Table Of ContentPsychopharmacology
in Oncology and
Palliative Care
A Practical Manual
Luigi Grassi
Michelle Riba
Editors
WORLD PSYCHIATRIC ASSOCIATINO
www.wpanet.org
Psychopharmacology in Oncology
and Palliative Care
ThiSisaFMBlankPage
Luigi Grassi (cid:129) Michelle Riba
Editors
Psychopharmacology in
Oncology and Palliative
Care
A Practical Manual
Editors
LuigiGrassi MichelleRiba
Instituteof Psychiatry DepartmentofPsychiatry
DepartmentofBiomedical&Specialty UniversityofMichigan
SurgicalSciences AnnArbor,Michigan
UniversityofFerrara USA
Ferrara,Italy
ISBN978-3-642-40133-6 ISBN978-3-642-40134-3(eBook)
DOI10.1007/978-3-642-40134-3
SpringerHeidelbergNewYorkDordrechtLondon
LibraryofCongressControlNumber:2014943454
#Springer-VerlagBerlinHeidelberg2014
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Foreword
TheeditorsofPsychopharmacologyinOncologyandPalliativeCare:APractical
Manual, published by the World Psychiatric Association, have graciously invited
me to write the foreword. The attention to psychopharmacology comes after the
firstbookintheseriescoveringthegeneralprinciplesonwhichpsycho-oncologyis
based. It is a tribute to the field that sufficient information exists today with an
evidencebaseandthatatextbookcanbepublishedfocusingonthepharmacologic
interventionsalone.Itisgoingtoserveasabenchmarkinthefieldinternationally.
ThebookrepresentsthecontinuingcollaborationbetweentheWorldPsychiatric
Association and the International Psycho-Oncology Society tomakeavailable the
most recent clinical and research approaches to psychiatric care of patients with
cancer. Drs. Grassi and Riba have called on global experts in specific areas to
provide updates relevant to the psychiatric, psychosocial, and ethical care of
children, elders, and those receiving palliative care for cancer. Such topics as
delirium, depression, anxiety, sleep, substance abuse, pain, fatigue, and sexual
disordersareoftenneglectedbytreatingphysiciansandtheirteamsduetolackof
knowledgeabouttherangeofevidence-basedinterventionsavailable.
This book, written largely by psychiatrists and psychologists, outlines the
information needed to improve care, outlined in succinct and readable language.
Patientsaroundtheworldwillexperienceabetterqualityoflifeastheygothrough
the cancer journey because of the information made available to their physicians
throughthechaptersinthisbook.
NewYork,NY JimmieHolland
February4,2014 WayneE.ChapmanChairinPsychiatricOncology,
MemorialSloanKetteringCancerCenter
ProfessorofPsychiatry,WeillCornellMedicalCollege
v
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Preface
Psycho-oncology has grown exponentially over the last years, with a mandatory
indication for multidisciplinary intervention and inclusion of psycho-oncology
programswithinmanynationalcancerplanacts.Theneedforpsychosocialtraining
ofallhealthcareprofessionalsworkinginoncologyisnowconsideredessentialfor
goodqualityofcancercare.
Psychopharmacologyhas acentral specific rolebothbecause oftheefficacyof
psychotropic drugs in the treatment of psychiatric disorders secondary to cancer
andbecauseofthenewdataderivedbypsychopharmacologicalresearchinpsychi-
atrythat,whenappliedinoncologyandpalliativecare,maybeofextremehelpin
relieving cancer patients from their suffering. A manual or practical text on
psychopharmacology in oncology has been lacking, and for this reason, the idea
of this book originated with the intention to fill this gap, by giving clinicians
practical indicationsandsuggestionsrelativetotheefficacyandsafetyofpsycho-
tropic drugs in the treatment of psychiatric disorders in cancer patients across the
trajectoryofdisease.Oneofthemainaimsofthebookisinfacttopresentthemain
issuesinvolvedinpsychopharmacologicalmanagementofpsychiatricdisordersin
cancerandpalliativecare,accordingtothedifferentpossiblepsychiatricdiagnoses,
with special attention to have psychopharmacological intervention within a broad
frameworkofanintegrativepsychosocial,patient-centeredapproach.Asecondaim
is to illustrate the significant and challenging problems clinicians may encounter
(e.g., drugs, pharmacological characteristics, side effects, drug–drug interaction,
doses,androuteofadministration)includingtheemergingthemeofadjuvantuseof
psychotropicdrugsforthetreatmentofsymptoms/syndromesnotmainlyrelatedto
psychiatricdisorders(e.g.,pain,hot-flashes,fatigue).Athirdaimistoexaminethe
needs of special populations, including children and adolescents, as well as the
elderly,affectedbycancer,whenpsychopharmacologytreatmentisindicated.
