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Baral A, Diggs BNA, Greengold J, Foronda C, Anglade D, Camacho-Rivera M, Islam JY, Vidot DC. State of the Science: Health Care Provider Communication of Cannabis Use Among Adults Living with Cancer. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024:10.1007/s13187-024-02484-z. [PMID: 39160419 DOI: 10.1007/s13187-024-02484-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/05/2024] [Indexed: 08/21/2024]
Abstract
Despite medicinal cannabis gaining popularity for managing symptoms in cancer patients, a knowledge gap exists in patient-provider communication crucial for monitoring outcomes, optimizing dosing, and educating healthcare providers to integrate cannabis into treatment plans. Our goal is to understand communication dynamics, identify gaps, and pave the way for effective cannabis communication for individuals living with cancer (PLWC). We searched PubMed, CINAHL, and EBSCO for articles published between 2013 and July 2023, capturing the key concepts of cannabis use in cancer patients and their communication with healthcare providers in oncology settings. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guided the review. Studies were appraised by applying the Johns Hopkins Evidence-Based Practice Model for Nursing and Healthcare Professionals. Of the 2384 articles reviewed, 14 met the inclusion criteria. Three were qualitative studies, and 11 were cross-sectional surveys. All studies were level III evidence. Studies captured patients' and providers' perspectives; five were conducted among cancer patients, and nine were among healthcare providers in oncology settings. Findings revealed variations in healthcare provider recommendations, patient-initiated discussions, and barriers to discussing medical cannabis (MC). The synthesis of this evidence highlights the complexities surrounding MC in oncology settings, including knowledge gaps among healthcare providers, patient-initiated discussions, and challenges in accessing and prescribing medicinal cannabis. This review contributes valuable insights into the current landscape of MC use in cancer care, emphasizing the need for improved communication, education, and support for both patients and healthcare providers.
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Affiliation(s)
- Amrit Baral
- Division of Epidemiology, Department of Public Health Sciences, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, USA.
- Sylvester Comprehensive Cancer Center, Miami, FL, 33136, USA.
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, 33146, USA.
| | - Bria-Necole A Diggs
- Division of Epidemiology, Department of Public Health Sciences, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, USA
- Sylvester Comprehensive Cancer Center, Miami, FL, 33136, USA
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, 33146, USA
| | - Judith Greengold
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, 33146, USA
| | - Cynthia Foronda
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, 33146, USA
| | - Debbie Anglade
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, 33146, USA
| | | | | | - Denise C Vidot
- Division of Epidemiology, Department of Public Health Sciences, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, USA
- Sylvester Comprehensive Cancer Center, Miami, FL, 33136, USA
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, 33146, USA
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Niyangoda D, Muayad M, Tesfaye W, Bushell M, Ahmad D, Samarawickrema I, Sinclair J, Kebriti S, Maida V, Thomas J. Cannabinoids in Integumentary Wound Care: A Systematic Review of Emerging Preclinical and Clinical Evidence. Pharmaceutics 2024; 16:1081. [PMID: 39204426 PMCID: PMC11359183 DOI: 10.3390/pharmaceutics16081081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 08/06/2024] [Accepted: 08/12/2024] [Indexed: 09/04/2024] Open
Abstract
This systematic review critically evaluates preclinical and clinical data on the antibacterial and wound healing properties of cannabinoids in integument wounds. Comprehensive searches were conducted across multiple databases, including CINAHL, Cochrane library, Medline, Embase, PubMed, Web of Science, and LILACS, encompassing records up to May 22, 2024. Eighteen studies met the inclusion criteria. Eleven were animal studies, predominantly utilizing murine models (n = 10) and one equine model, involving 437 animals. The seven human studies ranged from case reports to randomized controlled trials, encompassing 92 participants aged six months to ninety years, with sample sizes varying from 1 to 69 patients. The studies examined the effects of various cannabinoid formulations, including combinations with other plant extracts, crude extracts, and purified and synthetic cannabis-based medications administered topically, intraperitoneally, orally, or sublingually. Four animal and three human studies reported complete wound closure. Hemp fruit oil extract, cannabidiol (CBD), and GP1a resulted in complete wound closure in twenty-three (range: 5-84) days with a healing rate of 66-86% within ten days in animal studies. One human study documented a wound healing rate of 3.3 cm2 over 30 days, while three studies on chronic, non-healing wounds reported an average healing time of 54 (21-150) days for 17 patients by oral oils with tetrahydrocannabinol (THC) and CBD and topical gels with THC, CBD, and terpenes. CBD and tetrahydrocannabidiol demonstrated significant potential in reducing bacterial loads in murine models. However, further high-quality research is imperative to fully elucidate the therapeutic potential of cannabinoids in the treatment of bacterial skin infections and wounds. Additionally, it is crucial to delineate the impact of medicinal cannabis on the various phases of wound healing. This study was registered in PROSPERO (CRD42021255413).
