Oxford American Handbook of Hospice and Palliative Medicine and Supportive Care Published and Forthcoming Oxford American Handbooks Oxford American Handbook of Anesthesiology Oxford American Handbook of Cardiology Oxford American Handbook of Clinical Dentistry Oxford American Handbook of Clinical Exams and Practical Skills Oxford American Handbook of Clinical Diagnosis Oxford American Handbook of Clinical Medicine Oxford American Handbook of Clinical Pharmacy Oxford American Handbook of Critical Care Oxford American Handbook of Endocrinology and Diabetes Oxford American Handbook of Disaster Medicine Oxford American Handbook of Emergency Medicine Oxford American Handbook of Gastroenterology and Hepatology Oxford American Handbook of Geriatric Medicine Oxford American Handbook of Hospice and Palliative Medicine and Supportive Care Oxford American Handbook of Infectious Diseases Oxford American Handbook of Nephrology and Hypertension Oxford American Handbook of Neurology Oxford American Handbook of Obstetrics and Gynecology Oxford American Handbook of Oncology Oxford American Handbook of Ophthalmology Oxford American Handbook of Otolaryngology Oxford American Handbook of Pediatrics Oxford American Handbook of Physical Medicine and Rehabilitation Oxford American Handbook of Psychiatry Oxford American Handbook of Pulmonary Medicine Oxford American Handbook of Radiology Oxford American Handbook of Reproductive Medicine Oxford American Handbook of Rheumatology Oxford American Handbook of Sports Medicine Oxford American Handbook of Surgery Oxford American Handbook of Urology Oxford American Handbook of  Hospice and Palliative Medicine and Supportive Care Second Edition Edited by Sriram Yennurajalingam, MD Associate Professor of Palliative Care & Rehabilitation Medicine The University of Texas MD Anderson Cancer Center Houston, Texas Eduardo Bruera, MD Professor and Chair of Palliative Care & Rehabilitation Medicine The University of Texas MD Anderson Cancer Center Houston, Texas 1 1 Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide.Oxford is a registered trade mark of Oxford University Press in the UK and certain other countries. Published in the United States of America by Oxford University Press 98 Madison Avenue, New York, NY 006, United States of America. © Oxford University Press 206 First Edition published in 20 Second Edition published in 206 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license, or under terms agreed with the appropriate reproduction rights organization. Inquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above. You must not circulate this work in any other form and you must impose this same condition on any acquirer. Library of Congress Cataloging-i n- Publication Data Oxford American handbook of hospice and palliative medicine Oxford American handbook of hospice and palliative medicine and supportive care / edited by Sriram Yennurajalingam, Eduardo Bruera. — Second edition. p. ; cm. — (Oxford American handbooks) Handbook of hospice and palliative medicine and supportive care Preceded by Oxford American handbook of hospice and palliative medicine / edited by Eduardo Bruera, Sriram Yennurajalingam. 20. Includes bibliographical references and index. ISBN 978-0-9-937530- (alk. paper) I. Yennurajalingam, Sriram, editor. II. Bruera, Eduardo, editor. III. Title. IV. Title: Handbook of hospice and palliative medicine and supportive care. V. Series: Oxford American handbooks. [DNLM: . Palliative Care—Handbooks. 2. Hospice Care—Handbooks. 3. Hospices—Handbooks. WB 39] R726.8 362.7′56—dc23 205032794 9 8 7 6 5 4 3 2  Printed by Webcom, Canada This material is not intended to be, and should not be considered, a substitute for medical or other professional advice. Treatment for the conditions described in this material is highly dependent on the individual circumstances. And, while this material is designed to offer accurate information with respect to the subject matter covered and to be current as of the time it was written, research and knowledge about medical and health issues is constantly evolving and dose schedules for medications are being revised continually, with new side effects recognized and accounted for regularly. