Oxford Textbook of Palliative Medicine

This sixth edition of the Oxford Textbook of Palliative Medicine takes us now into the third decade for this definitive award-winning textbook. It has been rigorously updated to offer a truly global perspective, highlighting the best current evidence-based practices, and collective wisdom from more than 200 experts around the world.

This leading textbook covers all the new and emerging topics, updated and restructured to reflect major developments in the increasingly widespread acceptance of palliative medicine as a fundamental public health need. The sixth edition includes new sections devoted to family and caregiver issues, cardio-respiratory symptoms and disorders, and genitourinary symptoms and disorders. In addition, the multi-disciplinary nature of palliative care is emphasized throughout the textbook, covering areas from ethical and communication issues, the treatment of symptoms, and the management of pain.

The Oxford Textbook of Palliative Medicine is a truly comprehensive text. No hospital, hospice, palliative care service, or medical library should be without this essential source of information.

This sixth edition of the Oxford Textbook of Palliative Medicine is dedicated to the memory of Professor Kenneth Fearon husband of Professor Marie Fallon and a surgeon who became a world leader in the research and management of anorexia and cachexia. He modeled a work-life balance that is so critical in our field, with devotion to both his patients and his family.

Nathan I. Cherny, Norman Levan Chair of Humanistic Medicine, Chief Cancer Pain and Palliative Medicine Service, Department of Oncology, Shaare Zedek Medical Center, Jerusalem, Israel,Marie T. Fallon, St Columba's Hospice Chair of Palliative Medicine, University of Edinburgh, UK,Stein Kaasa, Oslo University Hospital, Department of Oncology; and University of Oslo, Institute of Clinical Medicine, Oslo, Norway,Russell K. Portenoy, Professor of Neurology and Family and Social Medicine, Albert Einstein College of Medicine; Executive Director, MJHS Institute for Innovation in Palliative Care; and Chief Medical Officer, MJHS Hospice and Palliative Care, New York, NY, USA,David C. Currow, University of Technology, Sydney Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Sydney, NSW, Australia

Nathan I. Cherny is Norman Levan Chair of Humanistic Medicine at Shaare Zedek Medical Center and Associate Professor of Medicine at Ben Gurion University, Israel. In 2015 he was awarded the ESMO (European Society of Medical Oncology) Award for his contributions to the development of oncology in Europe, and in 2016 was the recipient of the EAPC/EJPC (European Association of Palliative Care/ European Journal of Palliative Care) Palliative Care Policy Development Award. Nathan has diverse research interests including opioid responsiveness of neuropathic pain, opioid rotation, opioid side effects and their management, cancer pain syndromes, suffering, palliative sedation, communication issues in oncology and palliative care, bioethics, and public health. He teaches in the Hebrew University Medical School and runs courses in communication and palliative medicine. Nathan has edited five books and has published over 120 peer reviewed papers and has made numerous invited lectures worldwide.

Marie T. Fallon is the St Columba's Hospice Chair of Palliative Medicine at the University of Edinburgh, Honorary Consultant in Palliative Care at the Western General Hospital in Edinburgh and leads the Edinburgh Palliative and Supportive Care group (EpaS). Marie serves as Chief Investigator for EpaS on a large portfolio of clinical studies spanning investigator-led randomized controlled trials examining improved management of cancer-induced bone pain, neuropathic pain, and institutionalisation of pain assessment. Marie is also the lead in an international programme of RCTs in cannabinoids in cancer-related pain and has led the development of studies using fMRI in Edinburgh, UK.

Stein Kaasa is Professor of Palliative Medicine at the Institute of Cancer Research and Molecular Medicine at the Norwegian University of Science and Technology (NTNU), Norway. Stein specialises in medical oncology, radiotherapy, and palliative medicine. In 1993, he was appointed as the first professor in palliative medicine in Scandinavia and he was one of the founders of the palliative care unit in Trondheim and founder of the European Palliative Care Research Centre (PRC). He has been president of EAPC, the coordinator for a large EU-funded project, and is at present involved in several research collaborative and international partnerships on research and policy development. Stein has been an important advocate for evidence-based practice and has worked extensively to get palliative care research on the global agenda. Stein is also Director of the PRC and Chair of the European Association for Palliative Care Research Network and has published more than 450 articles and book chapters.

