1
|
Ton M, Newcomb PA, Jones S, Malen RC, Heffner JL. Cannabis use after a cancer diagnosis in a population-based sample of cancer survivors. Cancer Causes Control 2024; 35:1033-1042. [PMID: 38519643 DOI: 10.1007/s10552-024-01860-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/05/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE This study aimed to characterize the prevalence and correlates of cannabis use and the methods and reasons for use among recently diagnosed cancer survivors in a population sample within Washington state. METHODS We identified individuals diagnosed with invasive cancers in the prior 6 to 17 months from April 2020 to December 2020 using the Seattle-Puget Sound Surveillance, Epidemiology, and End Results (SEER) cancer registry. Participants (n = 1,515) completed a questionnaire, including demographics, medical history, cannabis use, and other substance use. Cancer characteristics and date of diagnosis were obtained from SEER registry data. We calculated weighted prevalence estimates and logistic regression models to evaluate correlates of cannabis use. RESULTS Overall, 41.3% of survivors reported cannabis use at any time after diagnosis, most commonly via edibles (60.5%) and smoking (43.8%). The most frequently reported reasons for use were sleep (54.5%), mood, stress, anxiety, and depression (44.3%), pain (42.3%), and recreation (42.3%). Cannabis use was associated with younger age, race (White vs. Asian), less education, former or current smoking, consuming more than 2 alcohol-containing drinks per day, having late-stage cancer, and cancer site. CONCLUSION In this first evaluation of cannabis use in a registry-linked, population-based sample of survivors of all cancer types, based in a state where recreational and medical cannabis have been legal for a decade, approximately 2 in 5 survivors reported post-diagnosis use. Given how common cannabis use is among cancer survivors, there is a great need to understand its impact on cancer treatment outcomes and the overall health of cancer survivors.
Collapse
Affiliation(s)
- Mimi Ton
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Polly A Newcomb
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Salene Jones
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA
| | - Rachel C Malen
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA
| | - Jaimee L Heffner
- Public Health Sciences Division, Fred Hutchinson Cancer Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA.
| |
Collapse
|
2
|
Bini A, Salerno S, Protti S, Pollastro F, Profumo A, Morini L, Merli D. Photodegradation of cannabidiol (CBD) and Δ 9-THC in cannabis plant material. Photochem Photobiol Sci 2024; 23:1239-1249. [PMID: 38739326 DOI: 10.1007/s43630-024-00589-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/24/2024] [Indexed: 05/14/2024]
Abstract
Δ9-THC, the psychotropic cannabinoid in Cannabis sativa L., for many years has been the focus of all the pharmacological attention as the main promising principle of the plant. Recently, however, cannabidiol (CBD) has brought a sudden change in the scenario, exponentially increasing the interest in pharmacology as the main non-psychotropic cannabinoid with potential therapeutic, cosmetical and clinical applications. Although the reactivity of CBD and Δ9-THC has been considered, little attention has been paid to the possible photodegradation of these cannabinoids in the vegetal matrix and the data available in the literature are, in some cases, contradictory. The aim of the present work is to provide a characterization of the photochemical behaviour of CBD and Δ9-THC in three cannabis chemotypes, namely I (Δ9-THC 2.50%w/w), II (CBD:Δ9-THC 5.82%w/w:3.19%w/w) and III (CBD 3.02%w/w).
Collapse
Affiliation(s)
- Arianna Bini
- Dipartimento di Chimica, Università degli Studi di Pavia, Viale Taramelli 10, 27100, Pavia, Italy
| | - Sofia Salerno
- Dipartimento di Chimica, Università degli Studi di Pavia, Viale Taramelli 10, 27100, Pavia, Italy
| | - Stefano Protti
- Dipartimento di Chimica, Università degli Studi di Pavia, Viale Taramelli 10, 27100, Pavia, Italy
| | - Federica Pollastro
- Department of Pharmaceutical Sciences, University of Piemonte Orientale, Novara, Italy
| | - Antonella Profumo
- Dipartimento di Chimica, Università degli Studi di Pavia, Viale Taramelli 10, 27100, Pavia, Italy
| | - Luca Morini
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100, Pavia, Italy
| | - Daniele Merli
- Dipartimento di Chimica, Università degli Studi di Pavia, Viale Taramelli 10, 27100, Pavia, Italy.
- INFN Sezione di Milano-Bicocca, Piazza della Scienza 3, 20126, Milan, Italy.
| |
Collapse
|
3
|
Troyer J, Tanco K. Review of the Use of Medicinal Cannabis Products in Palliative Care. Cancers (Basel) 2024; 16:1412. [PMID: 38611090 PMCID: PMC11011126 DOI: 10.3390/cancers16071412] [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: 03/04/2024] [Revised: 03/30/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
In this review, we discuss the potential role of cannabis and cannabinoids in the management of cancer-related symptoms. There is limited evidence demonstrating the effectiveness of cannabis-based products in treating cancer-related pain and gastrointestinal symptoms such as nausea, vomiting, and loss of appetite. Regarding the role of cannabis-based products in the treatment of insomnia and mood disorders, most studies looked at these symptoms as secondary outcomes with mixed results. Cannabis-based products have adverse effects, ranging from neuropsychiatric to systemic effects to potential drug interactions.
