Following publication of the first print edition in 1993, the Oxford Textbook of Palliative Medicine rapidly established itself as the definitive textbook on the subject. Each edition has received widespread critical acclaim, and the book is used across the world by a wide range of health care professionals involved in the care of patients with a terminal illness, or chronic, progressive conditions. Existing readers who automatically turn to the textbook will welcome this new fourth edition of their familiar reference; whilst it will prove invaluable to a new generation of palliative care professionals.

The Oxford Textbook of Palliative Medicine has continually evolved, keeping pace with the rapidly changing face of palliative care. Geoffrey Hanks and Nathan Cherny - the original editors of the textbook - are now joined by four new editors: leaders in the field from the US, UK, and Norway who give the textbook an increased global perspective. The content of the textbook emphasises the multi-disciplinary nature of palliative care throughout, and the 100 chapters cover all areas of palliative care, including: individual professional roles; ethics; communication, psychiatric, spiritual, and psychosocial issues; research in palliative care; the treatment of symptoms; and the role of palliative care in non-malignant diseases and conditions.

The online version of the Oxford Textbook of Palliative Medicine contains the full text of the print edition (which can be browsed by the contents list or searched), links from references in the text to external sources (via PubMed, ISI, and CrossRef), and all figures and illustrations from the print edition, downloadable into PowerPoint.

Geoffrey Hanks graduated from University College London with a BSc in anatomy and qualified in medicine in 1970. He has been working in palliative medicine since 1979, initially as a research fellow with Robert Twycross in Oxford. For almost 10 years he was consultant physician in charge of the palliative care units at the Royal Marsden Hospitals, London and Sutton, and honorary senior lecturer at the Institute of Cancer Research, University of London, and St Bartholomew's Hospital Department of Clinical Pharmacology. He was appointed to the first Chair of Palliative Medicine in the UK in the United Medical and Dental Schools of Guys and St Thomas' Hospitals, University of London, and was appointed Professor of Palliative Medicine in the University of Bristol in 1993. Positions held include Chairman of the Palliative Care Clinical Studies Development Group of the National Cancer Research Institute in the UK and Chairman of the National NHS Cancer Research & Development Commissioning Group.


Nathan Cherny is an Australian born, Israeli oncologist and palliative medicine physician. He holds the Norman Levan Chair of Humanistic Medicine at Shaare Zedek Medical Center in Jerusalem Israel. Prof Cherny graduated in medicine at Monash University Medical School in 1983 and then completed a Fellowship of the Royal Australian College of Physicians attaining specialist recognition in both Oncology and Palliative Medicine. He subsequently completed a fellowship in Cancer Pain and Palliative Medicine at Memorial Sloan Kettering Cancer Center. In 1994 Dr Cherny moved to Israel where he helped establish the Oncology and Palliative Medicine Unit at the Shaare Zedek Hospital in Jerusalem. He continues to head that Cancer Pain and Palliative Medicine Service, and, in addition, he continues to practice general oncology. Since 2008 he has been the chairman or the ESMO Palliative Care Working Group.


Stein Kaasa is considered to be the leading figure in European palliative care. He is a specialist in medical oncology, radiotherapy, and palliative medicine. Since 1993, he has been the Director of the Palliative Medicine Unit at Trondheim University Hospital, Norway, and Professor of Palliative medicine at the Faculty of Medicine, Norwegian University of Science and Technology (NTNU). He is also chairman of the Unit for Applied Clinical Research and the Institute of Environmental Medicine at NTNU, and Chairman of the Program for Research on Alternative Medicine of the Norwegian Research Council. He was responsible for the development of the core curriculum at the medical school of the NTNU. He is the current President of the European Association for Palliative Care (EAPC) and serves on the editorial board of several journals including Progress in Palliative Care, Palliative Medicine, and the Journal of Pain and Symptom Management.


Russell Portenoy is Chairman of the Department of Pain Medicine and Palliative Care, and the Gerald J. and Dorothy R. Friedman Chair in Pain Medicine and Palliative Care at Beth Israel Medical Center in New York. He is Chief Medical Officer of Beth Israel's Continuum Hospice Care/The Jacob Perlow Hospice, and Professor of Neurology and Anesthesiology at the Albert Einstein College of Medicine. Dr. Portenoy is president of the American Academy of Hospice and Palliative Medicine and a past president of the American Pain Society. He is the recipient of the Wilbert Fordyce Award for Lifetime Excellence in Clinical Investigation and the Distinguished Service Award from the American Pain Society, the Founder's Award from the American Academy of Pain Medicine, and the Bonica Award from the Eastern Pain Association. He serves on the Board of Directors of the American Pain Foundation and chairs various other forums and committees.


