Cancer Pain: Assessment and Management
http://www.100md.com
《新英格兰医药杂志》
Three percent of the American population is living with cancer. Many of these patients have pain that is due to the disease or to the treatment they are receiving for it. Annually, more than 500,000 persons have terminal cancer, and 60 to 80 percent of them have severe pain. Because these patients receive care from physicians in many different fields, the responsibility to improve pain control should fall on all the physicians who are providing care. Studies conducted more than a decade ago found that both the physicians specializing in the treatment of cancer and the patients who have the disease acknowledged that pain due to cancer was undertreated. These data prompted the Agency for Health Care Policy and Research to publish a comprehensive review of the literature and, in 1994, guidelines for the management of pain due to cancer. Despite the intention of these guidelines, pain in patients with cancer is still poorly managed, even in comprehensive cancer centers, as was brought to light by a recent report from the Institute of Medicine (published in 2001). This book provides physicians with the information necessary to turn around the Institute of Medicine's bad report card on treating pain due to cancer.
Both of the editors have spent more than two decades studying the treatment of pain in cancer, and both are internationally recognized leaders in the field. The list of editors and contributing authors reads like a who's who in the field of cancer-pain management. In spite of the title, most of the information in this book is applicable to patients who have pain from many other causes, not just from cancer. This well-organized book begins with a section on the biology and prevalence of pain in cancer and proceeds to sections on assessment and obstacles to pain management and on pharmacologic principles of opioid, nonopioid, and adjuvant medications. Potential obstacles to pain management are discussed in chapters on the management of side effects of opioid therapy and on the care of geriatric and pediatric patients and patients who have substance-abuse disorders. The basis for the laws regulating opioid treatment is summarized by Dahl, who spearheaded the inclusion of standards for pain assessment and management in the process of the Joint Commission on Accreditation of Healthcare Organizations.
Even the psychosocial impact of pain on patients and their families is adequately covered in the book. A chapter is devoted to the role of the family caregiver in the management of pain, and additional information for caregivers that can be found on the Web is referenced, as well as other reading material. It would have been helpful to include information for physicians and other health care providers that outlined specific interventions for pain. The coexistence with cancer of depression and its contribution to patients' perception of "pain," along with methods of treatment, are thoroughly reviewed. The management of pain requires a multidisciplinary team. Therefore, the roles of professionals in various disciplines — psychology, psychiatry, rehabilitation medicine, anesthesia, and neurosurgery — are also covered.
The chapters focused on cancer address the roles of radiation, chemotherapy, and neurosurgical interventions for pain. A unique and practical chapter titled "Cancer Pain Syndromes" describes syndromes of acute and chronic pain that are caused directly or indirectly by disease or by the medical interventions used to treat it. Among the topics included are headache from lumbar puncture, 5-fluorouracil–induced angina, pain associated with growth factors, radiation enteritis, hormone flare reactions, hypertrophic osteoarthropathy, otalgia, and plexopathy. Recommendations for treatment are made for some but not all of these disease-related effects. Given the comprehensiveness of this book, it is surprising that the interventions are not adequately covered. It would have been helpful to add recommendations for treating all the complications described or to have included at least a reference to another chapter in the book for such recommendations.
The goal Bruera and Portenoy had in creating this book was that it would lead to "improved understanding in treating this devastating disease," and they say they hope that it will "contribute to improvement in care." This comprehensive yet practical book contains all the information needed to provide appropriate interventions to relieve pain in patients who have cancer, while also dispelling the myths and concerns that have contributed to the reluctance of physicians to provide such care. This book should be in the library of every physician who comes into contact with patients with pain. It is truly superb.
Joanne E. Mortimer, M.D.
Eastern Virginia Medical School
Norfolk, VA 23507
Edited by Eduardo D. Bruera and Russell K. Portenoy. 485 pp., illustrated. New York, Cambridge University Press, 2003. $160. ISBN 0-521-77332-6.
