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Homages and Obituaries

Celebrating 25 years of the EAPC: Remembering Professor Geoffrey Hanks

Franco De Conno, Honorary Director, and Heidi Blumhuber, Executive Officer, the European Association for Palliative Care, share memories of Geoffrey Hanks, founding member and a former president of the EAPC, in our special series to celebrate our 25th anniversary.

You know that feeling when you wake up in the morning with that strange feeling of having lost something very important – as if a heavy weight compresses your body. This was how I felt when I heard that my great friend ‘Gioff’ had died. (Gioff was the nickname created by Heidi and me because ‘Geoffrey’ is too complicated for an Italian). I admired and loved him for his intelligence, courtliness and approachability. I first met him in Milan in 1988 at the first European congress of palliative care. His name was well known to me because he had published a lot on opioids but now he became our teacher; from his publications we started to learn how to use opioids and to understand the importance of morphine. But this knowledge caused something of a crisis for us because now we started to understand that neuroinvasive techniques were not so good for patients, and not the panacea we had first thought.

That congress spearheaded many changes; Vittorio Ventafridda, Derek Doyle, Geoff Hanks and many other pioneers decided to found the EAPC. I began to know Gioff and to appreciate him for his kindness and his very British approach to institutional relationships, yet he was also international and even ‘Latin’ when relaxing.

It was thanks to Gioff’s diplomacy and charm as chair of the scientific committee for the first EAPC congress held in Paris in 1990 that we had such a relaxed and friendly relationship with the local organising committee. After this congress our friendship grew. In April 1991, Gioff moved to St Thomas’ Hospital in London to take up the first Chair of Palliative Medicine – the first in Europe. In 1992, we established an ‘Expert group on the administration of morphine’. In 1994, we visited the Philippines, Singapore and Thailand to present the guidelines of the EAPC for the treatment of cancer pain and to present the data of our studies conducted in Milan. We had many funny incidents such as his first Malaysian massage (very painful), and my first dinner with Thai food (super spicy). The most important result of this trip was the decision to establish the EAPC Research Network. With Geoff’s scientific capacity and my organisational skills this was a great success and continues to this day. I’m very proud of this baby, but only with Geoff was it possible to achieve it. When he was nominated president of the EAPC in 1995, we worked increasingly together because my wife, Heidi Blumhuber, and I were executive officers of the association and we met regularly in Milan or in London to plan the activities of the association.
We remained in contact after we had both retired – less work but we maintained our friendship. During a holiday with us in Sardinia Gioff’s illness began, but he enjoyed going around in the small electric car, snorkelling and eating raw sea urchins in the boat. There were many enjoyable times in the past 20 years. Driving to Salzburg for the meeting on essential drugs for the treatment of cancer pain organised by the International Association for Hospice and Palliative Care, was one such moment. Gioff was a car lover – one of the most beautiful days of his life was when he bought his Jaguar, but he had never driven very fast because of the speed limits in his country. I drove at more than 200 Km/h leaving Gioff equally thrilled and terrified. Arriving in Salzburg, he confessed that his legs were very tired, particularly the left one because he’d had his foot on the brake all the time, yet throughout the trip he hadn’t said a word of complaint. This attitude and great dignity prevailed throughout Gioff’s illness.

Like Vittorio, Gioff regretted that in his professional life he had not been involved in the study of neurodegenerative suffering. He often spoke about the need to resolve the terrible problems of such patients. Perhaps this is the last message of Gioff and Vittorio: the need for more research on all the complexities of suffering. In the last months of his life, he was also anxious to maintain the balance in our world of rivalry and criticism. The memory of Gioff will be with us forever – Heidi and I will miss his voice and wisdom.

Tomorrow in Milan (5 December), at the 3rd International Seminar of the EAPC Research Network and the European Palliative Care Research Centre, Gioff’s life and work will be commemorated. The seminar is entitled the GW Hanks seminar, and Professor Marie Fallon will give an honorary lecture.

