Medical Cannabis Use in Glioma Patients Treated at a Comprehensive Cancer Center in Florida

A Scoping Review of Observational Research on Cannabis Use for Symptom Management in HIV and Cancer: Implications for Cannabis Nursing

BACKGROUND

People with HIV have a higher risk of developing non-AIDS-defining cancers in older age, leading to a significant population living with two conditions, HIV and cancer. There is an increasing interest in cannabis use for symptom management in people with chronic conditions; in 2023, the American Nurses Association officially recognised cannabis nursing as a specialty nursing practice focusing on the care of individuals seeking education/guidance in the therapeutic use of cannabis, supporting the urgency of its research. However, the scientific literature lacks a synthesised review in the focused populations.

AIM

To explore observational research on cannabis use for symptom management among people with HIV and/or cancer and identify gaps in current knowledge to inform future research and policy development.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist, a literature search of relevant articles was conducted in the databases PubMed (n = 552), PsycInfo (n = 204), CINAHL (n = 164) and Embase (n = 976). Upon screening 1738 articles, 142 were identified for full-text review and 51 were retained for data extraction.

RESULTS

There were more studies evaluating cannabis use among people with cancer than with HIV and no studies among people living with comorbid HIV and cancer. Most studies were cross-sectional with limited metrics on the perceived effectiveness and safety of cannabis use for symptom management and its dosing/mode of delivery for reducing symptoms. While studies focused on cannabis therapy under the provision of healthcare providers, individuals reported obtaining information about cannabis from friends/family/the Internet.

IMPLICATIONS FOR CANNABIS NURSING

This body of research could be strengthened by rigorous longitudinal study designs to build causal relationships on the therapeutic effects of cannabis use and the inclusion of reliable and valid symptom assessment measures over time, which facilitates developing clinical practice guidance and policymaking in cannabis nursing.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Adverse events associated with the use of cannabis-based products in people living with cancer: a systematic scoping review

PURPOSE

To summarise the extent and type of evidence in relation to adverse events (AEs) associated with the use of cannabis-based products (CBP) in people living with cancer.

METHODS

The Joanna Briggs Institute (JBI) methodology for scoping reviews was applied. A search was performed in MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Scopus, Web of Science Core Collections and AMED (Ovid) from their inception to 7 May 2023. Primary studies reporting AEs associated with any form of natural or synthetic CBP use in any cancer care setting and location were included.

RESULTS

One hundred fifty-two studies were included, with the most prevalent being randomised controlled trials (RCTs) (n = 61), followed by non-randomised controlled trials (n = 26) and case reports (n = 23). CBP was mainly used in gastrointestinal, liver, or peritoneal cancer (n = 98) and haematological or lymphoid cancer (n = 92), primarily to manage nausea and vomiting (n = 78) and cancer pain (n = 37). The most common CBP ingredients were combinations of THC and CBD (n = 69), synthetic THC (n = 47), single compounds of THC (n = 42) and CBD (n = 16) with diverse forms, administration routes and doses. The primary methods of administration were oral (n = 94) and inhalation (n = 54). A broad range of AEs were reported; the most common were related to the nervous system (n = 118), psychiatric (n = 101) and gastrointestinal system (n = 81). Diverse patient characteristics, significant under-reporting and low-quality reporting were observed in many studies.

CONCLUSIONS

More rigorous research designs that prioritise comprehensive, standardised reporting of AEs and CBP use are required to fully elucidate the safety profile of CBP use in cancer care.

Perception and Utilization of Cannabinoids in Patients Undergoing Radiation Treatment: Our Patients Are Curious

PURPOSE

Limited studies have described the utilization of cannabinoids among patients with cancer. This survey study aimed to characterize utilization patterns and perceptions of cannabinoid use for treatment-related side effects among patients receiving radiation treatment.

METHODS AND MATERIALS

This was an anonymous survey study of patients who were undergoing or recently completed radiation treatment at a comprehensive cancer center. Data on cannabinoid use during cancer treatment, reasons for the use of cannabinoids, perceived effects of cannabinoids, and formulations of usage were collected and summarized using descriptive statistics.

RESULTS

Of the 431 respondents, 111 (25.8%) patients reported cannabinoid use since their cancer diagnosis. Among the cannabinoid users, a majority (73.9%) experienced improvement in symptoms; 38.7% had better relief of cancer-treatment symptoms from cannabinoids in comparison to their prescription medications, and 16.2% lowered the amount of prescription pain medications needed after using cannabinoids. Cannabinoids appeared to be most effective in helping patients manage sleep (76.6%) and anxiety (72.1%). When asked about whether physicians should be discussing cannabinoid use, 45.1% of cannabinoid users wanted to speak with their doctors regarding its utilization. For patients who did not report cannabinoid use, a large majority (83.1%) never had discussions with their doctors regarding its utilization as part of their cancer care, and 34.8% wanted to learn more about cannabinoids from their doctors.

CONCLUSIONS

About 1 in 4 patients with cancer reported cannabinoid use to assist in symptom control. A majority had subjective alleviation of treatment-related symptoms from cannabinoid use. Regardless of cannabinoid use, a sizable percentage of patients never had any discussions about cannabinoids with their oncologists, with some expressing interest in learning more. Guidelines are needed to assist radiation oncologists on how cannabinoids may play a role in caring for patients.