Russell K. Portenoy is Executive Director and Chief Medical Officer of the MJHS Institute for Innovation in Palliative Care, and is Professor of Neurology and Family and Social Medicine at the Albert Einstein College of Medicine, New York. Prior to joining MJHS, he was founding Chairman of the Department of Pain Medicine and Palliative Care and the Gerald J. Friedman Chair in Pain Medicine and Palliative Care at Mount Sinai Beth Israel Medical Center. Russell is Past President of the American Academy of Hospice and Palliative Medicine and Past President of the American Pain Society. He previously chaired the American Board of Hospice and Palliative Medicine. A recipient of the Lifetime Achievement Award and the National Leadership Award of the American Academy of Hospice and Palliative Medicine, he has also received the Wilbert Fordyce Award for Lifetime Excellence in Clinical Investigation and the Distinguished Service Award from the American Pain Society, and was given the Founder's Award by the

Russell K. Portenoy is Executive Director and Chief Medical Officer of the MJHS Institute for Innovation in Palliative Care and is Professor of Neurology and Family and Social Medicine at the Albert Einstein College of Medicine, New York. Prior to joining MJHS, he was founding Chairman of the Department of Pain Medicine and Palliative Care and the Gerald J. Friedman Chair in Pain Medicine and Palliative Care at Mount Sinai Beth Israel Medical Center. Russell is Past President of both the American Academy of Hospice and Palliative Medicine and the American Pain Society. He previously chaired the American Board of Hospice and Palliative Medicine. Russell is recipient of the Lifetime Achievement Award, the National Leadership Award of the American Academy of Hospice and Palliative Medicine, the Wilbert Fordyce Award for Lifetime Excellence in Clinical Investigation, the Distinguished Service Award from the American Pain Society, and the Founder's Award by the American Academy of Pain Medicine.

David C. Currow is Professor of Palliative Medicine at University of Technology Sydney, the Matthew Flinders Distinguished Professor of Palliative and Supportive Care, Flinders University and Associate Director (Research) at the Wolfson Palliative Care Research Centre, University of Hull, UK. Research includes clinical trials and use of large datasets to understand better the impact of life-limiting illnesses on patients and caregivers. Research into chronic breathlessness is a particular area of interest. He is the principal investigator for the Australian national Palliative Care Clinical Studies Collaborative (PaCCSC) and is a foundation partner in the Australian national Palliative Care Outcomes Collaborative (PCOC), an initiative to improve palliative care clinical outcomes through point-of-care data collection.