Nicholas A. Christakis is an internist and social scientist who conducts research on social factors that affect health, health care, and longevity. He is a Professor of Medical Sociology in the Department of Health Care Policy at Harvard Medical School; Professor of Sociology in the Department of Sociology in the Harvard Faculty of Arts and Sciences; and an Attending Physician in the Department of Medicine at the Harvard-affiliated Mt. Auburn Hospital. Dr. Christakis received his BS from Yale University in 1984, his MD from Harvard Medical School and his MPH from the Harvard School of Public Health in 1989, and his PhD from the University of Pennsylvania in 1995. He was elected to the Institute of Medicine of the National Academy of Sciences in 2006. His current research focuses on health and social networks, and specifically how ill health, disability, health behavior, health care, and death in one person can influence the same phenomena in others in a person's social network.


Marie Fallon completed her Palliative Medicine Higher Specialist Training at St Thomas' Hospital London and in Bristol and was appointed to the St Columba's Hospice Chair of Palliative Medicine at the University of Edinburgh in 2006. She is based in the Edinburgh Cancer Research Centre and the Western General Hospital, Edinburgh. Her research background is in opioid analgesia, complex cancer pain and barriers to symptom control. She is a founder member of the University of Edinburgh's Translational Research in Pain Group, which has a particular interest in cancer-induced bone pain. She is the Chief Investigator on a portfolio of Cancer Research UK funded multi-centre trials investigating various aspects of cancer pain. She leads a team of several Research Fellows working on various aspects of cancer-induced bone pain. She is a member of the Advisory Board for Dimbleby Cancer Care and chairs the Pain Sub Committee of the NCRI Palliative Care Clinical Studies Group.