Patient-provider communication about the use of medical cannabis for cancer symptoms: a cross-sectional study

BACKGROUND

There has been limited study regarding patient-provider communication about medical cannabis for cancer symptom management. To address this gap, this study assesses the determinants and prevalence of patient-provider communication about the use of medical cannabis for cancer symptoms at a National Cancer Institute-designated Comprehensive Cancer Center.

METHODS

Individuals who completed cancer treatment from July 2017 to December 2019 were invited to participate in a survey regarding medical cannabis. An electronic survey was administered in English and Spanish from August to November 2021 and completed by 1592 individuals (response rate = 17.6%).

RESULTS

About one-third (33.5%) of participants reported discussing medical cannabis for cancer symptom management with a health-care provider. Controlling for other factors, individuals with malnutrition and/or cachexia had higher odds (odds ratio [OR] = 2.30, 95% confidence interval [CI] = 1.50 to 3.53) of reporting patient-provider discussions compared with individuals without malnutrition and/or cachexia. Similarly, individuals with nausea had higher odds (OR = 1.94, 95% CI = 1.44 to 2.61) of reporting patient-provider discussions compared with individuals without nausea. A smaller percentage (15.6%) of participants reported receiving a recommendation for medical cannabis for cancer symptom management. Among individuals who reported using cannabis, a little over one-third (36.1%) reported not receiving instructions from anyone on how to use cannabis or determine how much to take.

CONCLUSIONS

Overall, our study suggests that patient-provider communication about medical cannabis for cancer symptom management is limited. As interest and use of medical cannabis continues to grow among cancer patients, there is a need to ensure patients have access to high quality patient-provider communication.

Perceptions and engagement of patients with chronic conditions on the use of medical cannabis: a scoping review

CONTEXT

Studies generally focus on one type of chronic condition and the effect of medical cannabis (MC) on symptoms; little is known about the perceptions and engagement of patients living with chronic conditions regarding the use of MC.

OBJECTIVES

This scoping review aims to explore: (1) what are the dimensions addressed in studies on MC that deal with patients' perceptions of MC? and (2) how have patients been engaged in developing these studies and their methodologies? Through these objectives, we have identified areas for improving future research.

METHODS

We searched five databases and applied exclusion criteria to select relevant articles. A thematic analysis approach was used to identify the main themes: (1) reasons to use, to stop using or not to use MC, (2) effects of MC on patients themselves and empowerment, (3) perspective and knowledge about MC, and (4) discussion with relatives and healthcare professionals.

RESULTS

Of 53 articles, the main interest when assessing the perceptions of MC is to identify the reasons to use MC (n = 39), while few articles focused on the reasons leading to stop using MC (n = 13). The majority (85%) appraise the effects of MC as perceived by patients. Less than one third assessed patients' sense of empowerment. Articles determining the beliefs surrounding and knowledge of MC (n = 41) generally addressed the concerns about or the comfort level with respect to using MC. Only six articles assessed patients' stereotypes regarding cannabis. Concerns about stigma constituted the main topic while assessing relationships with relatives. Some articles included patients in the research, but none of them had co-created the data collection tool with patients.

CONCLUSIONS

Our review outlined that few studies considered chronic diseases as a whole and that few patients are involved in the co-construction of data collection tools as well. There is an evidence gap concerning the results in terms of methodological quality when engaging patients in their design. Future research should evaluate why cannabis' effectiveness varies between patients, and how access affects the decision to use or not to use MC, particularly regarding the relationship between patients and healthcare providers. Future research should consider age and gender while assessing perceptions and should take into consideration the legislation status of cannabis as these factors could in fact shape perception. To reduce stigma and stereotypes about MC users, better quality and accessible information on MC should be disseminated.

Palliative Care in Neuro-oncology

Historically, the practice of neurology as an independent subspecialty from internal medicine began in Europe and the United States in the 1930s. The American Academy of Neurology (AAN) was founded 75 years ago in 1948, solidifying its emergence as a stand-alone discipline of medicine. In 1967, St. Christopher's Hospice, the first free standing hospice home, was opened in London by Dame Cicely Saunders. Dame Saunders is considered a pioneer in the development of the hospice movement, and she embodies the importance of the multi-disciplinary team in the care of the patient, as she began her career as a nurse, then became a social worker and, finally, a physician. A decade later, in 1978, Dr. Balfour Mount, a Canadian urologic cancer surgeon, coined the term "palliative care" ("to improve the quality of life") after having spent time with Dr. Saunders at St. Christopher's some years earlier. The field of palliative care continued to develop as a distinct subspecialty focused on improving quality of life for patients at any age and in any stage of serious illness. In a 1996 position statement, the AAN made clear that the practice of primary palliative care is the responsibility of all neurologists to their patients. Finally, coming full circle, the specialty of neuro-palliative care, a subspecialty not just of neurology but of palliative medicine, became established around 2018. Neuro-palliative care can be seen as a specialty focusing on the holistic approach to symptom management in patients suffering from neurologic disease with the aim of improved symptom control and attention to the psychologic and spiritual aspects of illness.