Thebookconsistsofthreeparts.InPartI,thegeneralaspectsinpsychopharma-
cological treatment, with specific reference to oncology and palliative care, are
examined.Chapter1,byGrassiandRiba,servestodelineatethechangesintheuse
ofpsychotropicdrugsasapillarofinterventionforpsychiatricdisordersincancer
careandtheneedforreconceptualizingpsychopharmoncologyasanintegrationof
psychosocial and psychopharmacological treatments in clinical practice. In
Chap.2,RothandAliciprovideanoverview ofthegeneralprinciplesofpharma-
cokinetics and pharmacodynamics with a focus on psychotropic medications
vii
viii Preface
commonly used for patients with cancer and in palliative care settings. The most
significant diagnostic issues in terms of need for a comprehensive psychiatric
interview and mental status examination when conducted in oncology and pallia-
tivecaresettingsandaproperuseofpsychiatrictaxonomicsystemsarediscussed
byGrassi,Nanni,andRibainChap.3.MitchellandBultzdiscuss,inChap.4,the
need for a proper psychosocial assessment of cancer patients when planning for
psychopharmacological intervention. Screening for anxiety and depression, dis-
tress,cognitivedecline,adaptationtoillness,aswellasunmetneedsandwell-being
are comprehensively described by the authors. Chapter 5, by Grassi, Caruso and
Baile,dealswiththeimportanceofcommunicationandinterpersonalrelationships
inthediagnosticphaseandintheshareddecisionmakinginplanningapsychophar-
macologicalintervention,withparticularreferencetotheproblemofadherence.In
Chap. 6, Kogon and Spiegel underline the importance of a careful integration of
psychosocial and psychopharmacological treatment in cancer care. The authors
discuss the need for attention to the symbolic communication when clinicians
propose psychopharmacological treatment and the benefit of combining and
integrating psychotropic medication and psychosocial interventions. Tang and
Fielding in Chap. 7 examine the important theme of complementary and noncon-
ventional treatments. More specifically, the role of traditional Chinese medicine,
including herbal formulations, acupuncture, and activity-based interventions
(QigongandTaiChiChuane),andyogaisdescribedwithreferencetointegration
with psychopharmacology, and as a practice that more and more frequently is
providedincancersettings.
PartIIofthisbookisdedicatedtotheuseofpsychotropicdrugsforthetreatment
ofthespecificpsychiatricdisordersinclinicaloncologyandpalliativecaresettings.
