Index:

In the foreword to this book, Simon Wessely observes why we as a profession  are wary of fatigue. It is non-specific, difficult to measure and difficult to treat, but it is also a major source of morbidity to our patients. When lay people and doctors were asked to rate symptoms in order of importance, the professionals placed fatigue at the bottom of the list, while the public ranked it at the top.

The book is divided into three sections. The first covers definitions, epidemiology, models, and clinical associations of fatigue. The second is about the experience of fatigue and includes chapters on fatigue in people caring for patients with cancer and in children with cancer and their families. The last section covers the assessment and management of fatigue and includes an in-depth discussion of all the physical, emotional, psychiatric and social associations of fatigue.

This book opens with the statement that cancer-related fatigue is the most frequent, distressing, persistent, important, under diagnosed, and under treated symptom in cancer medicine. How true.

The book is divided into four large chapters. The first covers definitions and factors that influence the recognition and treatment of fatigue. The second covers the relationship between cancer-related fatigue and other cancer-related symptoms. The next is a discussion of the possible causative, predisposing and perpetuating factors in cancer-related fatigue. The last covers the treatment and includes discussion of exercise, energy management, sleep therapy, cognitive behavioral therapy, nutritional, pharmacological, complementary and immunological therapies.

Patarca-Montero or Armes?

This year sees the publication of two books devoted to cancer-related fatigue. Similar size and similar cost. The full Tables of Contents are available in the IAHPC’s Bookshop. Patarca-Montero has the advantage of being a single author text, but I think the multi-authored and multidisciplinary approach in Armes brings a greater depth and breadth to the discussion of what is a very complex clinical problem. In Patarca, key points are usefully highlighted in little boxes in the text. In Armes, there is a thought-provoking list of future areas for research at the end of each chapter. Patarca provides a little more detail about available therapies, particularly the complementary and alternative treatments. The Oxford book is better presented with the use of tables, dot-point lists and diagrams of concepts; whole pages of references in parentheses, four and a half consecutive pages in one case, within the text in the Haworth book are an annoyance and a strong recommendation for an alternative referencing system.

Both are worthy, scientifically-founded books that will do a lot to reinvigorate clinicians who have tired of fatigue and help get this complex symptom out of the too-hard basket.

This is the latest addition to Oxford’s Palliative Care Consultations series. The first two chapters provide concise descriptions of the oncological management of primary and metastatic brain tumours; in contrast to some oncology texts, the discussion does not stop when the patient’s disease relapses. There is a useful chapter on the pitfalls of anticonvulsant therapy in patients with intracranial malignancy.

Three chapters in the middle of the book, which deal with the non-oncological management, are particularly good. The first deals with the neuropsychological complications of the disease and therapies, including behavioural changes. The next discusses all aspects of family care. The third describes the management of the communication and swallowing problems suffered by these patients.

I was troubled by the discussions of how and when corticosteroids should be withdrawn from patients who become unconscious and cannot swallow. In one chapter, the ethical issues are briefly discussed; in another it is stated that corticosteroids can be stopped without weaning the dose; and in a third, the acute withdrawal of steroids is described as ‘a therapeutic strategy’ with an expected outcome of rapid deterioration that is, of course, undertaken only with the full understanding of the family. Is this not another opportunity for advance care planning with the patient and family? Recent Papal edicts aside, I thought this clinical problem probably deserved its own small chapter.

This is a useful and an up to date synopsis of the interface between neuro-oncology and palliative care. It will be a useful addition to the library shelf of any palliative care service.

This is a narrative-driven, longitudinal study of a small group of patients dying with cancer. It is divided into four main sections – Departure (Diagnosis), Exploration (Tests and Treatment), Anticipation (Remission and Recurrence), and Destination (the Deaths). There is a dearth of valid, truthful, experiential accounts of dying and the author’s extensive use of quotations allows us a glimpse of some of the most personal and sensitive issues while the respondents describe the effects of the disease and treatment on their own practical, emotional and social worlds. We see what it means, from the patients’ perspective, to live as fully as possible for what remained of their lives; physically restricted but psychologically invigorated.

The author correctly notes that the observations in this book are not generalizable, but there are important messages for those who work in medical oncology and palliative care. We don’t treat a case of breast cancer, we treat a person with breast cancer; and every person is a unique individual with differing practical, emotional and social needs, which we must recognize. Health care professionals need to understand how easily their actions and poor communication can compound a patient’s suffering. Hats off to the woman who had out-lived so many life expectancies given by her consultant that when she saw him next, she ordered ten more years!

The value of this book is in what the patients have to say. Anyone who works in palliative care will benefit from listening to them and it should be required reading for anyone training in medical or radiation oncology.

Roger Woodruff
Medical Oncologist and Director of Palliative Care, Austin Health, Melbourne, Australia
September 2004