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Affiliation(s)
- Dhakshila Niyangoda
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia; (D.N.); (M.M.); (M.B.)
- Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya 20400, Sri Lanka
| | - Mohammed Muayad
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia; (D.N.); (M.M.); (M.B.)
| | - Wubshet Tesfaye
- School of Pharmacy, Faculty of Health and Behavioural Sciences, University of Queensland, Queensland, QLD 4072, Australia;
| | - Mary Bushell
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia; (D.N.); (M.M.); (M.B.)
| | - Danish Ahmad
- School of Medicine and Psychology, Australian National University, Canberra, ACT 2601, Australia;
| | | | - Justin Sinclair
- Australian Natural Therapeutics Group, Byron Bay, NSW 2481, Australia;
- NICM Health Research Institute, Western Sydney University, Westmead, NSW 2145, Australia
| | - Shida Kebriti
- Eczanes Pharmaceuticals, Rydalmere, NSW 2116, Australia;
| | - Vincent Maida
- Temerity Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada;
- Hospice Vaughan, Woodbridge, ON L4H 3G7, Canada
| | - Jackson Thomas
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia; (D.N.); (M.M.); (M.B.)
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Wang Y, Robinson KR, Fechtel H, Hartog A. Medical Cannabis Use and Its Impact on Health Among Older Adults: Recent Research Findings and Future Directions. CURRENT ADDICTION REPORTS 2023; 10:837-843. [PMID: 38586531 PMCID: PMC10997349 DOI: 10.1007/s40429-023-00519-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 04/09/2024]
Abstract
Purpose of Review With the rapidly changing landscape of state level legalization of cannabis, older adults have become one of the fastest growing populations seeking medical cannabis (MC). However, research evidence on the risks and benefits of MC use in this population remains limited. This review aims to synthesize recent literature on the impacts of MC use in older adults and identify critical knowledge gaps to be addressed in future research. Recent Findings Recent literature showed that older adults often face financial and/or educational barriers and stigma associated with MC access. Emerging data showed that MC may have therapeutic effects on symptoms of conditions such as chronic pain, insomnia, anxiety/depression, dementia, nausea, and vomiting. However, available evidence is inconsistent and tends to rely on self-report and uncontrolled studies. While some adverse events associated with MC use were reported, it is generally well tolerated in older adults. Neurocognitive and psychological consequences and cardiovascular risks have been reported but again only in limited studies with inconsistent findings. Summary There is a need for more systematic and rigorous research on MC in older adults to determine its safety and efficacy. Research on dosing procedures and product characteristics, as well as how these may impact health outcomes, is crucial. More consistent evidence is needed to inform policy changes and patient/physician education to minimize potential risks and optimize benefits among older adults seeking MC as an alternative treatment.