In Chap. 8, Shimizu, Yosiuchi, and Onishi offer an overview of the treatment of
anxietydisordersandtrauma-andstressor-relateddisorders,accordingtothemost
recent changes provided by the DSM-5, and present the role of medications with
anti-anxiety properties and their adverse effects and drug interactions. The
extremely debated area of depression and depressive disorders is the focus of
Chap. 9 by Fitzgerald, Li, Grassi, and Rodin, who comprehensively discuss the
needforappropriatediagnosisofdepression,includingacarefulexaminationofthe
patient’s medical condition, for a correct prescription of antidepressant
medications, which takes into account both the profile of action and the potential
adverse effects and drug–drug interactions. Chaturvedi, Torta, and Ieraci summa-
rizeinChap.10thecomplexproblemofpharmacologicaltreatmentofsomatoform
disorders and other somatic symptom conditions (e.g., pain, fatigue, hot-flashes,
pruritus, anorexia and weight loss, and nausea and vomiting). The importance of
sensitiveexplorationofsomaticsymptoms,examinationofpossiblebiologicaland
neurotransmitter mechanisms, and appropriate intervention are highlighted by the
authors. In Chap. 11, the significant, though underestimated, area of bipolar
disorders,asaparticularchallengefortheoncologyteam,isreviewedbyEllingrod,
Hertz, and McInnis, who discuss psychopharmacological clinical strategies for
thesedisordersand,ingeneral,unstablemoodinpatientswithcancer,emphasizing
theneedforregularmonitoringofclinicalmoodsymptoms,medicationlevels,and
Preface ix
physical health. In Chap. 12, the correct approach to delirium, as one of the most
commonneuropsychiatriccomplications,associatedwithsignificantmorbidityand
mortality,isprovidedbyBreitbartandAlici,whopresentadetailedoverviewofthe
pharmacological management options for the disorder in cancer patients and in
palliative care settings. The role of multidisciplinary team intervention for psy-
chotic disorders is presented in Chap. 13 by Kim and Fang who discuss how to
integrate proper psychopharmacotherapy (e.g., choice of drugs, dosages, side
effects, drug–drug interactions) and communication strategies when treating both
patients with severe mental illness who have developed cancer and those who
developedpsychoticdisordersasaconsequenceofcancer.InChap.14,Monteiro,
Ribeiro,andXavierreviewthevastandimportantarearelativetothetreatmentof
sleep disorders, as a significant, yet underestimated problem to be addressed in
cancerandpalliativecaresettings.Screeningofsleepcomplaints,classificationof
the several expression of sleep disorders, evaluation of the possible etiologic
factors, and correct treatment are comprehensively discussed. The significant
problem of substance and alcohol abuse in cancer is reviewed in Chap. 15 by
Passik, Miller, Ruhele, and Kirsh who discuss the impact of these behaviors on
potentially life-saving and life-extending cancer treatments and the need for the
application of addiction medicine techniques and interventions in cancer care. In
Chap.16,BenedictandNelsonfocusattentiononcancer-relatedchangesinsexual
function by reviewing the possible interventions for both male and female cancer
patients,includingtheuseofmedical,educational,andpsychologicalstrategies,to
facilitate sexual recovery and promote satisfying sexual experiences for patients
andtheirpartners.
Inthethirdpartofthebook,somespecialissuesrelativetopsychopharmacology
inoncologyandpalliativecarearetakenintoconsideration.InChap.17,Lynnand
Valentine alert clinicians to the possible emergencies or dangers arising from
pharmacologicmanagement,includingserotoninsyndrome,neurolepticmalignant
syndrome,andoverdoseofpsychotropicdrugscommonlyutilizedinoncologyand
palliativecare.ForgeyandBursch,inChap.18,offerathoroughdescriptionofthe
veryimportantareaofchildhoodcancer,withspecificreferencetopsychopharma-
cological treatment recommendations for children with cancer, within a larger
framework of behavioral and family-based interventions management. The
age-related physiological changes that may affect the response to psychotropic
medication and their clinical implications for the use of psychopharmacologic
treatments in elderly patients with cancer are the aims of Chap. 19 by Iaboni,
Fitzgerald, and Rodin. In the following Chap. 20, Ferrari and Caraceni offer an
in-depth insight regarding end-of-life care, with specific reference to palliative
sedation therapy (PST). Evidence-based use of some psychotropic drugs is
describedbytheauthorstohelpcancerandpalliativecarephysicianswhendealing
with refractory symptoms (e.g., delirium, dyspnea, pain, nausea and vomiting) at
theendoflife.InChap.21,AliciandDunnpointoutthetopic ofpsychopharma-
cology research in oncology and palliative care, considering the problems and
urgent needs to be addressed (e.g., limited number of studies, methodological
limitations, the challenges in establishing psychiatric diagnoses, the validity of
