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Cancer Pain: Current Bench to Bedside Research
Vol. 41 No. 4 April 2011
Book Reviews
Not to diminish the value of this book, but as fair criticism, what I missed in this otherwise comprehensive treatment of the subject was some discussion about innovative models of care and the outcomes of educational efforts to improve cancer pain assessment and management in routine cancer care settings. For all that is known and written about, we are still challenged mightily by the seemingly low priority given to pain, despite (almost) universal agreement that it is important and such a significant burden to patients and their families. Although empirically sound information on what certain individual clinicians, clinical groups, and health care systems have done successfully is difficult to amass, it would have been useful to know what models of practice have been cost-effective, in summary form, to improve on the status quo. That said, order the book: operators are standing by! doi:10.1016/j.jpainsymman.2011.02.002
Cancer Pain: Current Bench to Bedside Research Stephen J. Bekanich, MD
Cancer Pain: From Molecules to Suffering Edited by Judith A. Paice, Rae F. Bell, Eija A. Kalso, and Olaitan A. Soyannwo Published by the International Association for the Study of Pain Press, Seattle, WA, USA 2010, 354 pages, $75.00 (IASP Members $60.00) (Softcover) This is a nontraditional text in that each chapter is based on a presentation from
Stephen J. Bekanich, MD, is Associate Professor of Medicine and Medical Director, Palliative Care Services, University of Miami Miller School of Medicine, Miami, Florida, USA.
809
a research symposium sponsored by the International Association for the Study of Pain. When I finished reading it, I felt as though I had just attended a spectacular conference where I was not forced to pick and choose among concurrent sessions but had the luxury of listening to all the experts in their respective fields. The breadth of subject matter here is wide and varied, giving the reader a profound appreciation for the multidisciplinary approach demanded by the nature of this complex set of clinical problems. There is cogency between the efforts of bench research and bedside applicability. With more than 40 contributing authors representing more than 10 countries, each aspect of cancer pain is addressed. The book is divided into six parts revolving around the domains of cancer pain: basic mechanisms, inflammation and hyperalgesia, opioid tolerance, clinical trial design, psychological aspects, and education and resources. Although there are some chapters that provide a general overview of the topic, most of them are structured to present the current state of the literature and provide suggestions on where future directions need to be aimed. The chapters are bursting with references, acting as a natural launch point for new projects. This is truly the ‘‘UpToDate’’ of cancer pain, the ultimate resource during the next few years for each topic, with only a few caveats mentioned at the conclusion of this review. Particular highlights of the book include the final two sections. The chapters tasked to expound on the psychology of cancer pain poignantly bring to life the mood disorders commonly found alongside cancer pain but too often neglected. The discussion on attention management was something this reviewer found fascinating, introducing me to concepts that necessitate integration into my role as a clinician-educator. The closing chapters on education and resources assist the reader in gaining a better worldwide perspective while providing tools for effective educational initiatives, from local to national in scope. The drawbacks of this text are limited but worth pointing out. Some of the sections leave out important clinical concerns. For instance, the mechanisms of cancer pain discuss only chemotherapy-induced neuropathy, radiotherapy-induced pain relief, and bone
810
Book Reviews
pain. Furthermore, throughout the book, the full spectrum of therapeutic interventions is not elaborated. Therefore, should readers be interested in implementing therapies that are discussed, then they need to look elsewhere. Finally, as expected at any symposium, there exists a fair amount of introductory overlap material throughout the sections. Overall this book is highly recommended as a resource for those who are newcomers to the field of cancer pain and those seasoned with experience. The editors would be doing us a favor to produce future additions in this fashion as the evidence base evolves. doi:10.1016/j.jpainsymman.2011.02.001
Practical Palliative Care Beth Popp, MD, FACP
Palliative Care: A Case-Based Guide Edited by Jane E. Loitman, Christian T. Sinclair, and Michael J. Fisch Published by Humana Press, Inc., New York, NY, USA 2010, 83 pages, $59.95 (Softcover) This little book consists of 10 chapters, each six to 10 pages long. It is a physically small paperback that could easily fit into the lab coat pocket of a house officer or medical student. Each chapter is written by a different author or pair of authors, with a total of 14 contributors. Most authors are affiliated with hospitals and hospice programs across the United States, and at least one practices in Canada. The style and presentation are remarkably consistent throughout the book. Although the
Beth Popp, MD, FACP, is Director of Palliative Medicine and Associate Program Director, Hematology/ Oncology, Maimonides Medical Center, Brooklyn, New York.