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Affiliation(s)
- Yan Wang
- Department of Epidemiology, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, USA
| | - Kendall R. Robinson
- Department of Epidemiology, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, USA
| | - Hannah Fechtel
- Department of Epidemiology, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, USA
| | - Alexis Hartog
- Department of Biology, University of Florida, 2004 Mowry Rd, Gainesville, FL 32610, USA
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Smith A, Olson RE, da Costa NC, Cuerton M, Hardy J, Good P. Quality of life beyond measure: Advanced cancer patients, wellbeing and medicinal cannabis. SOCIOLOGY OF HEALTH & ILLNESS 2023; 45:1709-1729. [PMID: 37283094 PMCID: PMC10946949 DOI: 10.1111/1467-9566.13684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/09/2023] [Indexed: 06/08/2023]
Abstract
Experiences of advanced cancer are assembled and (re)positioned with reference to illness, symptoms and maintaining 'wellbeing'. Medical cannabis is situated at a borderline in this and the broader social domain: between stigmatised and normalised; recreational and pharmaceutical; between perception, experience, discourse and scientific proof of benefit. Yet, in the hyper-medicalised context of randomised clinical trials (RCTs), cancer, wellbeing and medical cannabis are narrowly assessed using individualistic numerical scores. This article attends to patients' perceptions and experiences at this borderline, presenting novel findings from a sociological sub-study embedded within RCTs focused on the use of medical cannabis for symptom relief in advanced cancer. Through a Deleuzo-Guattarian-informed framework, we highlight the fragmentation and reassembling of bodies and propose body-situated experiences of wellbeing in the realm of advanced cancer. Problematising 'biopsychosocial' approaches that centre an individualised disconnected patient body in understandings of wellbeing, experiences of cancer and potential treatments, our findings foreground relational affect and embodied experience, and the role of desire in understanding what wellbeing is and can be. This also underpins and enables exploration of the affective reassembling ascribed to medical cannabis, with particular focus on how it is positioned within RCTs.
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Affiliation(s)
- Alexandra Smith
- School of Social ScienceThe University of QueenslandBrisbaneQueenslandAustralia
| | - Rebecca E. Olson
- School of Social ScienceThe University of QueenslandBrisbaneQueenslandAustralia
| | - Nathalia Cordeiro da Costa
- School of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneQueenslandAustralia
- School of Public HealthThe University of SydneySydneyNew South WalesAustralia
| | - Maddison Cuerton
- School of Social ScienceThe University of QueenslandBrisbaneQueenslandAustralia
| | - Janet Hardy
- Department of Palliative and Supportive Care Mater Health ServicesMater Research‐University of QueenslandSouth BrisbaneQueenslandAustralia
| | - Philip Good
- Department of Palliative and Supportive Care Mater Health ServicesMater Research‐University of QueenslandSouth BrisbaneQueenslandAustralia
- Department of Palliative CareSt. Vincent's Private Hospital BrisbaneBrisbaneQueenslandAustralia
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Kueppers G, Huang G, Dean D, Ciccolo JT, Vanderpool RC. Understanding Cannabis-Related Information Needs: An Analysis of Inquiries to the National Cancer Institute's Cancer Information Service. Cannabis Cannabinoid Res 2023. [PMID: 37856770 DOI: 10.1089/can.2023.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
Purpose: Given increased cannabis use for medical and nonmedical purposes alike, there is growing public interest related to the potential risks and benefits of cannabis use, particularly related to cancer. The purpose of this descriptive study was to analyze cannabis inquiries to the National Cancer Institute's Cancer Information Service (CIS). Materials and Methods: From September 2018 to June 2023, 190,070 noncannabis and 425 cannabis inquiries were documented by the CIS. Cannabis inquiries were delineated into two categories: nonmedical cannabis (NMC, n=240) or medical cannabis (MC, n=185). Chi-square tests were performed to determine differences between noncannabis and cannabis inquiries and descriptive analyses were used to identify patterns within cannabis-specific inquiries. Results: Statistically significant differences between noncannabis and cannabis inquiries were observed. In addition, there were variations in MC and NMC inquiries. For example, 73% of MC inquiries originated from cancer survivors and caregivers, whereas almost half of NMC inquiries (48%) were from individuals identifying as tobacco users. MC and NMC inquiries also differed by CIS access channel (e.g., instant chat, telephone), language used (English vs. Spanish), discussions of cancer continuum phases and cancer sites, and referrals provided to individuals for additional information and resources. Conclusion: Cannabis-related information needs of the public-as documented by the CIS-varied by several factors. Health information sources such as the CIS can help address cannabis-related questions and concerns, while noting differences in who is inquiring, how, and why.