Professor Geoffrey Warren Hanks (1946-2013): An appreciation of his contribution to Palliative Medicine
This obituary was first publish in Palliative Medicine, 2013- 27(8) 703–704

Augusto Caraceni, Director Palliative Care, Pain Therapy and Rehabilitation, National Cancer Institute of Milan, Italy
Karen Forbes, Professorial Teaching Fellow and Consultant in Palliative Medicine, University of Bristol and University Hospitals Bristol NHS Foundation Trust, UK
Sheila Payne, Director of the International Observatory on End of Life Care, Lancaster University, UK
Colette Reid, Consultant in Palliative Medicine, University Hospitals Bristol NHS Foundation Trust, UK

Many of you will have heard of the death of Professor Geoffrey Hanks, Emeritus Professor of Palliative Medicine at the University of Bristol, on June 27th 2013. Professor Hanks was the editor in chief of Palliative Medicine from 2001 until 2011, advancing the circulation of the journal as the official Journal of the European Association for Palliative Care and of the Association for Palliative Medicine of Great Britain and Ireland. We would like to remember and honour him here by describing his achievements and contribution to the specialty of Palliative Medicine.

Geoffrey Warren Hanks was born in Bangalore in 1946; and in many ways, the worldwide breadth of his origins, embedded in his exquisite British culture, always gave an additional quality to his special charisma.

After graduating from University College Hospital Medical School in 1970 he completed his clinical training and spent a year in general practice. He then explored his interest in clinical pharmacology, working from 1975 until 1979 in senior positions within the pharmaceutical industry. In 1979 he was appointed Research fellow and Honorary Senior Registrar at Sir Michael Sobell House, and the Oxford Regional Pain Relief Unit, where he conducted research and clinical work in the palliative care unit with Robert Twycross. In 1983, he was appointed to the first hospital consultant post in Palliative Medicine in the United Kingdom at the Royal Marsden Hospital. Here, he started the new clinical service at the Sutton branch of the hospital and was also responsible for developing the unit at Fulham Road and bringing them together as a single functional service. His work at the Royal Marsden on modified-release morphine was to revolutionise cancer pain management. Subsequently, he was offered the first University Chair in Palliative Medicine in Europe, at the United Medical and Dental Schools of Guy’s and St Thomas’ Hospitals (UMDS) of the University of London where the first hospital-based palliative care consultation service in the UK had been established. In 1993 he moved to Bristol to a new Chair and Department created for his team, who all moved with him. The research and teaching program in Bristol lead to the team achieving one of the most comprehensive courses in palliative medicine for undergraduate medical students in the UK, and the development of the first modular Masters degree in Palliative Medicine exclusively for doctors. Geoff was involved in clinical care, teaching and examining, and research throughout his career. He retired from his clinical role in Bristol in 2006, but continued as Emeritus Professor of Palliative Medicine at the University.

Innumerable appointments and invitations from national and international bodies brought Geoff to lecture in more than 40 different countries. He had considerable experience of committee work both in the UK and internationally. He chaired research (grant-awarding) committees for both major cancer care charities in the UK (Macmillan and Marie Curie), was Chairman of the Commissioning Group for the NHS Cancer Research and Development Programme, and was a member of many other advisory committees and boards for governmental and charitable organisations both in the UK and overseas. He was chair of the professional advisory committee at the Macmillan Cancer Relief Fund from 1985-2001. Under his chairmanship, Macmillan played an often forgotten but vital role in establishing palliative medicine as a specialty by funding the majority of the initial wave of training posts for senior registrars once formal approval had been given for subspecialty (and later, specialty) status to be accorded to palliative medicine.

Geoff was one of the 42 founding members of the European Association of Palliative Care in 1988, in Milan. Throughout his life he remained an enthusiastic supporter of the EAPC which has grown to represent more than 80,000 members across Europe. He chaired the Scientific committees of the first congress in Paris in 1990 and was Vice President, (1989-1995) President (1995-1999) and Honorary President of the Association. He participated and led a number of research and study groups within the EAPC and the EAPC Research Network being the main author of the EAPC guidelines on morphine and opioids for cancer pain in 1996, 2001 and 2012. He was the Senior Editor of four editions of the Oxford Textbook of Palliative Medicine, which was the first textbook of its kind, and was sincerely proud of this hugely “successful” publication.