Cannabis use among cancer patients and survivors in the United States: a systematic review

BACKGROUND

How cannabis products are being used by cancer patients and survivors in the United States is poorly understood. This study reviewed observational data to understand the modes, patterns, reasons, discontinuation, and adverse experiences of cannabis use.

METHODS

PubMed and PsycINFO database searches were conducted between May 2022 and November 2022. Of the 1162 studies identified, 27 studies met the inclusion criteria. The intercoder agreement was strong (0.81).

RESULTS

The majority (74%) of the studies were cross-sectional in design. Study samples were approximately equal proportions of men and women and majority White participants. The prevalence of cannabis use based on national samples ranged between 4.8% and 22%. The most common modes of cannabis intake were topical application (80%), smoking (73%), vaping (12%), and ingestion of edible products (10%). Younger age, male gender, being a current or former smoker, and higher socioeconomic status were associated with greater likelihood of cannabis use. The main motive for cannabis use was management of symptoms due to cancer or cancer treatment such as pain, nausea, lack of sleep, and anxiety. A majority of the participants across studies reported that cannabis helped reduce these symptoms. Lack of symptom improvement, side effects such as fatigue and paranoia, cost, and social stigma were identified as some of the reasons for discontinuing cannabis use.

CONCLUSIONS

It appears that cannabis may help cancer patients and survivors manage symptoms. However, more longitudinal studies are needed to determine whether positive experiences of cannabis use outweigh adverse experiences over time in this vulnerable population.

A Novel Detection of Cerebrovascular Disease using Multimodal Medical Image Fusion

BACKGROUND

Diseases are medical situations that are allied with specific signs and symptoms. A disease may be instigated by internal dysfunction or external factors like pathogens. Cerebrovascular disease can progress from diverse causes, comprising thrombosis, atherosclerosis, cerebral venous thrombosis, or embolic arterial blood clot.

OBJECTIVE

In this paper, authors have proposed a robust framework for the detection of cerebrovascular diseases employing two different proposals which were validated by use of other datasets.

METHODS

In proposed model 1, the Discrete Fourier transform is used for the fusion of CT and MR images which was classified them using machine learning techniques and pre-trained models while in proposed model 2, the cascaded model was proposed. The performance evaluation parameters like accuracy and losses were evaluated.

RESULTS

92% accuracy was obtained using Support Vector Machine using Gray Level Difference Statistics and Shape features with Principal Component Analysis as a feature selection technique while Inception V3 resulted in 95.6% accuracy while the cascaded model resulted in 96.21% accuracy.

CONCLUSION

The cascaded model is later validated on other datasets which results in 0.11% and 0.14% accuracy improvement over TCIA and BRaTS datasets respectively.

Prevalence, reasons for use, perceived benefits, and awareness of health risks of cannabis use among cancer survivors - implications for policy and interventions

BACKGROUND

There is increasing discourse on the use of cannabis as a palliative for cancer/cancer-treatment-related symptoms. We described the prevalent reasons for use, perceived benefits, and awareness of health risks from cannabis use for cancer management among cancer survivors.

METHODS

Cross-sectional survey of adult (≥ 18 years) cancer survivors from 41 US states receiving treatment at a comprehensive cancer center.

RESULTS

Of 1,886 cancer survivors included, 17.4% were current users, 30.5% were former users, and 52.2% were never users of cannabis. Among survivors who currently or formerly used cannabis after their cancer diagnosis (n = 510), the reasons for cannabis use in cancer management were; sleep disturbance (60%), pain (51%), stress (44%), nausea (34%), and mood disorder/depression (32%). Also, about a fifth (91/510) of survivors used cannabis to treat their cancer. Across the different symptoms assessed, over half of the survivors who reported a reason for using cannabis currently or after their cancer diagnosis perceived that cannabis was helpful to a great extent in improving their symptoms. However, of the 167 survivors who reported awareness of potential health risks from cannabis use, the awareness of adverse health risks associated with cannabis use was low: suicidal thoughts (5%), intense nausea and vomiting (6%), depression (11%), anxiety (14%), breathing problems (31%), and interaction with cancer drugs (35%).

CONCLUSION

Prevalence of cannabis use among survivors was notable, with most reporting a great degree of symptomatic improvement for the specified reason for use. However, only a few were aware of the health risks of cannabis use during cancer management.

IMPLICATIONS FOR CANCER SURVIVORS

With more cancer survivors using cannabis as a palliative in managing their cancer-related symptoms, future guidelines and policies on cannabis use in cancer management should incorporate cannabis-based interventions to minimize the inadvertent harm from cannabis use during cancer treatment among survivors.

Cannabis use among recently treated cancer patients: perceptions and experiences

PURPOSE

To characterize cannabis use among cancer patients, we aimed to describe 1) patterns of cannabis use across multiple cancer sites; 2) perceived goals, benefits, harms of cannabis; and 3) communication about cannabis.

METHODS

Patients with 9 different cancers treated at Memorial Sloan Kettering Cancer Center between March and August 2021 completed an online or phone survey eliciting cannabis use, attitudes, and communication about cannabis. Multivariable logistic regression estimated the association of cancer type and cannabis use, adjusting for sociodemographic characteristics and prior cannabis use.