Section 1: The worldwide status of palliative care
1.1. International progress in the development of palliative medicine, Carlos Centeno, Sheila Payne, and Eduardo Garralda
1.2. Essential medicines for palliative care, Lukas Radbruch and Liliana De Lima
1.3. Human rights issues, Frank Brennan and Liz Gwyther
1.4. Policy in palliative care, Stephen R. Connor
Section 2: The challenge of palliative medicine
2.1. Building definitional consensus in palliative care, Russell K. Portenoy
2.2. Core concepts in palliative care, Nathan I. Cherny and Russell K. Portenoy
2.3. The epidemiology of death and symptoms: Planning for population-based palliative care, Davinia Seah, David Marco, Jennifer Philip, and Megan B. Sands
2.4. Barriers to the delivery of palliative care, Barry Laird, Erna Haraldsdottir, and Charlie Hall
2.5. Ethnic and cultural aspects of palliative and end of life care, Jonathan Koffman and Natalia Calanzani
2.6. Health economics for palliative care, Peter S. Hall, Katharina Diernberger, and Liz Grant
Section 3: Service delivery issues in palliative care
3.1. Specialist palliative care along the trajectory of illness: Issues in the early integration of palliative care, Breffni Hannon, Stein Kaasa, and Camilla Zimmermann
3.2. Palliative care delivery models, Irene J. Higginson
3.3. Palliative medicine in the intensive care unit, Sharon Einav, Nathan I. Cherny, and J. Randall Curtis
3.4. Palliative care in the emergency department, Naomi George and Corita Grudzen
3.5. Palliative care in the nursing home, Jane Phillips and Annmarie Hosie
Section 4: Healthcare professionals in palliative care
4.1. The core team and the extended team, Dagny Faksv?g Haugen, Friedemann Nauck, and Deborah Witt Sherman
4.2. Burnout, compassion fatigue, and moral distress in palliative care, Nathan I. Cherny, Batsheva Werman, and Michael Kearney
4.3. Nursing Education in palliative care, Betty R. Ferrell, Polly Mazanec, Pam Malloy, and Rose Virani
4.4. Social work in palliative care, Terry Altilio, Bridget Sumser, and Nina Laing
4.5. The role of the chaplain in palliative care, George Handzo and Christina Puchalski
4.6. Occupational therapy in palliative care, Maria Denise Pessoa Silva, Fiona Rolls, Lynne White, Tamsin Longley, Jane Murphy, and Jill Cooper
4.7. The role of the creative arts in palliative care, Nigel Hartley
4.8. The role of the dietitian in palliative care, Samantha Cushen and Aoife Ryan
4.9. Physiotherapy in palliative care, Lucy Fettes and Matthew Maddocks
4.10. Speech and language therapy in palliative care, Tim Luckett and Katherine L.P. Reid
4.11. Clinical psychology in palliative care, E. Alessandra Strada
4.12. The contribution of the clinical pharmacist in palliative care, Ebtesam Ahmed
4.13. Medical rehabilitation and the palliative care patient, Andrew Malcom Cole
Section 5: Communication and palliative medicine
5.1. Communication with the patient and family, Thomas LeBlanc and James Tulsky
5.2. Practical considerations including difficult conversations, Susan D. Block
5.3. Advance care planning, Judith Rietjens, Ida Korfage, and Jane Seymour
Section 6: Family and caregiver issues
6.1. Family dynamics in the context of serious illness, Carrie Lethborg and David W. Kissane
6.2. Caregiver burden and distress, Rinat Nissim, Sarah Hales, and Gary Rodin
Section 7: Pain
7.1. Definition and assessment of chronic pain in advanced disease, Lucy N. Wyld, Clare Rayment, and Mike I. Bennett
7.2. Pathophysiology of pain in cancer and other terminal illnesses, Anthony H. Dickenson and Richard Gordon-Williams
7.3. Acute cancer pain syndromes, Nathan I. Cherny
7.4. Chronic cancer pain syndromes, Nathan I. Cherny
7.5. Principles of drug therapy, Ruth Miles, Steven Wanklyn, and Joy Ross
7.6. Opioid therapy: Optimizing analgesic outcomes, Nathan I. Cherny and Marie T. Fallon
7.7. Opioid therapy: Managing risks of abuse, addiction, and diversion, Joseph V. Pergolizzi, Jr., Jo Ann LeQuang, Flaminia Coluzzi, Dean Mariano, Andrew Nicolaou, and Christopher Gharibo
7.8. Non-opioid analgesics, Per Sj?gren, Frank Elsner, and Stein Kaasa