Three percent of the American population is living with cancer. Many of these patients have pain that is due to the disease or to the treatment they are receiving for it. Annually, more than 500,000 persons have terminal cancer, and 60 to 80 percent of them have severe pain. Because these patients receive care from physicians in many different fields, the responsibility to improve pain control should fall on all the physicians who are providing care. Studies conducted more than a decade ago found that both the physicians specializing in the treatment of cancer and the patients who have the disease acknowledged that pain due to cancer was undertreated. These data prompted the Agency for Health Care Policy and Research to publish a comprehensive review of the literature and, in 1994, guidelines for the management of pain due to cancer. Despite the intention of these guidelines, pain in patients with cancer is still poorly managed, even in comprehensive cancer centers, as was brought to light by a recent report from the Institute of Medicine (published in 2001). This book provides physicians with the information necessary to turn around the Institute of Medicine's bad report card on treating pain due to cancer.
Both of the editors have spent more than two decades studying the treatment of pain in cancer, and both are internationally recognized leaders in the field. The list of editors and contributing authors reads like a who's who in the field of cancer-pain management. In spite of the title, most of the information in this book is applicable to patients who have pain from many other causes, not just from cancer. This well-organized book begins with a section on the biology and prevalence of pain in cancer and proceeds to sections on assessment and obstacles to pain management and on pharmacologic principles of opioid, nonopioid, and adjuvant medications. Potential obstacles to pain management are discussed in chapters on the management of side effects of opioid therapy and on the care of geriatric and pediatric patients and patients who have substance-abuse disorders. The basis for the laws regulating opioid treatment is summarized by Dahl, who spearheaded the inclusion of standards for pain assessment and management in the process of the Joint Commission on Accreditation of Healthcare Organizations.
Even the psychosocial impact of pain on patients and their families is adequately covered in the book. A chapter is devoted to the role of the family caregiver in the management of pain, and additional information for caregivers that can be found on the Web is referenced, as well as other reading material. It would have been helpful to include information for physicians and other health care providers that outlined specific interventions for pain. The coexistence with cancer of depression and its contribution to patients' perception of "pain," along with methods of treatment, are thoroughly reviewed. The management of pain requires a multidisciplinary team. Therefore, the roles of professionals in various disciplines — psychology, psychiatry, rehabilitation medicine, anesthesia, and neurosurgery — are also covered.
The chapters focused on cancer address the roles of radiation, chemotherapy, and neurosurgical interventions for pain. A unique and practical chapter titled "Cancer Pain Syndromes" describes syndromes of acute and chronic pain that are caused directly or indirectly by disease or by the medical interventions used to treat it. Among the topics included are headache from lumbar puncture, 5-fluorouracil–induced angina, pain associated with growth factors, radiation enteritis, hormone flare reactions, hypertrophic osteoarthropathy, otalgia, and plexopathy. Recommendations for treatment are made for some but not all of these disease-related effects. Given the comprehensiveness of this book, it is surprising that the interventions are not adequately covered. It would have been helpful to add recommendations for treating all the complications described or to have included at least a reference to another chapter in the book for such recommendations.
The goal Bruera and Portenoy had in creating this book was that it would lead to "improved understanding in treating this devastating disease," and they say they hope that it will "contribute to improvement in care." This comprehensive yet practical book contains all the information needed to provide appropriate interventions to relieve pain in patients who have cancer, while also dispelling the myths and concerns that have contributed to the reluctance of physicians to provide such care. This book should be in the library of every physician who comes into contact with patients with pain. It is truly superb.
Joanne E. Mortimer, M.D.
Eastern Virginia Medical School
Norfolk, VA 23507
Malignant Liver Tumors: Current and Emerging Therapies
Second edition. Edited by Pierre A. Clavien, Yuman Fong, H. Kim Lyerly, Michael A. Morse, and Alan P. Venook. 482 pp., illustrated. Sudbury, Mass., Jones and Bartlett, 2004. $174.95. ISBN 0-7637-1857-2.
Hepatocellular carcinoma, although uncommon in the United States, is one of the few forms of cancer that is rising in incidence in the developed Western world. The second edition of this book consists of 36 chapters that are printed on nearly 500 pages of glossy paper. The editor-in-chief, Pierre-Alain Clavien of Switzerland, has four associate editors from the United States and 63 authors and coauthors from around the world. The book emphasizes the management of hepatocellular carcinoma in Western countries, as distinct from Africa and Asia (including Japan), where the disease is more common but seems to present differently. The book also deals with cholangiocarcinoma, metastatic liver cancer, and other rare liver tumors. It does appear to have something of a surgical bias — but this is probably not a bad thing, given that surgical resection and liver transplantation are still the treatments that offer the best outcome for patients who have most types of primary or secondary liver cancers.
