IAHPC BOOK REVIEW
EVIDENCE BASED SYMPTOM CONTROL IN PALLIATIVE CARE
Systematic Reviews and Validated Clinical Practice Guidelines for 15 Common Problems in Patients with Life Limiting Disease
Arthur Lipman, Kenneth Jackson and Linda Tyler (Eds)
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Pharmaceutical Products Press, The Hawarth Press, 2000
ISBN 0-7890-1014-3
247pp
RRP $US29.95 £25.60
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Also published in the Journal of Pharmaceutical Care in Pain and Symptom Control
Volume 7, No. 4, 1999 and Volume 8, No. 1, 2000
When I saw this book advertised I went straight to Amazon.com and bought it. At last, someone had taken the time and trouble to produce evidence
based clinical guidelines for palliative care. Chapters on anorexia and cachexia, anxiety, bleeding problems, constipation, delirium, depression, diarrhea, dyspnea, fatigue, oral mucosal problems,
nausea and vomiting, and nutrition and hydration problems. Each chapter with an introduction about treating the underlying cause when possible, a management algorithm, and tables categorizing
the reports of pharmacological treatment by level of evidence. But when I looked closely, it left a lot to be desired.
Edited and written by three academic pharmacists, one can accept if the clinical background and investigation of symptoms seems a little brief
or superficial. But it is on the pharmacological management of symptoms, which is the cornerstone of this book, that I found wanting. In the first chapter on anorexia and cachexia, treatment
with hydrazine is listed in the table and noted to be of continuing interest as an investigational agent. Chlebowski’s 1987 and 1990 studies of 101 and 65 patients are quoted as showing benefit
and given a level of evidence of I and II. What happened to the three randomised, placebo-controlled, double-blind trials published in 1994 (one by Kosty et al and two by Loprinzi et al), conducted
by respected collaborative trials groups on a total of 636 patients, that uniformly showed no benefit from hydrazine; and the quality of life was worse in the hydrazine arm in two of the three
studies. Three randomised trials are quoted for megestrol; I know of at least five others. In the chapter on anxiety, a trial by Holland of benzodiazepines and relaxation therapy is quoted, but
the patients studied were receiving active anticancer therapy and had a mean Karnovsky Performance Score of 85 - hardly the patients you would find under the care of a palliative care service.
In the chapter on dyspnea, Francombe’s descriptive reports on the value of nebulised morphine are discussed, but not the randomised, placebo-controlled, double-blind trial by Noseda et al that
showed no difference between morphine and saline. And so on.
The idea behind this book is excellent - there is no doubt about that. But it requires meticulous attention to detail and if the literature
reviews upon which the evidence-based guidelines are developed are incomplete, the value of the book is severely compromised. Great idea, but needs more work.
Roger Woodruff
Past Chairman, International Association for Hospice and Palliative Care (IAHPC)
Director of Palliative Care, Austin & Repatriation Medical Centre, Melbourne, Australia
AUTHOR INFORMATION
Arthur Lipman is Professor in the College of Pharmacy, University of Utah Health Sciences Centre, Utah, USA
Kenneth Jackson is Manager for Clinical Pharmacy Services at St. Dominic-Jackson Memorial Hospital, Jackson, Mississippi, USA
Linda Tyler is Professor at the College of Pharmacy at the University Hospital and Clinics at the University of Utah Health Sciences Centre,
Utah, USA
getinfo@haworthpressinc.com
 
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