Section 1: Introduction
1.1. Introduction, Geoff Hanks, Nathan I. Cherny, Stein Kaasa, Russ Portenoy, Nicholas Christakis & Marie Fallon
Section 2: The worldwide status of palliative care
2.1. International progress in creating palliative medicine as a specialized discipline, David Clark
2.2. Lessons learned from hospice in the United States of America, Perry Fine & Stephen Connor
2.3. Providing palliative care in resource-poor countries, Robert Twycross & M. R. Rajagopal
2.4. IAHPC list of the essential medicines for palliative care, Neil Macdonald
Section 3: The challenge of palliative medicine
3.1. The problem of suffering and the principles of assessment in palliative medicine, Nathan I. Cherny
3.2. The epidemiology of death and symptoms, Jane Ingham, Meg Sands & Michael Piza
3.3. Predicting survival in patients with advanced disease, Paul Glare, Christian Sinclair, Michael Downing & Patrick Stone
3.4. Palliative medicine and modern cancer care, Raphael Catane & Nathan Cherny
3.5. Barriers to the delivery of palliative care, Fiona Graham, Suresh Kumar & David Clark
3.6. Defining a good death, Karen Steinhauser & James Tulsky
3.7. Cultural aspects of palliative medicine, Jonathan Koffman & LaVera Crawley
3.8. The economic challenges of palliative medicine, Thomas Smith & J Brian Cassel
Section 4: The interdisciplinary team
4.1. The core team and the extended team, Dagny Faksvag Haugen, Friedemann Nauck & Augusto Caraceni
4.2. Nursing and palliative care, Deborah Witt Sherman
4.3. Social work in palliative care, Barbara Monroe
4.4. The role of the chaplain in palliative care, Rev. James M. Harper, III & Rabbi Jonathan E. Rudnick
4.5. Occupational therapy in palliative care, Jennifer Miller & Jill Cooper
4.6. Music therapy in palliative care, Clare O'Callaghan
4.7. The dietician and nutritionist in palliative care, Rosemary Richardson & Isobel Davidson
4.8. Physiotherapy in palliative care, Diane Robinson & Anne English
4.9. Speech and language therapy in palliative care, Alison MacDonald & Linda Armstrong
4.10. Art therapy in palliative care, Michele Wood
4.11. The contribution of stoma nurse specialist to palliative care, Jane Ellen Barr
4.12. Clinical psychology in palliative care, Fiona Cathcart
4.13. The clinical pharmacist in palliative care, Margaret Gibbs
Section 5: Ethical issues
5.1. Introduction, Kenneth Calman
5.2. Confidentiality, Ira Byock & Diane Palac
5.3. Truth-telling and consent, Martin Tattersall
5.4. Palliative medicine in children: ethical and legal issues, Vic Larcher & Dr Dilini Rajapakse
5.5. Euthanasia and physician-assisted suicide, Lars Johan Materstvedt & Dr Georg Bosshard
5.6. Withholding and withdrawing life-sustaining therapy, Joe Fins & Elizabeth Nilson
Section 6: Communication and palliative medicine
6.1. Communication with the patient and family in palliative medicine, Lesley Fallowfield
6.2. Talking with families and children about the death of a parent, Anna C. Muriel & Paula K. Rauch
6.3. Communication with professionals, David Jeffrey
6.4. Communication with the public, policy makers and the media, Kenneth Calman
Section 7: Research in palliative medicine
7.1. Research in palliative care: getting started, Geoffrey Hanks & Stein Kaasa
7.2. The principles of evidence-based medicine, Henry J. McQuay, Andrew Moore & Philip Wiffen
7.3. Clinical trials in palliative care, John Farrar
7.4. Qualitative research, Linda J. Kristjanson & Nessa Coyle
7.5. Research into psychosocial issues, David W. Kissane, Annette F. Street & Erin Schweers
7.6. Ethical issues in palliative care research, David Casarett
7.7. Measurement of pain and other symptoms, Jane Ingham, Russ Portenoy & Anthoulla Mohamudally
7.8. Quality of life measurement in palliative medicine - principles and practice, Stein Kaasa & John Havard Loge
7.9. Measurement of pain and other symptoms in the cognitively impaired, Keela Herr & Mary Ersek
7.10. Clinical and organisational audit and quality improvement in palliative medicine, Irene J. Higginson
Section 8: Principles of drug use in palliative medicine
8.1. Principles of drug use in palliative medicine, Geoffrey Hanks
Section 9: Disease modifying management in advanced cancer
9.1. The medical treatment of cancer in palliative care, Malcolm McIllmurray
9.2. Radiotherapy in symptom management, Peter J. Hoskin
9.3. The role of general surgery in the palliative care of patients with cancer, Robert Krouse
9.4. The role of orthopaedic surgery in the palliative care of patients with cancer, John Healey & Wakenda Tyler
9.5. The role of interventional radiology in the palliative care of patients with cancer, Tarun Sabharwal, N Fotiadis & Andy Adam
Section 10: The management of Common Symptoms and Disorders
10.1: The management of pain
10.1.1. Pathophysiology of pain in cancer and other terminal diseases, Gordon Williams & Tony Dickenson
10.1.2. Pain assessment and cancer pain syndromes, Nathan I Cherny
10.1.3. Neuropathic pain, Nanna Brix Finnerup & Troels Staehelin Jensen
10.1.4. Cancer induced bone pain, Lesley A Colvin & Marie Fallon
10.1.5. Breakthrough pain, Giovambattista Zeppetella
10.1.6. Opioid analgesic therapy, Geoffrey Hanks, Nathan Cherny & Marie Fallon
10.1.7. Non-opioid analgesics, Per Sjogren, Frank Elsner & Stein Kaasa
10.1.8. Adjuvant analgesics in pain management, David Lussier & Russell Portenoy
10.1.9. Injections, neural blockade, and implant therapies for pain control, Robert A. Swarm, Menelaos Karanikolas & Michael J. Cousins
10.1.10. The role of surgical neuroablation for pain control, Nicholas Park & Nik Patel
10.1.11. Treating pain with transcutaneous electrical nerve stimulation, Michaela Bercowitz & Nathan I. Cherny
