pain. She leads a team of several Research Fellows working on various aspects of cancer-induced bone pain. She is a member of the Advisory Board for Dimbleby Cancer Care and chairs the Pain Sub Committee of the NCRI Palliative Care Clinical Studies Group.

SECTION 1: INTRODUCTION; 1.1 Introduction; SECTION 2: THE WORLDWIDE STATUS OF PALLIATIVE CARE; 2.1 International progress in creating palliative medicine as a specialized discipline; 2.2 Lessons learned from hospice in the United States of America; 2.3 Providing palliative care in resource-poor countries; 2.4 IAHPC list of the essential medicines for palliative care; SECTION 3: THE CHALLENGE OF PALLIATIVE MEDICINE; 3.1 The problem of suffering and the principles of assessment in palliative medicine; 3.2 The epidemiology of death and symptoms; 3.3 Predicting survival in patients with advanced disease; 3.4 Palliative medicine and modern cancer care; 3.5 Barriers to the delivery of palliative care; 3.6 Defining a good death; 3.7 Cultural aspects of palliative medicine; 3.8 The economic challenges of palliative medicine; SECTION 4: THE INTERDISCIPLINARY TEAM; 4.1 The core team and the extended team; 4.2 Nursing and palliative care; 4.3 Social work in palliative care; 4.4 The role of the chaplain in palliative care; 4.5 Occupational therapy in palliative care; 4.6 Music therapy in palliative care; 4.7 The dietician and nutritionist in palliative care; 4.8 Physiotherapy in palliative care; 4.9 Speech and language therapy in palliative care; 4.10 Art therapy in palliative care; 4.11 The contribution of stoma nurse specialist to palliative care; 4.12 Clinical psychology in palliative care; 4.13 The clinical pharmacist in palliative care; SECTION 5: ETHICAL ISSUES; 5.1 Introduction; 5.2 Confidentiality; 5.3 Truth-telling and consent; 5.4 Palliative medicine in children: ethical and legal issues; 5.5 Euthanasia and physician-assisted suicide; 5.6 Withholding and withdrawing life-sustaining therapy; SECTION 6: COMMUNICATION AND PALLIATIVE MEDICINE; 6.1 Communication with the patient and family in palliative medicine; 6.2 Talking with families and children about the death of a parent; 6.3 Communication with professionals; 6.4 Communication with the public, policy makers and the media; SECTION 7: RESEARCH IN PALLIATIVE MEDICINE; 7.1 Research in palliative care: getting started; 7.2 The principles of evidence-based medicine; 7.3 Clinical trials in palliative care; 7.4 Qualitative research; 7.5 Research into psychosocial issues; 7.6 Ethical issues in palliative care research; 7.7 Measurement of pain and other symptoms; 7.8 Quality of life measurement in palliative medicine - principles and practice; 7.9 Measurement of pain and other symptoms in the cognitively impaired; 7.10 Clinical and organisational audit and quality improvement in palliative medicine; SECTION 8: PRINCIPLES OF DRUG USE IN PALLIATIVE MEDICINE; 8.1 Principles of drug use in palliative medicine; SECTION 9: DISEASE MODIFYING MANAGEMENT IN ADVANCED CANCER; 9.1 The medical treatment of cancer in palliative care; 9.2 Radiotherapy in symptom management; 9.3 The role of general surgery in the palliative care of patients with cancer; 9.4 The role of orthopaedic surgery in the palliative care of patients with cancer; 9.5 The role of interventional radiology in the palliative care of patients with cancer; SECTION 10: THE MANAGEMENT OF COMMON SYMPTOMS AND DISORDERS; 10.1: THE MANAGEMENT OF PAIN; 10.1.1 Pathophysiology of pain in cancer and other terminal diseases; 10.1.2 Pain assessment and cancer pain syndromes; 10.1.3 Neuropathic pain; 10.1.4 Cancer induced bone pain; 10.1.5 Breakthrough pain; 10.1.6 Opioid analgesic therapy; 10.1.7 Non-opioid analgesics; 10.1.8 Adjuvant analgesics in pain management; 10.1.9 Injections, neural blockade, and implant therapies for pain control; 10.1.10 The role of surgical