The Complete Guide to Relieving Cancer Pain and Suffering

Oncology, ONCOLOGY Vol 21 No 3, Volume 21, Issue 3

The book is organized around the questions or concerns that commonly arise among patients and families.

Authors: Richard B. Patt, MD, and Susan S. Lang
Publisher: Oxford University Press, New York
464 pages
Price: $18.95 (paperback)

Reviewed by
Charles F. von Gunten MD, PhD
Provost, Center for Palliative Studies
San Diego Hospice & Palliative Care
Medical Director
Doris A. Howell Service
UCSD Moores Cancer Center
San Diego, California

In the practice of oncology, one of the challenges is when a patient asks, "Doctor, what should I read?" I've always found myself tongue-tied when faced with this question. There are so many possibilities. Patients and/or their family members who ask this question seem to fall into different categories: the ones who want the one page summary, the ones who want a pamphlet, and the ones who want to master the subject. This book is for the latter group. It is designed to authoritatively answer the myriad questions that the inquisitive patient or family member may have about cancer pain management specifically, and supportive and palliative care of cancer in general.

The book is organized around the questions or concerns that commonly arise among patients and families. Examples include, "What is pain?" "How is it detected?" "Why is cancer pain different?" "Why do NSAIDs cause gastrointestinal distress." These are highlighted in bold as section and paragraph headings, which make it easy to scan a chapter or section for the issue about which one is seeking information.

The book provides in-depth information about drugs, doses, and the rationale for their use. While this might strike some as too detailed or running the risk of promoting self-medication or self-prescribing, I think it follows in the general spirit of modern Western medicine, giving the patient and family as much information as possible. The underlying assumption is that the more the patient and family understand, the more likely they are to adhere to the prescribed treatment plan. In my own practice, particularly with patients and families who signal their interest in this level of information, it is very helpful. The role of this book is to expand and reinforce what one can say in the consultation room.

A particular strength of this second edition is the chapter on mind-body approaches to easing pain. In my experience, this is the area of information that many oncologists are weakest at conveying. The chapter describes the rationale for mind-body approaches, explaining, for example, how distress aggravates pain and illness, how counseling or supportive therapy can help, and how coping and relaxation skills can reduce pain. The chapter also gives specific illustrations and exercises that the patient can perform, including progressive muscle relaxation, visualization, imagery and distraction, and self-hypnosis. I could imagine introducing this area to a patient, asking him or her to read about it, and then discussing what appeals most in a subsequent office appointment.

This book is designed for people who are planners—people whose anxiety is reduced by obtaining information and doing something proactive. The book finishes with a chapter called "If Death Approaches." The Appendix has a form for advance directives and naming a proxy for health-care decisions. Since the data clearly show that oncologists wait for patients to bring up subjects like this, the book should equip patients and families with the necessary information (as well as the encouragement) to talk about these issues with their doctor.

The one drawback about the book is its size. As the title ("The Complete Guide") implies, it is certainly no handbook. Indeed, as a text that could be used for a community college course on the subject, it might be a bit overwhelming for some people. Nevertheless, for that patient who wants to know "everything" and has lots of questions, this will be a great resource. It makes a great addition to home study readings that the oncologist or oncology nurse can recommend for the right patient or family member.

—Charles F. von Gunten,MD, PhD