Book Review

Principles and Practice of Supportive Oncology

N Engl J Med 1998; 339:1008-1009October 1, 1998

Article

Principles and Practice of Supportive Oncology
Edited by Ann Berger, Russell K. Portenoy, and David E. Weissman. 953 pp., illustrated. Philadelphia, Lippincott–Raven, 1998. $85. ISBN: 0-397-51559-6

Our understanding of supportive care has continued to expand the breadth and practice of oncology. Oncologists recognize the ways in which this understanding has changed their practice, whether they are managing distressing symptoms, complications due to new therapies and techniques, or sensitive issues at the end of life. For the first time, these major issues are addressed in a comprehensive textbook that can be a valuable resource in a rapidly evolving field.

The editors of Principles and Practice of Supportive Oncology address therapies that are curative and noncurative, that are physical and psychosocial, even spiritual, and that improve the quality of life of patients with cancer in all phases of their illness. Unlike traditional textbooks that are organized according to disease entities, this book has an innovative yet logical format. In the first section, for example, specific symptoms, such as taste disorders, diarrhea, and dysphagia, are presented in such a way as to show how the disease presents to the clinician. Additional sections of this thorough book cover special interventions, terminal care, and special topics, such as measurement of the quality of life, and there is a crucial chapter on care-giver stress and burnout.

The editors have done a masterly job of assembling an outstanding group of contributors, which includes nationally renowned medical and surgical oncologists in addition to specialists in the fields of pain management and supportive care. However, special recognition should be given to Dr. Portenoy, a pioneer in the field of supportive care, whose imprimatur is evident in the chapters on cancer pain, fatigue, and neurologic and psychiatric syndromes.

A particular strength of this book is that virtually all the cardinal symptoms and syndromes of cancer are covered in an informative and practical manner. The information is easily assessed and can be of invaluable benefit to the clinician. For example, in the chapter on anorexia and cachexia related to cancer, authorities from the Mayo Clinic recommend starting an 800-mg oral daily dose of megestrol acetate for appetite stimulation. The cost of the treatment and the way in which it is prescribed are provided.

Another strength is that a number of topics that have been neglected in standard oncology textbooks are discussed in this one by authorities in the field. Patients suffering from intractable dyspnea (suffocation) have a particularly distressing and not infrequent complication of cancer. Currently, opioids are the mainstay of therapy. The topic is addressed from a clinical-practice and research perspective by Bruera and Ripamonti, who have performed groundbreaking work in this area.

It is not surprising that the section on terminal care is outstanding. A chapter on patient–physician communication explains how to handle the most difficult subjects with patients, such as the diagnosis of a new cancer and issues concerning the end of life. The author, Dr. Creagan, offers a number of practical suggestions for these and other topics, including how to deal with the unavoidable but common situation of communicating a dire prognosis over the telephone. Although most of the book is devoted to clinical issues, the chapters on informed consent and quality of life also are of value to clinical researchers. The last section, dealing with selected topics, includes discussions of the late effects of long-term survival, geriatric issues, and psychological aspects of survival after cancer.

Principles and Practice of Supportive Oncology fills an important niche in cancer medicine and its application. I believe that it will be a valuable resource not only to oncologists, but also to primary care physicians and other health care givers interested in palliative medicine.

Marc L. Citron, M.D.
ProHEALTH Care Associates, Lake Success, NY 11042