RESULTS

Among 1258 respondents, 31% used cannabis after diagnosis, ranging from 25% for lung cancer to 59% for testicular cancer. Characteristics associated with cannabis use included younger age, lower education level, and cancer type. In multivariable analysis, compared to lung cancer patients, gastrointestinal cancer patients were more likely to use cannabis (odds ratio [OR] 2.64, 95% confidence interval [CI] 1.25-5.43). Cannabis use in the year prior to diagnosis was strongly associated with cannabis use after diagnosis (OR 19.13, 95% CI 11.92-30.72). Among users, reasons for use included difficulty sleeping (48%); stress, anxiety, or depression (46%); and pain (42%). Among respondents who used cannabis to improve symptoms, 70-90% reported improvement; < 5% reported that any symptom worsened. Only 25% discussed cannabis with healthcare providers.

CONCLUSIONS

Almost a third of cancer patients use cannabis, largely for symptom management. Oncologists may not know about their patients' cannabis use. To improve decision making about cannabis use during cancer care, research is needed to determine benefits and harms of cannabis use.

Recommandation par les infirmières en oncologie concernant la prise de cannabis au Canada pour soulager les nausées et les vomissements induits par la chimiothérapie : étude des facteurs d’influence

Une étude transversale descriptive a été réalisée pour déterminer les facteurs qui incitent les infirmières canadiennes en oncologie à suggérer la prise de cannabis à leurs patients pour soulager les nausées et vomissements induits par chimiothérapie (NVIC). Au total, 678 membres de l’Association canadienne des infirmières en oncologie (ACIO/CANO) ont reçu, entre le 8 février et le 10 avril 2022, une invitation à répondre au sondage, suivie de trois rappels. Une infirmière enseignante a aussi envoyé l’invitation à 131 autres infirmières en oncologie de l’est de l’Ontario. Le sondage s’appuyait sur le modèle d’utilisation de la recherche d’Ottawa. En tout, 27 personnes ont ouvert le lien du sondage et 25 l’ont rempli. Onze (47,8 %) d’entre elles ont répondu à la question sur l’efficacité du cannabis pour soulager les NVIC. Les trois principaux obstacles à recommander la prise de cannabis étaient la stigmatisation sociale, le manque de connaissances des infirmières et le manque de directives au sein du milieu de travail. Tous les participants ont relevé l’importance de la formation continue et de directives écrites sur le recours au cannabis pour soulager les NVIC. Le sondage a reçu peu de réponses, mais dans l’ensemble, les répondants se disaient mal préparés pour proposer la prise de cannabis en traitement des NVIC.

Factors influencing Canadian oncology nurses discussing cannabis use with patients experiencing chemotherapy-induced nausea

A descriptive, cross-sectional study was conducted to determine factors influencing Canadian oncology nurses discussing cannabis use with patients experiencing chemotherapy-induced nausea (CIN). A survey invitation and three reminders were sent to 678 members of the Canadian Association of Nurses in Oncology (CANO) between February 8 and April 10, 2022. An educator sent an extra invitation to 131 oncology nurses in Eastern Ontario. The survey was based on the Ottawa Model of Research Use. Twenty-seven opened the link to the survey and 25 responded. Of 25 nurses, 11 (47.8%) correctly answered the knowledge question about the effectiveness of cannabis for CIN. The top three barriers to discussing cannabis use were social stigma, nurses' lack of knowledge, and lack of guidance within the workplace. All participants identified needing continuing education and written guidance about use of cannabis for CIN. Although few oncology nurses responded to the survey, most indicated feeling inadequately prepared to discuss cannabis use with patients experiencing CIN.

Palliative care and end-of-life care in adults with malignant brain tumors

BACKGROUND

This systematic review provides updated insights, from the published literature in the past 5 years, based on the 2017 European Association of Neuro-Oncology (EANO) guidelines for palliative care in adults with malignant brain tumors. It provides an overview of palliative care options, including during the end-of-life phase for patients with malignant brain tumors.

METHODS

A systematic literature search was conducted from 2016 to 2021 focusing on four main topics: (1) symptom management, (2) caregiver needs, (3) early palliative care, and (4) care in the end-of-life phase. An international panel of palliative care experts in neuro-oncology synthesized the literature and reported the most relevant updates. A total of 140 articles were included.

RESULTS

New insights include that: Hippocampal avoidance and stereotactic radiosurgery results in a lower risk of neurocognitive decline in patients with brain metastases; levetiracetam is more efficacious in reducing seizures than valproic acid as first-line monotherapy antiseizure drug (ASD) in glioma patients; lacosamide and perampanel seem well-tolerated and efficacious add-on ASDs; and a comprehensive framework of palliative and supportive care for high-grade glioma patients and their caregivers was proposed. No pharmacological agents have been shown in randomized controlled trials to significantly improve fatigue or neurocognition.

CONCLUSIONS

Since the 2017 EANO palliative care guidelines, new insights have been reported regarding symptom management and end-of-life care, however, most recommendations remain unchanged. Early palliative care interventions are essential to define goals of care and minimize symptom burden in a timely fashion. Interventional studies that address pain, fatigue, and psychiatric symptoms as well as (the timing of) early palliative care are urgently needed.