Malignant Liver Tumors contains a moderate number of high-quality black-and-white figures. These include many reproductions of radiologic images, pathological specimens, and line drawings of surgical techniques, with the occasional flowchart, bar graph, and cartoon of pathophysiological processes. The text is very readable, with large subheadings on almost every page. Every chapter is fully referenced, and many also include an annotated list of selected readings.
The book has five major sections — "Epidemiology, Diagnosis, and Algorithms for Treatment," "Systemic and Regional Therapies," "Tumor Ablation," "Emerging Therapies," and "Special Tumors and Populations and Special Considerations." Most of the subjects can logically be assigned to one of these sections, but, interestingly, the chapters on resection and transplantation are in the section on tumor ablation, side by side with the latest information on thermal ablation, ethanol injection, and cryoablation. The section on emerging therapies offers an update on the status of the "dream list" of treatments, including vaccine-based, viral-based, and antibody treatment and the induction of apoptosis. The chapter on antiangiogenic agents is particularly useful, because this approach appears promising for hepatocellular carcinoma. This section also contains a comprehensive chapter on alternative and complementary treatments, which makes interesting reading, although little of the information presented is specific to the treatment of liver cancer. Some of the special considerations dealt with include liver tumors in children and pregnant women and variations in the pathogenesis and presentation of liver tumors in different parts of the world, including Asia, Africa, and South America — with a chapter given to each of these regions.
There is considerable overlap among a number of the chapters, which may represent a planned redundancy or incomplete editing. For example, radio-frequency ablation is given two dedicated chapters and is mentioned in several others. The chapter on therapy for liver tumors in patients with cirrhosis overlaps extensively with chapters on resection and transplantation, among others. Some aspects of liver cancer could have been dealt with in more detail, including staging and prognostication and the algorithms for deciding which treatment should be applied to which patient. If I were a physician who was consulting this book for advice on how to treat my patient, I would be impressed by how many treatment options my patient had, but I would have no idea how to pick the best one.
In summary, this book is a comprehensive reference on the diagnosis and management of primary and secondary malignant tumors of the liver, which will be valuable to hepatologists, oncologists, and others involved in diagnosing and treating liver cancer and an essential guide for surgical oncologists, liver surgeons, and transplantation surgeons.
Adrian M. Di Bisceglie, M.D.
Saint Louis University
St. Louis, MO 63110(Edited by Eduardo D. Brue)
Both of the editors have spent more than two decades studying the treatment of pain in cancer, and both are internationally recognized leaders in the field. The list of editors and contributing authors reads like a who's who in the field of cancer-pain management. In spite of the title, most of the information in this book is applicable to patients who have pain from many other causes, not just from cancer. This well-organized book begins with a section on the biology and prevalence of pain in cancer and proceeds to sections on assessment and obstacles to pain management and on pharmacologic principles of opioid, nonopioid, and adjuvant medications. Potential obstacles to pain management are discussed in chapters on the management of side effects of opioid therapy and on the care of geriatric and pediatric patients and patients who have substance-abuse disorders. The basis for the laws regulating opioid treatment is summarized by Dahl, who spearheaded the inclusion of standards for pain assessment and management in the process of the Joint Commission on Accreditation of Healthcare Organizations.
Even the psychosocial impact of pain on patients and their families is adequately covered in the book. A chapter is devoted to the role of the family caregiver in the management of pain, and additional information for caregivers that can be found on the Web is referenced, as well as other reading material. It would have been helpful to include information for physicians and other health care providers that outlined specific interventions for pain. The coexistence with cancer of depression and its contribution to patients' perception of "pain," along with methods of treatment, are thoroughly reviewed. The management of pain requires a multidisciplinary team. Therefore, the roles of professionals in various disciplines — psychology, psychiatry, rehabilitation medicine, anesthesia, and neurosurgery — are also covered.
