A Physician's Guide to Pain and Symptom Management in Cancer Patients

Cancer imposes severe physical, psychological, social, and spiritual burdens on patients and their families. In A Physician's Guide to Pain and Symptom Management in Cancer Patients, Dr. Janet Abrahm argues that this suffering should be prevented or treated at all stages: at diagnosis, during curative therapy, in the event that cancer recurs, during the final months. To help primary care physicians, advanced practicenurses, internists and oncologists alleviate distress, she provides a detailed guide both for the difficult discussions and for the treatment of the symptoms that are likely to occur.

In Part I, Dr. Abrahm reviews a variety of important issues facing cancer patients and their families, focusing particularly on the "unasked questions" they are afraid to raise but that weigh heavily on their minds. She reviews, for example, how to break bad news; how to discuss advance directives and living wills; how to answer requests for assisted suicide; how to overcome misconceptions and persuade patients to take the opioids they really need; and how to help patients and families cope when cure is no longer possible.

Part II is a comprehensive guide to controlling pain, managing other symptoms, providing comfort during the patient's last days, and helping the bereaved survivors. This thorough and compassionate manual is symptom-oriented and patient-focused, featuring the input of all members of the health care and hospice teams, as well as useful case histories, extensive tables of medications, illustrations of pain assessment scales, "practice points" for easy reference, and bibliographies for physicians and for patients and their families.

Janet L. Abrahm, M.D., is an associate professor of medicine in the Hematology/Oncology Division of the University of Pennsylvania School of Medicine and is medical director of Wissahickon Hospice. She is also a faculty scholar of the Project on Death in America.