Complementary and Alternative Medicine for Gliomas: Systematic Review and Critical Appraisal of Current Literature

BACKGROUND

Many patients with glioma and their caregivers seek complementary and alternative medicine (CAM) methods to comfort themselves, cope with cancer medication side effects, and feel they are taking control of their disease.

OBJECTIVE

To summarize existing evidence on safety and efficacy of CAM treatments for gliomas.

METHODS

We performed an exhaustive electronic literature search for in vitro, animal, and clinical studies (English language, all years available) on CAM modalities for gliomas.

RESULTS

A total of 378 studies (315 unique articles) were analyzed. Distribution was as follows: in vitro-274 (73%), animal-77 (20%), and clinical-26 (7%, 2491 patients). Most studies were conducted in China (n = 135, 43%), followed by the United States (n = 62, 20%) and Spain (n = 17, 5%-6%). Resveratrol was the most commonly investigated CAM therapy in the in vitro (n = 62) and in vivo (n = 17) setting. Safety/toxicity was examined in 21% of in vitro (cytotoxic at same dose in 48%), 39% of in vivo (no evidence of organ toxicity), and 50% of clinical studies (adverse events reported in 6). Cytotoxicity was the most frequent end point among in vitro (60%) and animal studies (56%), followed by synergistic action with chemotherapy and inhibition of invasiveness and migration. Finally, 7 of 26 studies found no clinical effect, whereas 5 reported possible impact on progression-free or overall survival, 3 demonstrated decrease or arrest of tumor progression, and 2 showed positive impact on symptoms and quality of life.

CONCLUSION

These findings will hopefully educate providers and patients and stimulate further research in the field of CAM therapy for gliomas.

Cannabinoids to Improve Health-Related Quality of Life in Patients with Neurological or Oncological Disease: A Meta-Analysis

Background: Cannabinoids have been suggested to alleviate frequently experienced symptoms of reduced mental well-being such as anxiety and depression. Mental well-being is an important subdomain of health-related quality of life (HRQoL). Reducing symptoms and maintaining HRQoL are particularly important in malignant primary brain tumor patients, as treatment options are often noncurative and prognosis remains poor. These patients frequently report unprescribed cannabinoid use, presumably for symptom relieve. As studies on brain tumor patients specifically are lacking, we performed a meta-analysis of the current evidence on cannabinoid efficacy on HRQoL and mental well-being in oncological and neurological patients. Methods: We performed a systematic PubMed, PsychINFO, Embase, and Web of Science search according to PRISMA guidelines on August 2 and 3, 2021. We included randomized controlled trials (RCTs) that assessed the effects of tetrahydrocannabinol (THC) or cannabidiol (CBD) on general HRQoL and mental well-being. Pooled effect sizes were calculated using Hedges g. Risk of bias of included studies was assessed using Cochrane's Risk of Bias tool. Results: We included 17 studies: 4 in oncology and 13 in central nervous system (CNS) disease. Meta-analysis showed no effect of cannabinoids on general HRQoL (g=-0.02 confidence interval [95% CI -0.11 to 0.06]; p=0.57) or mental well-being (g=-0.02 [95% CI -0.16 to 0.13]; p=0.81). Conclusions: RCTs in patients with cancer or CNS disease showed no effect of cannabinoids on HRQoL or mental well-being. However, studies were clinically heterogeneous and since many glioma patients currently frequently use cannabinoids, future studies are necessary to evaluate its value in this specific population.

Therapeutic and Supportive Effects of Cannabinoids in Patients with Brain Tumors (CBD Oil and Cannabis)

OPINION STATEMENT

The potential medicinal properties of Cannabis continue to garner attention, especially in the brain tumor domain. This attention is centered on quality of life and symptom management; however, it is amplified by a significant lack of therapeutic choices for this specific patient population. While the literature on this matter is young, published and anecdotal evidence imply that cannabis could be useful in treating chemotherapy-induced nausea and vomiting, stimulating appetite, reducing pain, and managing seizures. It may also decrease inflammation and cancer cell proliferation and survival, resulting in a benefit in overall patient survival. Current literature poses the challenge that it does not provide standardized guidance on dosing for the above potential indications and cannabis use is dominated by recreational purposes. Furthermore, integrated and longitudinal studies are needed but these are a challenge due to arcane laws surrounding the legality of such substances. The increasing need for evidence-based arguments about potential harms and benefits of cannabis, not only in cancer patients but for other medical use and recreational purposes, is desperately needed.

In the weeds: a retrospective study of patient interest in and experience with cannabis at a cancer center

BACKGROUND

Cannabis products, including the cannabinoids CBD and THC, are rising in popularity and increasingly used for medical purposes. While there is some evidence that cannabinoids improve cancer-associated symptoms, understanding regarding appropriate use remains incomplete.

PURPOSE

To describe patient experiences with medical cannabis with focus on use contexts and patients' reported benefits and harms.

METHODS

A standardized intake form was implemented in a dedicated medical cannabis clinic at an NCI-designated cancer center; data from this form was abstracted for all initial visits from October 2019 to October 2020. We report descriptive statistics, chi-square analysis, and multivariate logistic regression.