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Affiliation(s)
- George Kueppers
- Behavioral Research Program, National Cancer Institute, Rockville, Maryland, USA
| | - Grace Huang
- Public Health and Epidemiology, Westat, Rockville, Maryland, USA
| | - David Dean
- Behavioral Research Program, National Cancer Institute, Rockville, Maryland, USA
| | - Joseph T Ciccolo
- Behavioral Research Program, National Cancer Institute, Rockville, Maryland, USA
| | - Robin C Vanderpool
- Behavioral Research Program, National Cancer Institute, Rockville, Maryland, USA
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Waissengrin B, Leshem Y, Taya M, Meiri D, Merimsky O, Shamai S, Wolf I, Rubinek T. The use of medical cannabis concomitantly with immune checkpoint inhibitors in non-small cell lung cancer: A sigh of relief? Eur J Cancer 2023; 180:52-61. [PMID: 36535195 DOI: 10.1016/j.ejca.2022.11.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/02/2022] [Accepted: 11/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The use of medical cannabis has rapidly increased among cancer patients worldwide. Cannabis is often administered concomitantly with cancer medications, including immune checkpoint inhibitors (ICIs). As the cannabinoid receptors are abundantly expressed and modulate immune cells, it has been hypothesised that cannabis may attenuate the activity of ICIs. We aimed to assess the effect of cannabis on ICIs' efficiency in patients having non-small cell lung cancer (NSCLC). METHOD The murine model of CT26 tumour-bearing mice treated with an anti-PD-1 antibody and Δ9-tetrahydrocannabinol (THC) was used to evaluate the interaction between THC and ICIs in vivo. Correlation between use of medical cannabis and clinical outcome was evaluated in a cohort of 201 consecutive metastatic NSCLC patients treated with monotherapy pembrolizumab as a first-line treatment. RESULTS Median overall survival (OS) of the mice receiving a control vehicle, THC, anti-PD-1 antibody or their combination was 21, 24, 31 and 54 days, respectively (p < 0.05 for the combination treatment compared to a control vehicle), indicating that THC did not reduce the efficacy of anti-PD-1 therapy. Of 201 NSCLC patients treated with first-line monotherapy pembrolizumab for metastatic disease, 102 (50.7%) patients received licence for cannabis within the first month of treatment. Cannabis-treated patients were younger compared to the cannabis naïve patients (median age 68 versus 74, p = 0.003), with female predominance (62, 60.8% versus 34, 34.3%, p = 0.002) and with more prevailing brain metastasis (15.7% versus 5%, p = 0.013). Similar distribution of histology, smoking status, ECOG (Eastern Cooperative Oncology Group) and programmed death-ligand 1 expression was noted between the groups. Liver metastases were marginally significant (19.6% versus 10.1%, p = 0.058). The most common indication for cannabis was pain (71%) followed by loss of appetite (34.3%). Time to tumour progression was similar for cannabis-naive and cannabis-treated patients (6.1 versus 5.6 months, respectively, 95% confidence interval, 0.82 to 1.38, p = 0.386), while OS was numerically higher in the cannabis-naive group (54.9 versus 23.6 months) but did not reach statistical significance (95% confidence interval 0.99 to 2.51, p = 0.08). In multivariate analyses, we did not identify cannabis use as an independent predictor factor for mortality. CONCLUSIONS Preclinical and clinical data suggest no deleterious effect of cannabis on the activity of pembrolizumab as first-line monotherapy for advanced NSCLC. The differences in OS can most likely be attributed to higher disease burden and more symptomatic disease in the cannabis-treated group. These data provide reassurance regarding the absence of a deleterious effect of cannabis in this clinical setting.
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Affiliation(s)
- Barliz Waissengrin
- Oncology Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv, Israel
| | - Yasmin Leshem
- Oncology Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Weizmann Institute of Science, Rehovot, Israel
| | - Marwa Taya
- Oncology Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv, Israel
| | - David Meiri
- Faculty of Biology, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ofer Merimsky
- Oncology Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv, Israel
| | - Sivan Shamai
- Oncology Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv, Israel
| | - Ido Wolf
- Oncology Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv, Israel.
