Quick Reference for Oncology Clinicians

November 1, 2006

As a midcareer academic medical oncologist, I have found that some books are especially useful as a pocket reference. Some books are small enough for a briefcase, but not ideal for a coat pocket. Others are best sequestered on a bookshelf. Where a book is placed often influences how one will (or won't) use it or read it.

As a midcareer academic medical oncologist, I have found that some books are especially useful as a pocket reference. Some books are small enough for a briefcase, but not ideal for a coat pocket. Others are best sequestered on a bookshelf. Where a book is placed often influences how one will (or won't) use it or read it.

So where does this book belong, and how can it be used by oncologists, nurses, and other clinicians in today's busy clinical oncology settings? Just like an initial encounter with an original article in a journal, it is useful to know the authors' perspective and reputation before investing precious time reading. This handbook was edited by Jimmie Holland, MD, Donna Greenberg, MD, and Mary Hughes, MS, RN. Drs. Holland and Greenberg are senior level-academic psychiatrists who are world-renowned as experts in psycho-oncology. Mary Hughes is known for her clinical excellence and teaching ability as a clinical nurse specialist, and she has been an active leader at a national level with projects related to this field. These academicians and clinicians are joined by 19 highly qualified contributors from key disciplines in psycho-oncology, including psychiatry, psychology, pharmacology, nursing, social work, and chaplaincy.

Instead of getting the expertise (and perhaps biases) of one or two individuals known for work in a specific area, the contributors have shared the responsibility for communicating the entire body of psycho-oncology knowledge as effectively as possible. The overall effect of this approach is that it seems as if a "psycho-oncology whisperer" is standing by the reader, giving a "chalk-talk" on delirium or substance abuse or sexual dysfunction (or other pertinent topics) in a timely fashion. Each of us has fond feelings about the clinicians who taught us in real time, one-on-one or in small groups—an approach that reflects a true desire to teach. This book conveys that feeling and reflects that commitment on the part of the contributors.

Another issue that comes up when one is trying to decide whether to purchase a handbook (or how to rationalize it if you already clicked the "confirm" button on an Internet purchase) is why you need the book in the first place. I have found that some books are excellent but too detailed for my level of knowledge or too tangential to what I really need to know. I have a special interest in psycho-oncology from the framework of general medical oncology, and this book fell into an appropriate range of utility for me: It is not so general that I feel like it masters the obvious, and it is not obscure to the point that it lacks relevance.

Some examples may be helpful to illustrate this opinion. The Purpose and Overview is succinctly written and makes a compelling case for understanding distress and the associated National Comprehensive Cancer Network (NCCN) guidelines for screening and management. The distress thermometer and symptom checklist that is widely used by psycho-oncologists in academic cancer centers is included. The chapter on screening instruments permits access to the items and scoring methods in the widely used clinical and research-specific instruments.

The chapter on psychiatric emergencies provides a sense of what a "psychiatric code" might involve, what specific techniques might be used for calming an agitated patient, and how to assess the level of risk involved when assessing a suicidal patient. I found the chapter on common psychiatric disorders to be particularly strong in helping me understand how to assess and deal with the issue of substance abuse. This chapter describes specific techniques for dealing with patients with personality disorders, how to break bad news, and key communication issues related to children.

I have been carefully stockpiling notes and key articles to help me understand some of these issues, and this handbook gives this information to me directly, referencing key articles for further reading. Also, if I want to know which antidepressants come as wafers or orally dissolvable tablets and what the starting doses and "heads-up" issues are surrounding those drugs, that information is also included.

As always, some points could be improved. In the section on psychological and nonpharmacologic interventions, the section on complementary treatments was limited to music/dance therapy, art therapy, and journaling. Although there were other sections about support groups and the role of exercise, I think that a more robust characterization of complementary therapy and references to some of the excellent cancer center Web resources in this realm would be useful. This topic area is actually covered reasonably well in the book overall, but the key points are scattered and could be better encapsulated. I noticed that Table 6.6, which lists the criteria for major depression, is missing the criteria related to psychomotor agitaton or retardation. Finally, one of the most useful Web resources for topics related to coping with cancer is the National Cancer Institute's Physicians Data Query (PDQ), which can be found at www.cancer.gov. This book lists the government site incorrectly as www.nci.org.

Overall, I highly recommend the $20 investment in this handbook. Buy it and put it in your briefcase. Take a look at it before rounds or talks that get started a few minutes late, or at the airport when you have some extra time. Once you are familiar with its content, you'll find that you want to recommend it to others, but you won't want to lend it out—you are better off keeping it tucked away where you can find it. A version of this book that could be used with a personal digital assistant (PDA) would be most welcome.

—Michael J. Fisch, MD, MPH, FACP