By reading the list of his publications one can easily follow the main course of a new discipline tackling the pharmacology of opioids and the refinement of cancer pain management. Research and teaching went hand in hand in his career; his papers, even those published many years ago, are still so relevant. The metabolism of morphine and the explanation of its unexpected potency when given orally, opioid side effects, the use of methadone, the cognitive effects of opioids are only a few publications in his rich portfolio.
Across his curriculum vitae and publications the personal relationships which characterized his professional and intellectual pathway also emerge. Geoff had an authoritative role in all the areas of palliative care where he was practically involved, he was perceived as both a leader and a resource. Indeed, at international conferences, we said often that everyone wanted their little piece of him, their audience with Geoff. He had an inclusive way of dealing with all complex situations and could keep his opinion without making you feel judged or left out. He had the ability to keep his own unmatchable style, while accepting local, cultural, and even idiosyncratic diversities and deliver back his own British sense of humour as a gift in any situation, while always ready to accept jokes and irony on his side from others. He never let his superiority be an issue in dialogue with anyone, with an almost royal touch in his manners. In a research meeting in Sicily, when he was president of the EAPC, he was given in the conference centre guesthouse a room where the Pope, John Paul 2nd, had been accommodated. When he was told that the room with no less than the Pope’s bed had been reserved for him, he liked the joke very much.

Many messages have been sent to the journal from colleagues worldwide since the news of his death. Those who wrote remembered his kindness, gentleness, wisdom and dry humour. He was described as a leader, friend, mentor and a man who fought against indifference. It is also clear from the many messages received that Geoff was a man who inspired confidence and nurtured ability in others. His career is replete with doctors who began their clinical and research careers and studied successfully for postgraduate degrees under his supervision and care. Geoff valued contributions from others, no matter what their role or status. He made you feel as if your opinion mattered, even to this ‘giant’ of Palliative Medicine. Those of us who worked with him clinically also watched him make patients feel this way. Once, on the professorial ward round, having dealt with an elderly man’s symptom problems, Geoff finished by asking “Is there anything else I can do for you?” The man replied that he was having difficulty putting his slippers on because he couldn’t bend down. Geoff did not look for a nurse, instead he knelt down at the patient’s feet and put his slippers on for him. This is his greatest legacy; his teaching by example that, no matter how important we are, we can always treat others with respect, kindness and compassion.

We will miss his charming, intriguing smile, but we will also keep it with us for the rest of our lives.

The death at age 67 of Professor Geoffrey W. Hanks DSc, MB Lond. FRCP, FRCPEd. FFPM
from IAHPC Hospice Palliative Care News - 2013; Volume 14, No 7, July

All who had the pleasure of meeting or working with Geoff Hanks will understandably have different memories and descriptions of him. What no-one will deny is that he was a giant – intellectually, clinically, as a researcher, as a teacher, as a committee man, as an editor, as a pioneer in palliative medicine.

Already qualified as a physician and clinical pharmacologist he went to Oxford to train under Robert Twycross before being appointed Consultant in Palliative Care in The Royal Marsden Hospital (London and Sutton). When the first Chair of Palliative Medicine was created in St Thomas´s and Guys Hospital, London he was the obvious man for the job. After seeing his team settled, he then moved to Bristol to be Professor of Palliative Medicine and remained there until his relatively recent retirement.

He served on the Board of the Cancer Relief Macmillan Fund in the UK, on the Board of IAHPC (2008-2010), and on the Board of the EAPC finally serving as a distinguished President. He will also be remembered with affection and deep gratitude as the Editor-in-Chief of the journal Palliative Medicine, now recognised as one of the finest specialist medical journals in the world, largely thanks to him.

With MacDonald and Doyle he was a Co- Editor of the Oxford Textbook of Palliative Medicine and sat on umpteen editorial boards. All this whilst serving as a senior clinician, a medical professor and a supervisor of PhD students, and playing his full role in the University of Bristol.

Always gentle and gracious, far more ready to listen than to talk, a delightful host, a riveting lecturer, an oenologist and one of the best friends many of us have ever had. Palliative Medicine has lost one of its giants but we, who are left, will always be able to say we knew, and learnt from, one of the finest doctors and colleagues at work in this young specialty to which he gave so much.

By Derek Doyle

The staff, board of IAHPC and members extend their most sincere condolences to Geoff´s wife, family and friends!

From the 2009 IAHPC Newsletter Archives read an article written by Geoffrey Hanks entitled Research in palliative care: we´re making encouraging progress. To view click here

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