10.1.12. Acupuncture, Jacqueline Filshie & John W. Thompson
10.1.13. Psychological and psychiatric interventions in pain control, William Breitbart, Steven D. Passik & David Casper
10.2 Gastro-intestinal symptoms
10.2.1. Palliation of nausea and vomiting, Kathryn A. Mannix
10.2.2. Dysphagia, dyspepsia and hiccup, Claud Regnard
10.2.3. Constipation and diarrhoea, Nigel Sykes
10.2.4. Pathophysiology and management of malignant bowel obstruction, Carla Ripamonti & Sebastian Mercadante
10.2.5. Jaundice, ascites and hepatic encephalopathy, Jeremy Keen
10.3 Weight loss in palliative medicine
10.3.1. Classification and pathophysiology of the anorexia/cachexia syndrome, Florian Strasser & Vickie Baracos
10.3.2. Classification, clinical assessment and treatment of the anorexia-cachexia syndrome., Ken Fearon, Vickie Baracos & Sharon Watanabe
10.4 Fatigue and asthenia
10.4. Fatigue and asthenia, Sriram Yennurajalingam & Eduardo Bruera
10.5 Clinical management of anaemia, cytopenias and thrombosis in palliative medicine
10.5. Clinical management of anaemia, cytopenias and thrombosis in palliative medicine, Robert Turner
10.6 Pruritus and sweating in palliative medicine
10.6. Pruritus and sweating in palliative medicine, Mark R. Pittelkow & Charles L. Loprinzi
10.7 Skin problems in palliative medicine
10.7.1. Medical aspects, Michal Lotem
10.7.2. Nursing aspects, Patricia Grocott & Vicky Robinson
10.7.3. Lymphoedema, Vaughan Keeley
10.8 Genito-urinary problems in palliative medicine
10.8. Genito-urinary problems in palliative medicine, Richard W. Norman & Greg Bailly
10.9 Mouth care
10.9. Mouth care, Franco De Conno, Cinzia Martini, Alberto Sbanotto, Carla Ripamonti & Vittorio Ventafridda
10.10 Endocrine and metabolic complications of advanced cancer
10.10. Endocrine and metabolic complications of advanced cancer, Mark Bower & Sarah Cox
10.11 Neurological problems in advanced cancer
10.11. Neurological problems in advanced cancer, Augusto Caraceni, Cinzia Martini & Fabio Simonetti
10.12 Sleep in palliative care
10.12. Sleep in palliative care, Michael J. Sateia & Ira Byock
10.13 Withdrawing life support - clinical advice for challenging scenarios
10.13. Withdrawing life support - clinical advice for challenging scenarios, Gordon D. Rubenfeld
10.14 Clinical management of bleeding complications
10.14. Clinical management of bleeding complications, Jose Pereira & Sophie Pautex
Section 11: Issues in specific neoplastic disease
11.1. Palliative medicine in malignant respiratory diseases, Kin-Sang Chan, Doris M.W. Tse, Michael M.K. Sham & Anne Berit Thorsen
11.2. Head and neck cancer, Barbara A. Murphy, Anthony Cmelak, Steven Bayles, Ellie Dowling, Cheryl R Billante, Sheila Ridner, Kirsten Hamean, Stewart Bond, Anne Marie Flores & Wisawatapnimit Panarut
11.3. Brain tumours, Claudia Bausewein, Gian Domenico Borasio & Raymond Voltz
Section 12: Palliative medicine in non-malignant disease
12.1. Introduction, Marie Fallon
12.2. AIDS in adults, Roger Woodruff & David Cameron
12.3. Palliative medicine and non-malignant, end-stage respiratory disease, Richard M. Leach
12.4. Palliative medicine for patients with end-stage heart disease, Andrew D. McGavigan, Francis G. Dunn & Carolyn Datta
12.5. Palliative medicine in non-malignant neurological disorders, G.D. Borasio, A. Rogers, S. Lorenzl & R. Voltz
12.6. Palliative medicine in end-stage renal failure, Jo Chambers
12.7. Palliative medicine in intensive care, Simon Cohen & Thomas J. Prendergast
Section 13: Paediatric palliative medicine
13.1. Special consideration for children in palliative medicine, Betty Davies & Harold Siden
13.2. Paediatric pain control, Stephen C. Brown & Patricia A. McGrath
13.3. Symptom control in life-threatening illness in children, John J. Collins
13.4. Psychological adaptation of the dying child, Michael M. Stevens
13.5. Bereavement issues and staff support when caring for children, Betty Davies & Stacy Orloff
Section 14: Geriatric palliative medicine
14.1. Palliative medicine in dementia, Ladislav Volicer
14.2. Palliative medicine and care of the elderly, Diane E. Meier & Nathan Goldstein
Section 15: Psychiatric, psychosocial and spiritual issues in palliative medicine
15.1. Sprititual issues in palliative medicine, Susan McClement & Harvey Chochinov
15.2. The emotional problems of the patient in palliative medicine, Mary L.S. Vachon
15.3. The family perspective, Joan T. Panke & Betty R. Ferrell
15.4. The stress of professional caregivers, Liz Jamieson, Emma Teasdale, Alison Richardson & Amanda Ramirez
15.5. Psychiatric symptoms in palliative medicine, William Breitbart
15.6. Bereavement, David W. Kissane & Talia Zaider
Section 16: Rehabilitation in palliative medicine
16.1. Rehabilitation in palliative medicine, Deborah Franklin & Andrea Cheville
Section 17: Complementary therapies in palliative medicine
17.1. Complementary therapies in palliative medicine, Gary Deng & Barrie R. Cassileth
Section 18: Palliative medicine in the home
18.1. Palliative medicine in the home: an overview, Derek Doyle
18.2. Palliative medicine in the home: North America, S. Lawrence Librach
Section 19: The terminal phase
19.1. The terminal phase, Mike Harlos
19.2. Sedation in palliative medicine, Eric Krakauer & Thomas Quinn
Section 20: Education and training in palliative medicine
20.1. Introduction, Kenneth Calman
20.2. Postgraduate education in palliative medicine, Meg Hegarty & David Currow
20.3. Training specialists in palliative medicine, Charles von Gunten, Barry Buckholz & Frank Ferris
20.4. The role of the humanities in palliative medicine, Deborah Kirklin
20.5. Informatics and palliative medicine, Jose Pereira