RESULTS

Among 163 unique new patients, cannabis therapy was commonly sought for sleep, pain, anxiety, and appetite. Twenty-nine percent expressed interest for cancer treatment; 40% and 46% reported past use of CBD and THC, respectively, for medical purposes. Among past CBD users, the most commonly reported benefits were less pain (21%) or anxiety (17%) and improvement in sleep (15%); 92% reported no side effects. Among those with past THC use, reported benefits included improvement in appetite (40%), sleep (32%), nausea (28%), and pain (17%); side effects included feeling "high." Seeking cannabis for anti-neoplastic effects was associated with receipt of active cancer treatment in both univariate and multivariate analysis.

CONCLUSION

Cancer patients seek medical cannabis to address a wide variety of concerns despite insufficient evidence of benefits and harms. As more states move to legalize medical and recreational cannabis, cancer care providers must remain aware of emerging data and develop knowledge and skills to counsel their patients about its use.

Attitudes and Beliefs of Cancer Patients Demanding Medical Cannabis Use in North Thailand

OBJECTIVE

Cannabis is therapeutic for numerous medical conditions. The demand for medical cannabis (MC) use in cancer patients is increasing, even with many patients lacking proper knowledge about MC. Therefore, this study aimed to describe the attitudes and beliefs of cancer patients demanding MC use in northern Thailand.

METHODS

This cross-sectional study administered multistage random sampling to recruit 565 cancer patients who indicated that they demand MC use in northern Thailand. These patients responded to a self-administered structured questionnaire about their feelings on MC. We used descriptive statistics, including frequency and percentage, to describe categorical data, whereas we used mean and standard deviation for continuous data.

RESULTS

Out of a total of 565 participants, 59.7% were female, 40.3% were male, and 46.4% were middle-aged adults, with a mean age of 58.3 ± 13.0 years. Of these participants who demanded the use of MC, the top three most common types of cancers were breast cancer (27.8%), colorectal cancer (21.4%), and lung cancer (10.6%). Most of the participants (51.2%) had early-stage cancer, and 46.5% received chemotherapy. We found that patients who demanded MC use had a generally positive attitude (53.3%). Among the patients who required MC use, 55.4% believed that it would help relieve side effects caused by modern treatments, cure cancer (38.8%), relieve suffering from cancer symptoms (30.6%), and cause one to live longer and to improve their health (16.3%). Most patients' decisions regarding MC use (45.3%) demanded MC use after receiving modern treatments, and 95.6% demanded MC use with modern treatment. Overall, these patients (65.3%) needed MC from the MC clinic in the Government Hospital.

CONCLUSIONS

This study highlights the attitudes and beliefs towards MC use among cancer patients, their positive expectations of the outcome, and the need for MC use.

Routes of administration, reasons for use, and approved indications of medical cannabis in oncology: a scoping review

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.

Mental Health Symptoms during the COVID-19 Pandemic among Cancer Survivors Who Endorse Cannabis: Results from the COVID-19 Cannabis Health Study

Our objective was to examine the prevalence of mental health symptoms and the behavioral impact of the COVID-19 pandemic on cancer survivors who endorse cannabis. Participants included 158 adults (≥18 years) who self-reported medicinal cannabis use and responded to our internet-based questionnaire (21 March 2020−24 March 2021). Data included 79 cancer survivors and 79 age-matched adults without a history of cancer. Descriptive statistics were used to compare demographics, the prevalence of generalized anxiety (GAD-7), depression (CES-D-10), and changes in behavior during the COVID-19 pandemic by cancer survivorship status. Overall, 60.8% and 48.1% of cancer survivors self-reported the use of cannabis to manage their anxiety and depression, respectively. Probable clinical depression (CES-D-10 score ≥ 10) and anxiety (GAD-7 score ≥ 10) were identified in 50.7% and 38.9% of cancer survivors, respectively. Cancer survivors were more likely to report that their anxiety symptoms made it very or extremely difficult to work, take care of home, or get along with others than their counterparts. Cancer survivors with anxiety and/or depression were more likely to fear giving COVID-19 to someone else (47.5% vs. 23.1%, p = 0.023) and to fear being diagnosed with COVID-19 (77.5% vs. 38.5%, p < 0.001) compared to cancer survivors without anxiety and depression symptoms. Further research is recommended to evaluate the use of cannabis as palliative care to improve mental health among cancer survivors.

Cannabis, a Miracle Drug with Polyvalent Therapeutic Utility: Preclinical and Clinical-Based Evidence

Cannabis sativa L. is an annual herbaceous dioecious plant which was first cultivated by agricultural human societies in Asia. Over the period of time, various parts of the plant like leaf, flower, and seed were used for recreational as well as therapeutic purposes. The main chemical components of Cannabis sativa are termed as cannabinoids, among them the key psychoactive constituent is Δ-9-tetrahydrocannabinol and cannabidiol (CBD) as active nonpsychotic constituent. Upon doing extensive literature review, it was found that cannabis has been widely studied for a number of disorders. Very recently, a pure CBD formulation, named Epidiolex, got a green flag from both United States Food and Drug Administration and Drug Enforcement Administration for 2 rare types of epilepsies. This laid a milestone in medical cannabis research. This review intends to give a basic and extensive assessment, from past till present, of the ethnological, plant, chemical, pharmacological, and legal aspects of C. sativa. Further, this review contemplates the evidence the studies obtained of cannabis components on Alzheimer's, Parkinson's, amyotrophic lateral sclerosis, multiple sclerosis, emesis, epilepsy, chronic pain, and cancer as a cytotoxic agent as well as a palliative therapy. The assessment in this study was done by reviewing in extensive details from studies on historical importance, ethnopharmacological aspects, and legal grounds of C. sativa from extensive literature available on the scientific databases, with a vision for elevating further pharmaceutical research to investigate its total potential as a therapeutic agent.