The chapters focused on cancer address the roles of radiation, chemotherapy, and neurosurgical interventions for pain. A unique and practical chapter titled "Cancer Pain Syndromes" describes syndromes of acute and chronic pain that are caused directly or indirectly by disease or by the medical interventions used to treat it. Among the topics included are headache from lumbar puncture, 5-fluorouracil–induced angina, pain associated with growth factors, radiation enteritis, hormone flare reactions, hypertrophic osteoarthropathy, otalgia, and plexopathy. Recommendations for treatment are made for some but not all of these disease-related effects. Given the comprehensiveness of this book, it is surprising that the interventions are not adequately covered. It would have been helpful to add recommendations for treating all the complications described or to have included at least a reference to another chapter in the book for such recommendations.
The goal Bruera and Portenoy had in creating this book was that it would lead to "improved understanding in treating this devastating disease," and they say they hope that it will "contribute to improvement in care." This comprehensive yet practical book contains all the information needed to provide appropriate interventions to relieve pain in patients who have cancer, while also dispelling the myths and concerns that have contributed to the reluctance of physicians to provide such care. This book should be in the library of every physician who comes into contact with patients with pain. It is truly superb.
Joanne E. Mortimer, M.D.
Eastern Virginia Medical School
Norfolk, VA 23507
Edited by Eduardo D. Bruera and Russell K. Portenoy. 485 pp., illustrated. New York, Cambridge University Press, 2003. $160. ISBN 0-521-77332-6.
Three percent of the American population is living with cancer. Many of these patients have pain that is due to the disease or to the treatment they are receiving for it. Annually, more than 500,000 persons have terminal cancer, and 60 to 80 percent of them have severe pain. Because these patients receive care from physicians in many different fields, the responsibility to improve pain control should fall on all the physicians who are providing care. Studies conducted more than a decade ago found that both the physicians specializing in the treatment of cancer and the patients who have the disease acknowledged that pain due to cancer was undertreated. These data prompted the Agency for Health Care Policy and Research to publish a comprehensive review of the literature and, in 1994, guidelines for the management of pain due to cancer. Despite the intention of these guidelines, pain in patients with cancer is still poorly managed, even in comprehensive cancer centers, as was brought to light by a recent report from the Institute of Medicine (published in 2001). This book provides physicians with the information necessary to turn around the Institute of Medicine's bad report card on treating pain due to cancer.
Both of the editors have spent more than two decades studying the treatment of pain in cancer, and both are internationally recognized leaders in the field. The list of editors and contributing authors reads like a who's who in the field of cancer-pain management. In spite of the title, most of the information in this book is applicable to patients who have pain from many other causes, not just from cancer. This well-organized book begins with a section on the biology and prevalence of pain in cancer and proceeds to sections on assessment and obstacles to pain management and on pharmacologic principles of opioid, nonopioid, and adjuvant medications. Potential obstacles to pain management are discussed in chapters on the management of side effects of opioid therapy and on the care of geriatric and pediatric patients and patients who have substance-abuse disorders. The basis for the laws regulating opioid treatment is summarized by Dahl, who spearheaded the inclusion of standards for pain assessment and management in the process of the Joint Commission on Accreditation of Healthcare Organizations.
Even the psychosocial impact of pain on patients and their families is adequately covered in the book. A chapter is devoted to the role of the family caregiver in the management of pain, and additional information for caregivers that can be found on the Web is referenced, as well as other reading material. It would have been helpful to include information for physicians and other health care providers that outlined specific interventions for pain. The coexistence with cancer of depression and its contribution to patients' perception of "pain," along with methods of treatment, are thoroughly reviewed. The management of pain requires a multidisciplinary team. Therefore, the roles of professionals in various disciplines — psychology, psychiatry, rehabilitation medicine, anesthesia, and neurosurgery — are also covered.
The chapters focused on cancer address the roles of radiation, chemotherapy, and neurosurgical interventions for pain. A unique and practical chapter titled "Cancer Pain Syndromes" describes syndromes of acute and chronic pain that are caused directly or indirectly by disease or by the medical interventions used to treat it. Among the topics included are headache from lumbar puncture, 5-fluorouracil–induced angina, pain associated with growth factors, radiation enteritis, hormone flare reactions, hypertrophic osteoarthropathy, otalgia, and plexopathy. Recommendations for treatment are made for some but not all of these disease-related effects. Given the comprehensiveness of this book, it is surprising that the interventions are not adequately covered. It would have been helpful to add recommendations for treating all the complications described or to have included at least a reference to another chapter in the book for such recommendations.