neuroablation for pain control; 10.1.11 Treating pain with transcutaneous electrical nerve stimulation; 10.1.12 Acupuncture; 10.1.13 Psychological and psychiatric interventions in pain control; 10.2 GASTRO-INTESTINAL SYMPTOMS; 10.2.1 Palliation of nausea and vomiting; 10.2.2 Dysphagia, dyspepsia and hiccup; 10.2.3 Constipation and diarrhoea; 10.2.4 Pathophysiology and management of malignant bowel obstruction; 10.2.5 Jaundice, ascites and hepatic encephalopathy; 10.3 WEIGHT LOSS IN PALLIATIVE MEDICINE; 10.3.1 Classification and pathophysiology of the anorexia/cachexia syndrome; 10.3.2 Classification, clinical assessment and treatment of the anorexia-cachexia syndrome; 10.4 FATIGUE AND ASTHENIA; 10.4 Fatigue and asthenia; 10.5 CLINICAL MANAGEMENT OF ANAEMIA, CYTOPENIAS AND THROMBOSIS IN PALLIATIVE MEDICINE; 10.5 Clinical management of anaemia, cytopenias and thrombosis in palliative medicine; 10.6 PRURITUS AND SWEATING IN PALLIATIVE MEDICINE; 10.6 Pruritus and sweating in palliative medicine; 10.7 SKIN PROBLEMS IN PALLIATIVE MEDICINE; 10.7.1 Medical aspects; 10.7.2 Nursing aspects; 10.7.3 Lymphoedema; 10.8 GENITO-URINARY PROBLEMS IN PALLIATIVE MEDICINE; 10.8 Genito-urinary problems in palliative medicine; 10.9 MOUTH CARE; 10.9 Mouth care; 10.10 ENDOCRINE AND METABOLIC COMPLICATIONS OF ADVANCED CANCER; 10.10 Endocrine and metabolic complications of advanced cancer; 10.11 NEUROLOGICAL PROBLEMS IN ADVANCED CANCER; 10.11 Neurological problems in advanced cancer; 10.12 SLEEP IN PALLIATIVE CARE; 10.12 Sleep in palliative care; 10.13 WITHDRAWING LIFE SUPPORT - CLINICAL ADVICE FOR CHALLENGING SCENARIOS; 10.13 Withdrawing life support - clinical advice for challenging scenarios; 10.14 CLINICAL MANAGEMENT OF BLEEDING COMPLICATIONS; 10.14 Clinical management of bleeding complications; SECTION 11: ISSUES IN SPECIFIC NEOPLASTIC DISEASE; 11.1 Palliative medicine in malignant respiratory diseases; 11.2 Head and neck cancer; 11.3 Brain tumours; SECTION 12: PALLIATIVE MEDICINE IN NON-MALIGNANT DISEASE; 12.1 Introduction; 12.2 AIDS in adults; 12.3 Palliative medicine and non-malignant, end-stage respiratory disease; 12.4 Palliative medicine for patients with end-stage heart disease; 12.5 Palliative medicine in non-malignant neurological disorders; 12.6 Palliative medicine in end-stage renal failure; 12.7 Palliative medicine in intensive care; SECTION 13: PAEDIATRIC PALLIATIVE MEDICINE; 13.1 Special consideration for children in palliative medicine; 13.2 Paediatric pain control; 13.3 Symptom control in life-threatening illness in children; 13.4 Psychological adaptation of the dying child; 13.5 Bereavement issues and staff support when caring for children; SECTION 14: GERIATRIC PALLIATIVE MEDICINE; 14.1 Palliative medicine in dementia; 14.2 Palliative medicine and care of the elderly; SECTION 15: PSYCHIATRIC, PSYCHOSOCIAL AND SPIRITUAL ISSUES IN PALLIATIVE MEDICINE; 15.1 Sprititual issues in palliative medicine; 15.2 The emotional problems of the patient in palliative medicine; 15.3 The family perspective; 15.4 The stress of professional caregivers; 15.5 Psychiatric symptoms in palliative medicine; 15.6 Bereavement; SECTION 16: REHABILITATION IN PALLIATIVE MEDICINE; 16.1 Rehabilitation in palliative medicine; SECTION 17: COMPLEMENTARY THERAPIES IN PALLIATIVE MEDICINE; 17.1 Complementary therapies in palliative medicine; SECTION 18: PALLIATIVE MEDICINE IN THE HOME; 18.1 Palliative medicine in the home: an overview; 18.2 Palliative medicine in the home: North America; SECTION 19: THE TERMINAL PHASE; 19.1 The terminal phase; 19.2 Sedation in palliative medicine; SECTION 20: EDUCATION AND TRAINING IN PALLIATIVE MEDICINE; 20.1 Introduction; 20.2 Postgraduate education in palliative medicine; 20.3 Training specialists in palliative medicine; 20.4 The role of the humanities in palliative medicine; 20.5 Informatics and palliative medicine