Demographics, Perceptions, and Use of Medical Marijuana among Patients in Florida

Medical marijuana (MMJ) is currently legal in 35 US states, with an estimated 3.6 million state-legal medical cannabis patients. Although there are currently over 440,000 MMJ patients in the state of Florida, there are limited data on their demographics, reasons and patterns of use, and successes or failures of treatment. The goal of this study is to examine the demographics, perceptions, and use of medical cannabis among patients in Florida, as well as their perceptions of the quality of information received from physicians and dispensaries. One hundred and fifty-seven MMJ patients completed an online survey regarding their characteristics and use. Patients in Florida shared many characteristics with patients in other states, such as race, use frequency, and administration technique. Patients most commonly used MMJ to treat their symptoms of anxiety, pain, and stress and reported great therapeutic effectiveness. A majority (65%) of patients also reported either a reduction or total discontinuation of at least one prescription or over-the-counter drug. The findings highlight the need to further investigate the use of MMJ as a viable treatment for pain and anxiety and to improve access of quality cannabis information to patients, physicians, and dispensary employees.

Cannabinoid receptor 2 selective agonists and Alzheimer's disease: An insight into the therapeutic potentials

Endocannabinoid system has been extensively studied in recent decades, particularly the cannabinoid receptors CB1 and CB2, due to their important role in neuroinflammation. Among these, CB2 has gained prominence due to its selective overexpression in glial cells during neuroinflammation. In contrast to CB1 agonists, CB2 agonists have no side effects such as ataxia, hypothermia, euphoria, psychological, or addiction liabilities. CB2 and its selective agonists' above-mentioned unique properties have become a research focus in neurodegenerative disorders such as Alzheimer's disease (AD). The review discusses the neuroprotective role of CB receptors, particularly CB2, in AD, as well as the significance and limitations of this research.

A Mapping Literature Review of Medical Cannabis Clinical Outcomes and Quality of Evidence in Approved Conditions in the USA from 2016 to 2019

In 2017, a National Academies of Sciences, Engineering, and Medicine (NASEM) report comprehensively evaluated the body of evidence regarding cannabis health effects through the year 2016. The objectives of this study are to identify and map the most recently (2016-2019) published literature across approved conditions for medical cannabis and to evaluate the quality of identified recent systematic reviews, published following the NASEM report. Following the literature search from 5 databases and consultation with experts, 11 conditions were identified for evidence compilation and evaluation: amyotrophic lateral sclerosis, autism, cancer, chronic noncancer pain, Crohn's disease, epilepsy, glaucoma, human immunodeficiency virus/AIDS, multiple sclerosis (MS), Parkinson's disease, and posttraumatic stress disorder. A total of 198 studies were included after screening for condition-specific relevance and after imposing the following exclusion criteria: preclinical focus, non-English language, abstracts only, editorials/commentary, case studies/series, and non-U.S. study setting. Data extracted from studies included: study design type, outcome definition, intervention definition, sample size, study setting, and reported effect size. Few completed randomized controlled trials (RCTs) were identified. Studies classified as systematic reviews were graded using the Assessing the Methodological Quality of Systematic Reviews-2 tool to evaluate the quality of evidence. Few high-quality systematic reviews were available for most conditions, with the exceptions of MS (9 of 9 graded moderate/high quality; evidence for 2/9 indicating cannabis improved outcomes; evidence for 7/9 indicating cannabis inconclusive), epilepsy (3 of 4 graded moderate/high quality; 3 indicating cannabis improved outcomes; 1 indicating cannabis inconclusive), and chronic noncancer pain (12 of 13 graded moderate/high quality; evidence for 7/13 indicating cannabis improved outcomes; evidence from 6/7 indicating cannabis inconclusive). Among RCTs, we identified few studies of substantial rigor and quality to contribute to the evidence base. However, there are some conditions for which significant evidence suggests that select dosage forms and routes of administration likely have favorable risk-benefit ratios (i.e., epilepsy and chronic noncancer pain). The body of evidence for medical cannabis requires more rigorous evaluation before consideration as a treatment option for many conditions, and evidence necessary to inform policy and treatment guidelines is currently insufficient for many conditions.

Daily Lifestyle Modifications to Improve Quality of Life and Survival in Glioblastoma: A Review

Survival in glioblastoma remains poor despite advancements in standard-of-care treatment. Some patients wish to take a more active role in their cancer treatment by adopting daily lifestyle changes to improve their quality of life or overall survival. We review the available literature through PubMed and Google Scholar to identify laboratory animal studies, human studies, and ongoing clinical trials. We discuss which health habits patients adopt and which have the most promise in glioblastoma. While results of clinical trials available on these topics are limited, dietary restrictions, exercise, use of supplements and cannabis, and smoking cessation all show some benefit in the comprehensive treatment of glioblastoma. Marital status also has an impact on survival. Further clinical trials combining standard treatments with lifestyle modifications are necessary to quantify their survival advantages.