The goal Bruera and Portenoy had in creating this book was that it would lead to "improved understanding in treating this devastating disease," and they say they hope that it will "contribute to improvement in care." This comprehensive yet practical book contains all the information needed to provide appropriate interventions to relieve pain in patients who have cancer, while also dispelling the myths and concerns that have contributed to the reluctance of physicians to provide such care. This book should be in the library of every physician who comes into contact with patients with pain. It is truly superb.
Joanne E. Mortimer, M.D.
Eastern Virginia Medical School
Norfolk, VA 23507
Malignant Liver Tumors: Current and Emerging Therapies
Second edition. Edited by Pierre A. Clavien, Yuman Fong, H. Kim Lyerly, Michael A. Morse, and Alan P. Venook. 482 pp., illustrated. Sudbury, Mass., Jones and Bartlett, 2004. $174.95. ISBN 0-7637-1857-2.
Hepatocellular carcinoma, although uncommon in the United States, is one of the few forms of cancer that is rising in incidence in the developed Western world. The second edition of this book consists of 36 chapters that are printed on nearly 500 pages of glossy paper. The editor-in-chief, Pierre-Alain Clavien of Switzerland, has four associate editors from the United States and 63 authors and coauthors from around the world. The book emphasizes the management of hepatocellular carcinoma in Western countries, as distinct from Africa and Asia (including Japan), where the disease is more common but seems to present differently. The book also deals with cholangiocarcinoma, metastatic liver cancer, and other rare liver tumors. It does appear to have something of a surgical bias — but this is probably not a bad thing, given that surgical resection and liver transplantation are still the treatments that offer the best outcome for patients who have most types of primary or secondary liver cancers.
Malignant Liver Tumors contains a moderate number of high-quality black-and-white figures. These include many reproductions of radiologic images, pathological specimens, and line drawings of surgical techniques, with the occasional flowchart, bar graph, and cartoon of pathophysiological processes. The text is very readable, with large subheadings on almost every page. Every chapter is fully referenced, and many also include an annotated list of selected readings.
The book has five major sections — "Epidemiology, Diagnosis, and Algorithms for Treatment," "Systemic and Regional Therapies," "Tumor Ablation," "Emerging Therapies," and "Special Tumors and Populations and Special Considerations." Most of the subjects can logically be assigned to one of these sections, but, interestingly, the chapters on resection and transplantation are in the section on tumor ablation, side by side with the latest information on thermal ablation, ethanol injection, and cryoablation. The section on emerging therapies offers an update on the status of the "dream list" of treatments, including vaccine-based, viral-based, and antibody treatment and the induction of apoptosis. The chapter on antiangiogenic agents is particularly useful, because this approach appears promising for hepatocellular carcinoma. This section also contains a comprehensive chapter on alternative and complementary treatments, which makes interesting reading, although little of the information presented is specific to the treatment of liver cancer. Some of the special considerations dealt with include liver tumors in children and pregnant women and variations in the pathogenesis and presentation of liver tumors in different parts of the world, including Asia, Africa, and South America — with a chapter given to each of these regions.
There is considerable overlap among a number of the chapters, which may represent a planned redundancy or incomplete editing. For example, radio-frequency ablation is given two dedicated chapters and is mentioned in several others. The chapter on therapy for liver tumors in patients with cirrhosis overlaps extensively with chapters on resection and transplantation, among others. Some aspects of liver cancer could have been dealt with in more detail, including staging and prognostication and the algorithms for deciding which treatment should be applied to which patient. If I were a physician who was consulting this book for advice on how to treat my patient, I would be impressed by how many treatment options my patient had, but I would have no idea how to pick the best one.
In summary, this book is a comprehensive reference on the diagnosis and management of primary and secondary malignant tumors of the liver, which will be valuable to hepatologists, oncologists, and others involved in diagnosing and treating liver cancer and an essential guide for surgical oncologists, liver surgeons, and transplantation surgeons.
Adrian M. Di Bisceglie, M.D.
Saint Louis University
St. Louis, MO 63110(Edited by Eduardo D. Brue)