Vol. 41 No. 4 April 2011
book is part of ‘‘Current Clinical Oncology,’’ edited by Maurie Markman, MD, the cases are not all from oncology. In the Introduction section, the editors list three aims for their book. First, they aim to provide practical points for applying the principals of palliative care. Second, they aim to provide perspective on aspects of palliative care that are still in transition or have variations in practice style. Third, they aim to provide a framework for the less ‘‘recipe-driven’’ areas of care, such as communication. The book meets each of these aims. The format for each chapter is eminently readable, the content and references are up to date, and the information is helpful for the busy clinician. Each chapter begins with an abstract, a list of key words, and presentation of the case, followed by questions for consideration. Key points are presented in bullet form. The overall content is excellent, and the ability to cover complex topics so concisely is a credit to the authors and editors. Overall, the book can serve as a useful introduction for medical students, residents, or nonpalliative care physicians looking to become more familiar with palliative medicine or can be used by palliative care specialists in their teaching activities. There are a few concerns, however. For some cases, the clinical descriptions do not ring entirely true. For example, the wound care case describes a woman with breast cancer metastatic to liver, bone and lung, who is treated with chemotherapy, radiation and surgery, and develops radiation necrosis. Chemotherapy followed by radiation and surgery is usually a course of action for locally advanced disease, not disease metastatic to multiple viscera. And what is the source of this radiation necrosis that causes the wound and which is discussed in the next section? Description of a patient with breast cancer metastatic to the viscera as having a goal of ‘‘disease treatment aimed at cure’’ is odd because this is clearly not a curable disease. Use of tamoxifen in the setting of metastatic disease is referred to as maintenance, whereas most oncologists use ‘‘maintenance’’ to mean treatment in the setting of complete remission to prevent recurrence. Part of the Communication section is mixed. The discussion about simultaneous goals of care
Book Reviews
Not to diminish the value of this book, but as fair criticism, what I missed in this otherwise comprehensive treatment of the subject was some discussion about innovative models of care and the outcomes of educational efforts to improve cancer pain assessment and management in routine cancer care settings. For all that is known and written about, we are still challenged mightily by the seemingly low priority given to pain, despite (almost) universal agreement that it is important and such a significant burden to patients and their families. Although empirically sound information on what certain individual clinicians, clinical groups, and health care systems have done successfully is difficult to amass, it would have been useful to know what models of practice have been cost-effective, in summary form, to improve on the status quo. That said, order the book: operators are standing by! doi:10.1016/j.jpainsymman.2011.02.002
Cancer Pain: Current Bench to Bedside Research Stephen J. Bekanich, MD
Cancer Pain: From Molecules to Suffering Edited by Judith A. Paice, Rae F. Bell, Eija A. Kalso, and Olaitan A. Soyannwo Published by the International Association for the Study of Pain Press, Seattle, WA, USA 2010, 354 pages, $75.00 (IASP Members $60.00) (Softcover) This is a nontraditional text in that each chapter is based on a presentation from
Stephen J. Bekanich, MD, is Associate Professor of Medicine and Medical Director, Palliative Care Services, University of Miami Miller School of Medicine, Miami, Florida, USA.