| | - Tami Rubinek
- Oncology Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv, Israel
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Olson RE, Smith A, Huggett G, Good P, Dudley M, Hardy J. Using a qualitative sub-study to inform the design and delivery of randomised controlled trials on medicinal cannabis for symptom relief in patients with advanced cancer. Trials 2022; 23:752. [PMID: 36064621 PMCID: PMC9444122 DOI: 10.1186/s13063-022-06691-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/24/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Recruitment for randomised controlled trials in palliative care can be challenging; disease progression and terminal illness underpin high rates of attrition. Research into participant decision-making in medicinal cannabis randomised controlled trials (RCTs) is very limited. Nesting qualitative sub-studies within RCTs can identify further challenges to participation, informing revisions to study designs and recruitment practices. This paper reports on findings from a qualitative sub-study supporting RCTs of medicinal cannabis for symptom burden relief in patients with advanced cancer in one Australian city. METHODS Semi-structured qualitative interviews were conducted with 48 patients with advanced cancer, eligible to participate in a medicinal cannabis RCT (n=28 who consented to participate in an RCT; n=20 who declined). An iterative and abductive approach to thematic analysis and data collection fostered exploration of barriers and enablers to participation. RESULTS Key enablers included participants' enthusiasm and expectations of medicinal cannabis as beneficial (to themselves and future patients) for symptom management, especially after exhausting currently approved options, and a safer alternative to opioids. Some believed medicinal cannabis to have anti-cancer effects. Barriers to participation were the logistical challenges of participating (especially due to driving restrictions and fatigue), reluctance to interfere with an existing care plan, cost, and concerns about receiving the placebo and the uncertainty of the benefit. Some declined due to concerns about side-effects or a desire to continue accessing cannabis independent of the study. CONCLUSIONS The findings support revisions to subsequent medicinal cannabis RCT study designs, namely, omitting a requirement that participants attend weekly hospital appointments. These findings highlight the value of embedding qualitative sub-studies into RCTs. While some challenges to RCT recruitment are universal, others are context (population, intervention, location) specific. A barrier to participation found in research conducted elsewhere-stigma-was not identified in the current study. Thus, findings have important implications for those undertaking RCTs in the rapidly developing context of medical cannabis.
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Affiliation(s)
- Rebecca E Olson
- School of Social Science, The University of Queensland, Michie Building #9, St Lucia, QLD, 4072, Australia.
| | - Alexandra Smith
- School of Social Science, The University of Queensland, Michie Building #9, St Lucia, QLD, 4072, Australia
| | - Georgie Huggett
- Department of Palliative and Supportive Care Mater Health Services, Mater Research-University of Queensland, Raymond Terrace, South Brisbane, QLD, Australia
| | - Phillip Good
- Department of Palliative and Supportive Care Mater Health Services, Mater Research-University of Queensland, Raymond Terrace, South Brisbane, QLD, Australia
- Department of Palliative Care, St. Vincent's Private Hospital Brisbane, 411 Main Street, Kangaroo Point, QLD, Australia
| | - Morgan Dudley
- School of Social Science, The University of Queensland, Michie Building #9, St Lucia, QLD, 4072, Australia
| | - Janet Hardy
- Department of Palliative and Supportive Care Mater Health Services, Mater Research-University of Queensland, Raymond Terrace, South Brisbane, QLD, Australia
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Vinette B, Côté J, El-Akhras A, Mrad H, Chicoine G, Bilodeau K. Routes of administration, reasons for use, and approved indications of medical cannabis in oncology: a scoping review. BMC Cancer 2022; 22:319. [PMID: 35331185 PMCID: PMC8953058 DOI: 10.1186/s12885-022-09378-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/07/2022] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Some patients diagnosed with cancer use medical cannabis to self-manage undesirable symptoms, including nausea and pain. To improve patient safety and oncological care quality, the routes of administration for use of medical cannabis, patients' reasons, and prescribed indications must be better understood. METHODS Based on the Joanna Briggs Institute guidelines, a scoping review was conducted to map the current evidence regarding the use of medical cannabis in oncological settings based on the experiences of patients diagnosed with cancer and their healthcare providers. A search strategy was developed with a scientific librarian which included five databases (CINAHL, Web of Science, Medline, Embase, and PsycINFO) and two grey literature sources (Google Scholar and ProQuest). The inclusion criteria were: 1) population: adults aged 18 and over diagnosed with cancer; 2) phenomena of interest: reasons for cannabis use and/or the prescribed indications for medical cannabis; 3) context: oncological setting. French- or English-language primary empirical studies, knowledge syntheses, and grey literature published between 2000 and 2021 were included. Data were extracted by two independent reviewers and subjected to a thematic analysis. A narrative description approach was used to synthesize and present the findings. RESULTS We identified 5,283 publications, of which 163 met the eligibility criteria. Two main reasons for medical cannabis use emerged from the thematic analysis: limiting the impacts of cancer and its side effects; and staying connected to others. Our results also indicated that medical cannabis is mostly used for three approved indications: to manage refractory nausea and vomiting, to complement pain management, and to improve appetite and food intake. We highlighted 11 routes of administration for medical cannabis, with oils and oral solutions the most frequently reported. CONCLUSION Future studies should consider the multiple routes of administration for medical cannabis, such as inhalation and edibles. Our review highlights that learning opportunities would support the development of healthcare providers' knowledge and skills in assessing the needs and preferences of patients diagnosed with cancer who use medical cannabis.