Exploring the Use of Medical Marijuana for Supportive Care of Oncology Patients

Medical marijuana, also known as cannabis, is being sought by patients and survivors to alleviate common symptoms of cancer and its treatments that affect their quality of life. The National Academy of Sciences (2017) reports conclusive or substantial evidence that cannabis is successful in treating chronic cancer pain and chemotherapy-induced nausea and vomiting, moderate evidence that cannabinoids are beneficial for sleep disorders that accompany chronic illnesses, and limited evidence supporting use for appetite stimulation and anxiety. However, due to the fact that cannabis is classified as a Schedule I controlled substance, there is an absence of rigorous, scientific evidence to guide health-care professionals. In addition, the Schedule I designation makes it illegal for health-care professionals in the United States to prescribe, administer, or directly distribute these drugs. Legislation has outpaced research in this area. Therefore, the National Council of State Boards of Nursing (NCSBN) appointed a medical marijuana guideline committee to create guidelines for the nursing care of patients using medical marijuana, marijuana education in nursing programs, and guidelines for advanced practice registered nurses (APRNs) certifying a patient for the use of medical marijuana (The NCSBN Medical Marijuana Guidelines Committee, 2018). Six states/districts authorize APRNs to recommend the use of medical marijuana to patients with qualifying conditions (Kaplan, 2015). As of March 2021, 35 states plus the District of Columbia have authorized the use of medical marijuana (DISA Global Solutions, 2021). Therefore, APRNs will be caring for these patients and need to know the medical, pharmacological, and legal issues surrounding medical cannabis use.

Cannabinoids in glioblastoma multiforme-hype or hope?

Cannabis and its derivatives are being used increasingly by patients with cancer, including patients with glioblastoma multiforme (GBM), the most common and aggressive primary brain malignancy. Despite promising preclinical data suggesting potential anti-cancer effects for cannabinoids in GBM, clinical and safety data are lacking. This editorial will discuss a recent Phase 1b trial of nabiximols oromucosal spray in combination with dose-intense temozolomide in patients with recurrent GBM in the context of other relevant findings in this field.

Nanodelivery Systems Targeting Epidermal Growth Factor Receptors for Glioma Management

A paradigm shift in treating the most aggressive and malignant form of glioma is continuously evolving; however, these strategies do not provide a better life and survival index. Currently, neurosurgical debulking, radiotherapy, and chemotherapy are the treatment options available for glioma, but these are non-specific in action. Patients invariably develop resistance to these therapies, leading to recurrence and death. Receptor Tyrosine Kinases (RTKs) are among the most common cell surface proteins in glioma and play a significant role in malignant progression; thus, these are currently being explored as therapeutic targets. RTKs belong to the family of cell surface receptors that are activated by ligands which in turn activates two major downstream signaling pathways via Rapidly Accelerating Sarcoma/mitogen activated protein kinase/extracellular-signal-regulated kinase (Ras/MAPK/ERK) and phosphatidylinositol 3-kinase/a serine/threonine protein kinase/mammalian target of rapamycin (PI3K/AKT/mTOR). These pathways are critically involved in regulating cell proliferation, invasion, metabolism, autophagy, and apoptosis. Dysregulation in these pathways results in uncontrolled glioma cell proliferation, invasion, angiogenesis, and cancer progression. Thus, RTK pathways are considered a potential target in glioma management. This review summarizes the possible risk factors involved in the growth of glioblastoma (GBM). The role of RTKs inhibitors (TKIs) and the intracellular signaling pathways involved, small molecules under clinical trials, and the updates were discussed. We have also compiled information on the outcomes from the various endothelial growth factor receptor (EGFR)-TKIs-based nanoformulations from the preclinical and clinical points of view. Aided by an extensive literature search, we propose the challenges and potential opportunities for future research on EGFR-TKIs-based nanodelivery systems.

Medical Marijuana Policy Reform Reaches Florida: A Scoping Review

BACKGROUND

Florida became the first state in the U.S. South to legalize the use of medical marijuana to treat a variety of health conditions including chronic pain, epilepsy, and spasticity symptoms from multiple sclerosis. While there are over 200,000 medical marijuana patients in Florida, there remain financial, psychological, and insurance coverage barriers which reduce access for many patients.

PURPOSE

This scoping review, with a focus on state health policy, first describes some clinical studies examining the therapeutic benefits of medical marijuana. Next, there is a discussion of the Florida regulatory environment and major legislation. Also, the review describes how the current Florida policy landscape presents challenges for physicians and patients.

METHODS

A scoping review of the literature was conducted in PubMed and Google Scholar using the search terms, "medical marijuana" and "medical cannabis" to identify research articles, newspaper reports, and government documents. The purpose of the review was to identify research investigating the therapeutic efficacy of medical marijuana and state policies affecting physician practice.

RESULTS

The review concluded there was general scientific consensus of therapeutic benefits for patients, especially for chronic pain, from the use of medical marijuana. The review also identified several barriers for physicians and patients around cost, stigma, and lack of insurance coverage which constrains use and access.

DISCUSSION

The review discusses several directions for future medical marijuana policy and research with the aim to improve therapeutic benefits for Florida patients.