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulation. The publisher and the authors make no representations or warranties to readers, express or implied, as to the accuracy or completeness of this material. Without limiting the foregoing, the publisher and the authors make no representations or warranties as to the accuracy or efficacy of the drug dosages mentioned in the material. The authors and the publisher do not accept, and expressly disclaim, any responsibility for any liability, loss or risk that may be claimed or incurred as a consequence of the use and/or application of any of the contents of this material. v Preface In the United States, hospice and palliative medicine has emerged as a new subspecialty recently recognized by the American Board of Medical Specialties. During the last 0 years there has been a very significant increase in the number of inpatient and outpatient palliative care programs, as well as a major increase in the number of patients who access hospice for end- of- life care. Unfortunately, educational efforts are lagging behind, and the vast major- ity of medical students, residents, and even fellows receive minimal palliative medicine education in the United States. However, these junior physicians, along with a number of busy clinical specialists, are exposed to patients with progressive incurable illnesses and their families on a daily basis. The purpose of this handbook is to provide up- to- date, practical, and concise information to healthcare professionals delivering care to patients requiring hospice and palliative care in the United States. This includes phy- sicians, nurse practitioners, fellows, residents, and students. All the chapters are primarily aimed at the clinical and administrative arrangements within the American healthcare system, including the hospice Medicare benefit. We believe this book will provide rapid access to most of the daily bedside clinical and administrative needs, and it will hopefully help our col- leagues in the delivery of excellent palliative and hospice care. We would like to acknowledge the authors of each of the chapters for having committed their time and effort to our joint project. We would also like to acknowledge the commitment to excellence by Oxford University Press and in particular Andrea Knobloch, our Senior Editor, for the excellent work in coordinating our book. Finally, we would like to acknowledge the daily effort of healthcare professionals who have contributed by their daily clinical work, education, and research to the development of the extraor- dinary body of knowledge that we have had the privilege to synthesize in this book. Sriram Yennurajalingam, MD Eduardo Bruera, MD Houston, June 205 vii Contents Contributors  xi  Definitions and Key Elements in Palliative and Supportive Care   Sriram Yennurajalingam and Eduardo Bruera 2 Symptom Assessment  5 Marvin Omar Delgado Guay 3 Clinical Decision- Making  2 Eduardo Bruera 4 Pain Assessment and Management  27 Angelique Wong and Suresh K. Reddy 5 Fatigue  69 Sriram Yennurajalingam 6 Cachexia  83 Egidio Del Fabbro 7 Dehydration  93 Shalini Dalal 8 Anxiety and Depression  0 Paul W. Walker and Anis Rashid 9 Sleep Disturbance  3 Marvin Omar Delgado Guay and Sriram Yennurajalingam 0 Chronic Nausea and Vomiting  25 Shalini Dalal viii CONTENTS  Constipation and Bowel Obstruction  37 Joseph A. Arthur 2 Delirium  53 Shirley H. Bush 3 Clinical Issues Related to Palliative Sedation  67 Shirley H. Bush 4 Breathlessness  7 Jeff Myers and Deborah Dudgeon 5 Emergencies in Palliative Care  85 Meiko Kuriya and Rony Dev 6 Other Symptoms: Xerostomia, Hiccups, Pruritis, Pressure Ulcers and Wound Care, Lymphedema, and Myoclonus  95 Paul W. Walker 7 Management of Cancer Treatment–R elated Adverse Effects  207 David Hui 8 Radiotherapy and Palliative Care  223 Elizabeth A. Barnes 9 Hospice Approach to Palliative Care  23 Joan K. Harrold and Charles F. von Gunten 20 Psychosocial and Cultural Considerations in Palliative Care  245 V. S. Periyakoil 2 Spiritual Issues in Palliative Care  257 Christina M. Puchalski, Betty R. Ferrell, and Edward O’Donnell CONTENTS ix 22 The Palliative Care Team  273 Eduardo Bruera 23 Family Conference: Role in Palliative Care  279 Margaret Isaac and J. Randall Curtis 24 Ethical Aspects of Palliative Medicine  287 James D. Duffy 25 Prognostication in Palliative Care  309 David Hui 26 Frequent Pharmacological Interactions in Palliative Care  323 Mary Lynn McPherson and Kashelle Lockman 27 Pediatric Palliative Care  345 Donna S. Zhukovsky and Rhonda Robert 28 Palliative Care in Older Adults  36 Brook A. Calton and Christine S. Ritchie 29 Palliative Care in End- Stage Heart Failure  375 José L. Ramos and Marieberta Vidal 30 Palliative Care in End- Stage Liver Disease  385 Valentina Medici and Frederick J. Meyers 3 Kidney Palliative Care  397 Sara Davison and David Hui 32 Palliative Care in Patients with AIDS  407 Kirsten Wentlandt and Camilla Zimmermann 33 Palliative Care in End- Stage Neurological Disease  49 Tobias Walbert