Symptom Management in Advanced Cancer.
Symptom Management in Advanced Cancer Robert Twycross Oxford: Radcliffe Medical Press, 1997. 2nd edition, 378 pp, paperback
Although the second edition of this informative and practically helpful book is no larger than the first, it now contains useful information on the problems of dehydration and sweating as well as the use of transcutaneous electrical nerve stimulation in the treatment of lymphoedema. Additionally, areas such as delirium and constipation are dealt with in a fashion superior to that seen in many textbooks of geriatric medicine.
The book is easy to read and provides practical advice to all from pre-registration house physician to consultant level. A particularly poignant section highlights the reasons why a patient can be difficult to care for. Increasingly, many of us will be dealing with the palliative care of large numbers of older people and it is helpful to identify factors that may affect patient care and have a ready management plan available. Issues--such as the stopping of dexamethasone in patients with advanced intracranial malignancy--that are both practical and ethical, are dealt with in a sympathetic fashion with easy to follow advice.
There is an excellent explanation of the palliation of raised intracranial pressure through the administration of morphine or diamorphine, but for me the best chapter was `Drug profiles', which not only covers many of the indications for drugs such as cortico-steroids but also provides useful tables of the comparative anti-inflammatory potency as well as the side effects of many of these commonly used drugs. This is a chapter that many of us would find ourselves reaching for, not only in palliative care but in much of our day-to-day geriatric medicine practice.
Overall, one cannot fault this splendid work which, as well as providing an excellent overview of symptoms management, has many chapters pertinent to everyday geriatric medicine. This book should be made available to every health care professional dealing with older patients in the palliative stage of their illness as well as being freely available on all care of the elderly wards.
MARGOT GOSNEY Department of Geriatric Medicine, Royal Liverpool University Hospital