Abstract
By Janet L. Abrahm, Amanda Moment, Arden O'Donnell. Baltimore, MD: Johns Hopkins University Press, 2014, 630 pages, $39.95.
In the third edition of her book A Physician's Guide to Pain and Symptom Management in Cancer Patients, Dr. Janet Abrahm again provides wonderfully clear and evidence-based guidance on management of the physical and psychosocial challenges experienced by patients with cancer. In this text she expands her work on such timely topics as prognostic conversations, prescription drug abuse, and physician self-care. In new chapters, Dr. Abrahm collaborates with social work colleagues to discuss issues of sexuality and intimacy, as well as means of navigating the complexities that exist within the families of cancer patients.
Dr. Abrahm maintains her effective approach of using clinical vignettes throughout the text. Her patient stories engage the reader and provide an anchor to the material taught in the book. This new edition includes subtle but highly relevant additions to its in-depth coverage of physical symptom management. One notable expanded section provides more detailed information on the use of methadone. This information is useful both for clinicians who are experienced with using this complex drug, as well as those who might newly incorporate it into their practice.
Other additions address areas of current societal interest and concern. One such subject involves conversations related to advance care planning. Dr. Abrahm provides a more detailed roadmap for holding conversations related to planning and prognosis. She perceptively identifies concerns clinicians might have when discussing prognosis and cites evidence to respectfully alleviate these fears. Her presentation of the material adeptly encourages providers to have these conversations along the trajectory of a patient's illness. In a nod to the rising concern over deaths related to prescription drug abuse, risk of aberrant opioid use is covered. Dr. Abrahm strengthens her chapter on pain assessment with screening tools for addictive potential and additional references to empower clinicians in safe prescribing of opioids.
In collaboration with social work colleagues, Dr. Abrahm includes two new chapters in her book. A chapter entitled “Working with Patients' Families” provides many insightful recommendations. The chapter begins with suggestions for assessment of a patient's perception of “family” and mapping out of roles. A structured model is then used to help clinicians understand the function of different families. The authors acknowledge the challenges and frustrations of working with families that are disengaged, enmeshed, or demonstrate low versus high flexibility. These acknowledgments make the chapter relatable, and the authors' concrete recommendations for managing these family structures are highly applicable to everyday clinical work.
This chapter highlights other factors that affect families and their decision-making processes. Culture is discussed, with helpful practice points for obtaining cultural details in a sensitive and structured fashion. The authors describe characteristics that might determine whether a patient or family requires more support, such as the presence of mental health or substance use issues. Noting the challenges of working with patients with personality disorders, useful approaches to providing them with the best clinical care possible are provided. The chapter concludes with a discussion of the important issue of domestic violence including description of a case in which ethics and domestic violence consultants were helpful. Overall, this chapter provides practitioners with excellent tools with which to navigate different family circumstances and relevant recommendations for seeking help from additional experts.
Another new chapter, “Sexuality, Intimacy, and Cancer” provides refreshing discussion around topics that many clinicians struggle to discuss with patients. The authors review the evidence indicating that patients wish to discuss issues of sexuality, though these conversations are not happening. They encourage physician self-reflection in this area and provide practical examples of language for initiating conversations about sexuality. These practice recommendations are offered in a nonjudgmental manner; and the authors provide reassurance that clinicians do not need to know all of the answers, but rather should emphasize a commitment to assisting with issues of sexuality, including referrals to appropriate resources and providers. The effective presentation of this material is likely to inspire clinicians to learn skills for assisting patients with sexuality issues.
In addition to giving clinicians tools to discuss issues of sexuality, the authors discuss how gay, lesbian, and transgendered patients may experience changes to their sexuality around a cancer diagnosis and feel less satisfied with emotional support from health care professionals. To mitigate the isolation experienced by these populations, the authors propose referral to counselors or support groups. The aging contingent of cancer patients is discussed, suggesting interventions for assessing sexuality concerns among this population, such as depression and anxiety screening and providing reassurance. There is a nicely written section on partners of cancer patients, with a description of the struggles they face when their companion is seriously ill; and the emotional challenges faced by single people are also presented. Through their focus on these very relevant populations, the authors offer a much-needed voice to groups that might otherwise not receive attention around issues of sexuality.
Also of note is an expanded segment on self-care that includes information about compassion fatigue, a meaningful topic that extends to clinicians across all fields of medicine. Dr. Abrahm offers pragmatic means and resources for managing this fatigue that can, as she states, lead to burnout. She also offers relevant suggestions for efforts hospitals can make, such as grief rounds, to support clinicians who work with seriously ill patients.
Overall, this book is a practical and well-written reference for clinicians who work with cancer patients and their families. In this third edition Dr. Abrahm expands on her excellent coverage of symptom management and includes new chapters to address complex psychosocial topics that are high yield. It should serve as a useful guide to all clinicians seeking to augment their knowledge on management of the various physical and psychological symptoms experienced by the cancer population.