809
a research symposium sponsored by the International Association for the Study of Pain. When I finished reading it, I felt as though I had just attended a spectacular conference where I was not forced to pick and choose among concurrent sessions but had the luxury of listening to all the experts in their respective fields. The breadth of subject matter here is wide and varied, giving the reader a profound appreciation for the multidisciplinary approach demanded by the nature of this complex set of clinical problems. There is cogency between the efforts of bench research and bedside applicability. With more than 40 contributing authors representing more than 10 countries, each aspect of cancer pain is addressed. The book is divided into six parts revolving around the domains of cancer pain: basic mechanisms, inflammation and hyperalgesia, opioid tolerance, clinical trial design, psychological aspects, and education and resources. Although there are some chapters that provide a general overview of the topic, most of them are structured to present the current state of the literature and provide suggestions on where future directions need to be aimed. The chapters are bursting with references, acting as a natural launch point for new projects. This is truly the ‘‘UpToDate’’ of cancer pain, the ultimate resource during the next few years for each topic, with only a few caveats mentioned at the conclusion of this review. Particular highlights of the book include the final two sections. The chapters tasked to expound on the psychology of cancer pain poignantly bring to life the mood disorders commonly found alongside cancer pain but too often neglected. The discussion on attention management was something this reviewer found fascinating, introducing me to concepts that necessitate integration into my role as a clinician-educator. The closing chapters on education and resources assist the reader in gaining a better worldwide perspective while providing tools for effective educational initiatives, from local to national in scope. The drawbacks of this text are limited but worth pointing out. Some of the sections leave out important clinical concerns. For instance, the mechanisms of cancer pain discuss only chemotherapy-induced neuropathy, radiotherapy-induced pain relief, and bone
810
Book Reviews
pain. Furthermore, throughout the book, the full spectrum of therapeutic interventions is not elaborated. Therefore, should readers be interested in implementing therapies that are discussed, then they need to look elsewhere. Finally, as expected at any symposium, there exists a fair amount of introductory overlap material throughout the sections. Overall this book is highly recommended as a resource for those who are newcomers to the field of cancer pain and those seasoned with experience. The editors would be doing us a favor to produce future additions in this fashion as the evidence base evolves. doi:10.1016/j.jpainsymman.2011.02.001
Practical Palliative Care Beth Popp, MD, FACP
Palliative Care: A Case-Based Guide Edited by Jane E. Loitman, Christian T. Sinclair, and Michael J. Fisch Published by Humana Press, Inc., New York, NY, USA 2010, 83 pages, $59.95 (Softcover) This little book consists of 10 chapters, each six to 10 pages long. It is a physically small paperback that could easily fit into the lab coat pocket of a house officer or medical student. Each chapter is written by a different author or pair of authors, with a total of 14 contributors. Most authors are affiliated with hospitals and hospice programs across the United States, and at least one practices in Canada. The style and presentation are remarkably consistent throughout the book. Although the
Beth Popp, MD, FACP, is Director of Palliative Medicine and Associate Program Director, Hematology/ Oncology, Maimonides Medical Center, Brooklyn, New York.
Vol. 41 No. 4 April 2011
book is part of ‘‘Current Clinical Oncology,’’ edited by Maurie Markman, MD, the cases are not all from oncology. In the Introduction section, the editors list three aims for their book. First, they aim to provide practical points for applying the principals of palliative care. Second, they aim to provide perspective on aspects of palliative care that are still in transition or have variations in practice style. Third, they aim to provide a framework for the less ‘‘recipe-driven’’ areas of care, such as communication. The book meets each of these aims. The format for each chapter is eminently readable, the content and references are up to date, and the information is helpful for the busy clinician. Each chapter begins with an abstract, a list of key words, and presentation of the case, followed by questions for consideration. Key points are presented in bullet form. The overall content is excellent, and the ability to cover complex topics so concisely is a credit to the authors and editors. Overall, the book can serve as a useful introduction for medical students, residents, or nonpalliative care physicians looking to become more familiar with palliative medicine or can be used by palliative care specialists in their teaching activities. There are a few concerns, however. For some cases, the clinical descriptions do not ring entirely true. For example, the wound care case describes a woman with breast cancer metastatic to liver, bone and lung, who is treated with chemotherapy, radiation and surgery, and develops radiation necrosis. Chemotherapy followed by radiation and surgery is usually a course of action for locally advanced disease, not disease metastatic to multiple viscera. And what is the source of this radiation necrosis that causes the wound and which is discussed in the next section? Description of a patient with breast cancer metastatic to the viscera as having a goal of ‘‘disease treatment aimed at cure’’ is odd because this is clearly not a curable disease. Use of tamoxifen in the setting of metastatic disease is referred to as maintenance, whereas most oncologists use ‘‘maintenance’’ to mean treatment in the setting of complete remission to prevent recurrence. Part of the Communication section is mixed. The discussion about simultaneous goals of care