7.9. Adjuvant analgesics: principles of use, Ebtesam Ahmed, Russell K. Portenoy, and Mona Patel
7.10. 7.10 Interventional approaches for chronic pain, Robert A. Swarm, Menelaos Karanikolas, Lesley K. Rao, and Rajiv K. Shah
7.11. Neurostimulation in pain management, Helena Knotkova
7.12. Behavioral and psychosocial interventions for pain management, Joseph Winger, Carolyn E. Keeler, and Francis Keefe
7.13. Integrative medicine therapies in pain management, Noah Samuels and Eran Ben-Arye
7.14. Management issues in bone pain, Peter Hoskin
7.15. Management issues in neuropathic pain, Nanna Finnerup and Lise Ventzel
7.16. Management issues in visceral pain, Victor T. Chang
7.17. Management issues in chronic pain following cancer therapy, Judith A. Paice
7.18. Paediatric pain control, Renee McCulloch
Section 8: Gastrointestinal symptoms and disorders
8.1. Dysphagia, dyspepsia, and hiccups, Katherine Clark
8.2. Nausea and vomiting, Saskie Dorman
8.3. Constipation and diarrhoea, Philip J. Larkin
8.4. Jaundice, ascites, and encephalopathy, Alexandra Shingina and Anne M. Larson
8.5. Aetiology, classification, assessment, and treatment of the anorexia-cachexia syndrome, Vickie Baracos and Sharon Watanabe
8.6. Parenteral nutrition, Jann Arends and Florian Strasser
Section 9: Cardio-respiratory symptoms and disorders
9.1. Breathlessness and other respiratory symptoms in palliative care, Miriam Johnson and David C. Currow
9.2. Cough and other pulmonary symptoms, Doris Tse and Kin-Sang Chan
Section 10: Skin and oral symptoms and disorders
10.1. Skin problems in palliative care, Sebastian Probst and Georgina Gethin
10.2. Palliative wound and ostomy care, Charles P. Tilley, Mei R. Fu, Janet H. Van Cleave, Allison R. Most, and Christopher Comfort
10.3. Lymphoedema and oedema of advanced disease, Vaughan Keeley
10.4. Oral care, Andrew N. Davies
Section 11: Genitourinary symptoms and disorders
11.1. Dysuria, frequency, and bladder spasm, Christopher Evans, Jennifer G. Rothschild, Noah Canvasser, and Frederick Meyers
11.2. Obstructive urinary disorders, Noah E. Canvasser, Jennifer G. Rothschild, Frederick J. Meyers and Christopher P. Evans
Section 12: Constitutional symptoms and related disorders
12.1. Fatigue, Sriram Yennurajalingam and Eduardo Bruera
12.2. Sexuality in palliative care: Discussing patient sexuality and intimacy in palliative care, Lauren Kadwell, Jane Ussher, Emilee Gilbert, Janette Perz, and Amanda Hordern
12.3. Sleep disorders, Kyriaki Mystakidou, Efi Parpa, and Eleni Tsilika
12.4. Assessment and management of thrombotic complications, Simon Noble, Nicola Pease, and Nicholas Chinn-Yee
12.5. Assessment and management of bleeding complications in the medically ill, Bill Hulme, Sarah Wilcox, Paul Ashwood, Laura Deacon, Hazel Gilkes, and Victoria Montgomery
Section 13: Psychiatric and psychological symptoms and disorders
13.1. Coping and resilience in palliative medicine, Tzeela Cohen and Simon Wein
13.2. Depression, demoralization, and suicidality, David W. Kissane
13.3. Fear, anxiety, and adjustment disorder in palliative care, Kerry A. Sherman and Christopher J. Kilby
13.4. Delirium, Meera Agar, Yesne Alici, Augusto Caraceni, and William Breitbart
13.5. Bereavement, David W. Kissane
Section 14: Palliative care in cancer
14.1. The oncologist s role in delivering palliative care, Nathan I. Cherny and Stein Kaasa
14.2. Disease-modifying therapies in advanced cancer-medical treatment, Olav Dajani and Karin Jordan
14.3. Radiotherapy in symptom management, Peter Hoskin
14.4. The role of general surgery in the palliative care of patients with cancer, Robert Krouse and Brian Badgwell
14.5. Orthopaedic surgery in the palliation of cancer, Mohamed Yakoub and John Healey
14.6. Integrative oncology in palliative medicine, Eran Ben Arye and Noah Samuels
14.7. Interventional radiology in the palliation of cancer, Tarun Sabharwal, Nicos I. Fotiadis, and Andy Adam
14.8. Neurological problems in advanced cancer, Augusto Caraceni, Fabio Simonetti, and Cinzia Martini
14.9. Endocrine and metabolic complications of advanced cancer, Richella Ryan and Ruth Casey
