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 this text, the author argues that this suffering should be prevented or treated at diagnosis, during curative therapy, in the event that cancer recurs, or during the final months. To help primary care physicians, internists and oncologists alleviate distress, she provides a guide for the difficult discussions and for the treatment of the symptoms that are likely to occur. In the first section, Janet Abrahm reviews a variety of issues facing cancer patients and their families, focusing particularly on the "unasked questions" they are afraid to raise but which 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. The second section is a comprehensive guide to controlling pain, managing other symptoms, providing comfort during the patient's last days, and helping the bereaved survivors. The manual is symptom-orientated and patient-focused, featuring the input of all members of the health-care and hospice teams, as well as case histories and tables of medications, illustrations of pain assessment scales, "practice points" for easy reference and bibliographies for physicians and for patients and their families.