Janet L. Abrahm - Comprehensive Guide to Supportive and Palliative Care for Patients with Cancer

4th Edition

Janet L. Abrahm, MD

With Molly E. Collins, MD, and Bethany-Rose Daubman, MD

JOHNS HOPKINS UNIVERSITY PRESS

Baltimore

Drug dosage: The author and publisher have made reasonable efforts to determine that the selection and dosage of drugs discussed in this text conform to the practices of the general medical community. The medications described do not necessarily have specific approval by the US Food and Drug Administration for use in the diseases and dosages for which they are recommended. In view of ongoing research, changes in governmental regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert of each drug for any change in indications and dosage and for warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently used drug.

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All rights reserved. Published 2022

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Previous editions of this work were published as A Physicians Guide to Pain and Symptom Management in Cancer Patients, by Janet L. Abrahm, MD.

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Library of Congress Cataloging-in-Publication Data

Names: Abrahm, J. (Janet), author. | Collins, Molly, 1980 author. | Daubman, Bethany-Rose, 1985 author.

Title: Comprehensive guide to supportive and palliative care for patients with cancer / Janet L. Abrahm, MD ; with Molly E. Collins, MD, Bethany-Rose Daubman, MD.

Other titles: Physicians guide to pain and symptom management in cancer patients

Description: Fourth edition. | Baltimore : Johns Hopkins University Press, 2022. | A physicians guide to pain and symptom management in cancer patients / Janet L. Abrahm ; with Amanda Moment and Arden ODonnell. | Includes bibliographical references and index.

Identifiers: LCCN 2021036802 | ISBN 9781421443980 (hardcover) | ISBN 9781421443904 (ebook)

Subjects: LCSH: CancerPalliative treatment. | PainTreatment.

Classification: LCC RC271.P33 A27 2022 | DDC 616.99/406dc23

LC record available at https://lccn.loc.gov/2021036802

A catalog record for this book is available from the British Library.

The enhancements and full bibliography can be found at www.press.jhu.edu.

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For Stacie

Janet L. Abrahm, MD

Professor of Medicine, Harvard Medical School

Hermioni L. Amonoo, MD, MPP

Assistant Professor, Psychiatry, Harvard Medical School

Molly E. Collins, MD

Associate Professor, Fox Chase Cancer Center / Lewis Katz School of Medicine at Temple University

Bethany-Rose Daubman, MD

Assistant Professor of Medicine, Harvard Medical School

Amanda Moment, MSW, LICSW

Clinical Social Worker, Intensive Palliative Care Unit, Brigham and Womens Hospital

Arden ODonnell, MPH, MSW, LICSW, APHSW-C

Adjunct Assistant Professor, Smith College School for Social Work

Rev. Kathleen (Katie) Pakos Rimer, MDiv, EdD, BCC

Palliative Care Chaplain, Boston; and Former Director, Spiritual Care and Education, Beth Israel Deaconess Medical Center of Harvard Medical School

As I sit down to write my acknowledgments for the fourth edition, it is the winter of 2021, in the midst of the COVID-19 crisis. I am fortunate to live and work in Massachusetts, one of the safest states. I continue my palliative care inpatient work at Brigham and Womens Hospital, though I spent from March through June 2020 at home, doing virtual consults. But since July, Ive been back in person, and I am very grateful to be among the first to be vaccinated.

Palliative care could not be more relevant than it has been this year. I am grateful for the work all my colleagues throughout the country and throughout the world have been doing to ameliorate the suffering of those with COVID-19 and their families and loved ones, as well as the staff taking care of these patients. I cannot be prouder of our field than I am at this moment.

As it has changed many things about how we deliver care, COVID-19 has also changed how we conduct family meetings when families are barred from the bedside. Whether on Zoom, Microsoft Teams, Facetime, Doximity, or other platforms, my colleagues and I try to be sure that the voices of patients and their families are heard and that the clinicians messages are really understood. Because we couldnt be everywhere we were needed, my colleagues and I prepared numerous palliative care symptom management and communication guides, which we made into pocket cards and put online; we finalized system-wide palliative and comfort care order sets in our electronic health record (Epic) so that clinicians could provide basic comprehensive comfort-focused care when we were not able to consult on all the patients who needed us.

Some things have stayed constant, and for that Im also very grateful. Mary Cooley, PhD, OCN, CRNP, and I have been working together now for more than 25 years. I have acknowledged and thanked her in each edition of this book. For the first edition, Mary shared with me her office and her insights into grief, bereavement, and the needs of cancer patients and their families; and for a number of years, she has supported me in my clinical and educational efforts in palliative care, and we continue our close collaboration. Mary continues to be a nationally recognized, award-winning nurse-scientist, my great friend and research mentor, and leader of the innovative projects that we hope will bring the materials contained in this book into the day-to-day care of cancer patients throughout the country, especially where there are no trained palliative care clinicians to provide expert symptom management consultations. We translated our evidence-based treatment suggestions into computable algorithms and just received funding, as part of the governments Moonshot programs, to program them so that palliative care recommendations will be available in the electronic health record for clinicians as they sit with their patients. Oncologists who have no access to palliative care specialists will receive personalized treatment recommendations for patients with pain, nausea, vomiting, constipation, diarrhea, treatment-related skin problems, anxiety, depression, insomnia, and fatigue at each visit. Mary continues to inspire me and challenge me to be more creative and inventive, while remaining practical.

In the eight years since the third edition was completed, I am grateful that Ive been able to continue to grow in knowledge and understanding of our field. I owe this growth to the extraordinary generosity of my patients and their families, my colleagues in Boston and throughout the world, my trainees, and the staff with whom I work. I am particularly grateful to Jessica Goldhirsch, LCSW, MSW, MPH, for our work together over the past five years, creating courses with our inpatient and outpatient medical interpreter colleagues that consist of dialogues and role plays. These courses address the challenges the interpreters face when asked to interpret conversations in which bad news is delivered, goals of care and resuscitation options discussed, and in which cultural bumps abound. Jessica and I share these insights and the importance of partnering with interpreters in