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Affiliation(s)
- Billy Vinette
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada.
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada.
- Quebec Network On Nursing Intervention Research, Montreal, QC, Canada.
- Center for Innovation in Nursing Education, Montreal, QC, Canada.
| | - José Côté
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada
- Quebec Network On Nursing Intervention Research, Montreal, QC, Canada
- Research center of the Montreal University Hospital Center, Montreal, QC, Canada
| | - Ali El-Akhras
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
| | - Hazar Mrad
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
| | - Gabrielle Chicoine
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada
- Quebec Network On Nursing Intervention Research, Montreal, QC, Canada
- Center for Innovation in Nursing Education, Montreal, QC, Canada
- Research center of the Montreal University Hospital Center, Montreal, QC, Canada
| | - Karine Bilodeau
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
- Quebec Network On Nursing Intervention Research, Montreal, QC, Canada
- Center for Innovation in Nursing Education, Montreal, QC, Canada
- Research center of the Montreal University Hospital Center, Montreal, QC, Canada
- Research Center of the Centre Intégré Universitaire de Santé Et de Services Sociaux de L'Est-de-L'Île-de-Montréal, Montreal, QC, Canada
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9
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Uber A, Ebelhar JS, Lanzel AF, Roche A, Vidal-Anaya V, Brock KE. Palliative Care in Pediatric Oncology and Hematopoietic Stem Cell Transplantation. Curr Oncol Rep 2022; 24:161-174. [DOI: 10.1007/s11912-021-01174-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 12/18/2022]
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10
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Philip J, Panozzo S, Collins A, Weil J, Whyte J, Barton M, Coperchini M, Rametta M, Le B. Fact versus fiction: bridging contrasting medicinal cannabis information needs. Intern Med J 2021; 51:975-979. [PMID: 34155769 DOI: 10.1111/imj.15361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/11/2020] [Accepted: 11/19/2020] [Indexed: 11/27/2022]
Abstract
Regulatory changes now permit the availability and prescribing of medicinal cannabis in Australia. Public awareness and patient interest are high. Using a co-design approach involving cancer patients, carers and oncology and palliative care clinicians, two information resources were developed to provide readily available sources of important information for cancer patients and clinicians who are considering the use of medicinal cannabis. Focus groups and evaluation interviews revealed some areas of dissonance between consumers and clinicians concerning aspects of medicinal cannabis.
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Affiliation(s)
- Jennifer Philip
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Palliative Nexus, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Parkville Integrated Palliative Care Service, Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Stacey Panozzo
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Palliative Nexus, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Parkville Integrated Palliative Care Service, Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Anna Collins
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Palliative Nexus, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Jennifer Weil
- Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Jan Whyte
- Western and Central Melbourne Integrated Cancer Service, Melbourne, Victoria, Australia
| | - Michael Barton
- Western and Central Melbourne Integrated Cancer Service, Melbourne, Victoria, Australia
| | | | - Meri Rametta
- Parkville Integrated Palliative Care Service, Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Brian Le
- Parkville Integrated Palliative Care Service, Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Oldfield K, Eathorne A, Tewhaiti-Smith J, Beasley R, Semprini A, Braithwaite I. Experiences, patient interactions and knowledge regarding the use of cannabis as a medicine in a cohort of New Zealand doctors in an oncology setting. Postgrad Med J 2020; 98:35-42. [PMID: 33218966 DOI: 10.1136/postgradmedj-2020-139013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/12/2020] [Accepted: 10/20/2020] [Indexed: 11/03/2022]
Abstract