14.10. Malignant Bowel obstruction, Jason W. Boland and Elaine G. Boland
14.11. Palliative care issues in head and neck cancers, Catriona Mayland and Simon N. Rogers
14.12. Palliative care issues in populations with haematological malignancies, Thomas William LeBlanc and Arjee El-Jawahri
14.13. Anaemia, cytopenias, and thrombosis in palliative medicine, Nancy Zhu and Cynthia Wu
Section 15: Issues in populations with non-cancer illnesses
15.1. HIV/AIDS, Meera Pahuja and Peter Selwyn
15.2. Advanced diseases of the lung, Natasha Smallwood and Nicole Goh
15.3. Advanced heart disease, Steve Pantilat, Patricia Davidson, and Mitch Psotka
15.4. Dementia, Eric Widera, Shaida Talebreza, and Rachelle Emily Bernacki
15.5. Neurological disorders other than dementia, Stefan Lorenzl and Raymond Voltz
15.6. Palliative care and end-stage liver disease, Arpan Patel and Anne Walling
15.7. End-stage kidney disease, Fliss E.M. Murtagh
15.8. Palliative care in catastrophic disasters and humanitarian crises, Anne Wilkinson and Marianne Matzo
Section 16: Issues of the very young and the very old
16.1. Involving children and families when someone important is dying or has died, Erna Haraldsdottir and Sally Paul
16.2. Care of children with advanced illness, Myra Bluebond-Langner, Richard W. Langner, and Ignasi Clemente
16.3. Palliative medicine and care of the elderly, Meera Agar and Jane Phillips
Section 17: Spiritual issues in palliative medicine
17.1. Spiritual issues in palliative medicine, Susan McClement, Genevieve Thompson, and Jamie Penner
17.2. Integration of spiritual care into palliative care service delivery models, Yvan Beaussant, Alexandra Nichipor, and Tracy A. Balboni
Section 18: The terminal phase
18.1. Predicting survival in patients with advanced disease, Christian T. Sinclair
18.2. Physiology of dying, David Hui and Masanori Mori
18.3. Management of the actively dying patient, Judith Lacey and Nathan I. Cherny
Section 19: Ethical issues
19.1. Practical bioethics in the care of patients with advanced illness, Robert C. Macauley
19.2. Requests for futile or inappropriate interventions near the end of life, Alexander A. Kon
19.3. 3 Autonomy and shared decision making in a multi-cultural world, Nathan I. Cherny
19.4. Truth-telling and consent, Linda Emanuel, Rebecca Johnson, and Lara Boyken
19.5. Ethics in paediatric palliative care, Richard D.W. Hain
19.6. Ethical issues in physician aid-in-dying, Lars Johan Materstvedt
19.7. Withholding and withdrawing life-sustaining treatment (including artificial nutrition and hydration), Danielle Ko, Hannah Evans-Barns, and Craig Blinderman
19.8. Medical and ethical considerations in palliative sedation at the end of life, Eric L. Krakauer
Section 20: Assessment tools and Informatics
20.1. Palliative care needs assessment tools, Afaf Girgis, Amy Waller, and Breanne Hobden
20.2. Informatics and literature search, Jennifer Tieman and David C. Currow
20.3. Validated assessment tools for psychological, spiritual, and family issues, Madeline Li, Tracy A. Balboni, Rinat Nissim, and Gary Rodin
Section 21: Teaching and training in palliative medicine
21.1. Physicians, Karen Forbes and Jane Gibbins
21.2. Nurses, Geana Paula Kurita and Philip J. Larkin
21.3. Teaching and training in palliative social work, chaplaincy, and pharmacy, Myra Glajchen, George Handzo, and Ebtesam Ahmed
Section 22: Research in palliative medicine
22.1. Research in palliative care, Marianne Hjermstad and Stein Kaasa
22.2. The principles of evidence-based medicine, Miriam Johnson and David C. Currow
22.3. Understanding clinical trials in palliative care research, P?l Klepstad and Stein Kaasa
22.4. Qualitative research, Kate Flemming
22.5. Research into psychosocial issues, David K. Kissane, Christopher H. Grossman, and Clare O'Callaghan
22.6. Ethical issues in palliative care research, Tyler Tate and David Casarett
22.7. Quality of life and patient-reported outcome measures, Jon H?vard Loge and Stein Kaasa
22.8. Health services research in palliative and end-of-life care, Tinne Smets and Luc Deliens
22.9. Clinical audit in palliative medicine, Irene J. Higginson and Mevhibe Hocaoglu