PURPOSE OF STUDY To explore the experiences, patient interactions and knowledge regarding the use of cannabis as a medicine in New Zealand doctors in an oncology setting. STUDY DESIGN An observational cross-sectional survey undertaken between November 2019 and January 2020 across four secondary-care hospital oncology departments within New Zealand (Auckland, Wellington, Christchurch and Dunedin). Participants were a convenience sample of doctors; consultants, registrars, medical officers of special status and house surgeons working in oncology departments. Of 53 individuals approached, 45 participated (85% Response Rate). The primary outcome was reporteddoctor-patient interactions. Secondary outcomes included knowledge of cannabis-based products, their efficacy, prescribing regulations and educational access. RESULTS Of 44 doctors, 37 (84%, 95% CI: 70 to 93) reported patient requests to prescribe cannabis-based products and 43 (98%, 95% CI: 88 to 100) reported patients using illicit cannabis for medical symptoms. Primary request reasons were pain, nausea/vomiting and cancer treatment. 33/45 (73%, 95% CI: 58 to 85) cited knowledge of at least one cannabis-based product and 27/45 (60%, 95% CI: 44 to 74) indicated at least one condition that had evidence of efficacy. 36/44 (82%, 95% CI: 67 to 92) expressed future prescribing concerns but all were willing to use a cannabis-based product developed with traditional medical provenance. CONCLUSION In the oncology setting, patients are asking doctors about symptomatic and curative treatment with cannabis-based products. Doctors are not biased against the use of products showing medical provenance; however, NZ-specific clinical and regulatory guidelines are essential to support patient discussions and appropriate prescribing.
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Affiliation(s)
- Karen Oldfield
- Medical Research Institute of New Zealand, Wellington, New Zealand .,School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand
| | - Allie Eathorne
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | | | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand.,School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand
| | - Alex Semprini
- Medical Research Institute of New Zealand, Wellington, New Zealand.,School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand
| | - Irene Braithwaite
- School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand
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Rajasekhara S, Portman DG, Chang YD, Haas MF, Randich AL, Bromberg HS, Rashid S, Donovan KA. Rate of cannabis use in older adults with cancer. BMJ Support Palliat Care 2020; 12:178-181. [PMID: 33177114 DOI: 10.1136/bmjspcare-2020-002384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/02/2020] [Accepted: 10/16/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Older adults with cancer are increasingly inquiring about and using cannabis. Despite this, few studies have examined cannabis use in patients with cancer aged 65 years and older as a separate group and identified characteristics associated with use. The current study sought to determine the rate of cannabis use in older adult patients with cancer and to identify demographic and clinical correlates of use. METHODS We conducted a retrospective review of patients with cancer referred for specialised symptom management between January 2014 and May 2017 who underwent routine urine drug testing for tetrahydrocannabinol as part of their initial clinic visit. RESULTS Approximately 8% (n=24) of patients with cancer aged 65 years and older tested positive for tetrahydrocannabinol compared with 30% (n=51) of young adults and 21% (n=154) of adults. At the univariate level, more cannabis users had lower performance status than non-users (p=0.02, Fisher's exact test). There were no other demographic and clinical characteristics significantly associated with cannabis use in older adults. CONCLUSIONS Older adult patients made up nearly 25% (n=301) of the total sample and had a rate of cannabis use of 8%. As one of the first studies to assess cannabis use via objective testing rather than self-report, this study adds significantly to the emerging literature on cannabis use in people aged 65 years and older. Findings suggest the rate of use in older adults living with cancer is higher than that among older adults in the general population.
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Affiliation(s)
- Sahana Rajasekhara
- Department of Supportive Care Medicine, Moffitt Cancer Center, Tampa, Florida, USA
| | - Diane G Portman
- Department of Supportive Care Medicine, Moffitt Cancer Center, Tampa, Florida, USA
| | - Young D Chang
- Department of Supportive Care Medicine, Moffitt Cancer Center, Tampa, Florida, USA
| | - Meghan F Haas
- Department of Supportive Care Medicine, Moffitt Cancer Center, Tampa, Florida, USA
| | - Anthony L Randich
- Department of Supportive Care Medicine, Moffitt Cancer Center, Tampa, Florida, USA
| | - Hannah S Bromberg
- Department of Supportive Care Medicine, Moffitt Cancer Center, Tampa, Florida, USA
| | - Saima Rashid
- Department of Supportive Care Medicine, Moffitt Cancer Center, Tampa, Florida, USA
| | - Kristine A Donovan
- Department of Supportive Care Medicine, Moffitt Cancer Center, Tampa, Florida, USA
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