Collapse
Affiliation(s)
| | - Kimberson Tanco
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| |
Collapse
|
4
|
Dasram MH, Naidoo P, Walker RB, Khamanga SM. Targeting the Endocannabinoid System Present in the Glioblastoma Tumour Microenvironment as a Potential Anti-Cancer Strategy. Int J Mol Sci 2024; 25:1371. [PMID: 38338649 PMCID: PMC10855826 DOI: 10.3390/ijms25031371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/08/2024] [Accepted: 01/17/2024] [Indexed: 02/12/2024] Open
Abstract
The highly aggressive and invasive glioblastoma (GBM) tumour is the most malignant lesion among adult-type diffuse gliomas, representing the most common primary brain tumour in the neuro-oncology practice of adults. With a poor overall prognosis and strong resistance to treatment, this nervous system tumour requires new innovative treatment. GBM is a polymorphic tumour consisting of an array of stromal cells and various malignant cells contributing to tumour initiation, progression, and treatment response. Cannabinoids possess anti-cancer potencies against glioma cell lines and in animal models. To improve existing treatment, cannabinoids as functionalised ligands on nanocarriers were investigated as potential anti-cancer agents. The GBM tumour microenvironment is a multifaceted system consisting of resident or recruited immune cells, extracellular matrix components, tissue-resident cells, and soluble factors. The immune microenvironment accounts for a substantial volume of GBM tumours. The barriers to the treatment of glioblastoma with cannabinoids, such as crossing the blood-brain barrier and psychoactive and off-target side effects, can be alleviated with the use of nanocarrier drug delivery systems and functionalised ligands for improved specificity and targeting of pharmacological receptors and anti-cancer signalling pathways. This review has shown the presence of endocannabinoid receptors in the tumour microenvironment, which can be used as a potential unique target for specific drug delivery. Existing cannabinoid agents, studied previously, show anti-cancer potencies via signalling pathways associated with the hallmarks of cancer. The results of the review can be used to provide guidance in the design of future drug therapy for glioblastoma tumours.
Collapse
Affiliation(s)
| | | | | | - Sandile M. Khamanga
- Division of Pharmaceutics, Faculty of Pharmacy, Rhodes University, Makhanda 6139, South Africa (R.B.W.)
| |
Collapse
|
5
|
Tanco K, Olson A, Fellman B, Jankowski M, Lai SY, Shete S, Harbison K, Scheid J, Bruera E. Analysis of Dispensing and Utilization Patterns of Medical Cannabis Products in State Licensed Cannabis Dispensaries. J Palliat Med 2023; 26:1482-1487. [PMID: 37285183 DOI: 10.1089/jpm.2023.0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Background: To understand real-world dispensing and utilization patterns of medical cannabis (MC) and its financial impact on patients, we analyzed the database of a cannabis company licensed in New York state. Objectives: To evaluate the tetrahydrocannabinol (THC)/cannabidiol (CBD) dose ratios, association of various medical conditions to THC/CBD dose, and the cost of products in registered patients receiving MC from four licensed state dispensaries. Design: Retrospective analysis conducted on anonymized data between January 1, 2016 and December 31, 2020 listing 422,201 dispensed products from 32,845 individuals aged 18 years and older. Setting/Subjects: Adult patients with medical certification for cannabis use in New York, USA. Measurements: The database included patient's age, gender, qualifying medical condition, type and dose of product, medication directions, and amount of product dispensed. Results: Findings showed a median age of 53 years with 52% of patients female. Males were found to use more products than females (1.06:1). Pain (85%) was the most common medical condition and inhalation (57%) the most common route except when used for cancer-directed treatment and neurological conditions. Individuals received a median of six prescriptions costing a median of $50/product. Average THC:CBD ratios were 28:0.5 mg/day and 12:0.25 mg/dose. Neurological conditions demonstrated the highest average cost [mean (95% confidence interval {CI}): $73 ($71-$75)] and average CBD/dose per product [mean (95% CI): 5.89 (5.38-6.40)]. Individuals with a history of substance use disorder utilizing MC as an alternative substance displayed the highest average THC/dose [mean (95% CI): 14.25 (13.36-15.14)]. Conclusion: MC was utilized for various medical conditions with variability in THC:CBD ratio seen depending on the condition. Cost variation was also observed based on the individual's medical condition.
Collapse
Affiliation(s)
- Kimberson Tanco
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amanda Olson
- Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Bryan Fellman
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mika Jankowski
- Hematology Affairs Department, Lilly LLC, Hematology Medical Science Liaison, Indianapolis, Indiana, USA
| | - Stephen Y Lai
- Department of Head and Neck Surgery, and The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sanjay Shete
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kevin Harbison
- Training and Development Department, PharmaCann, Lead Retail Pharmacist, Amherst, New York, USA
| | - Jennifer Scheid
- Department of Physical Therapy, Daemen University, Amherst, New York, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
6
|
Guedon M, Le Bozec A, Brugel M, Clarenne J, Carlier C, Perrier M, Laurent M, Hettler D, Mongaret C, Bouché O, Slimano F. Cannabidiol-drug interaction in cancer patients: A retrospective study in a real-life setting. Br J Clin Pharmacol 2023; 89:2322-2328. [PMID: 36849134 DOI: 10.1111/bcp.15701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/06/2023] [Accepted: 02/16/2023] [Indexed: 03/01/2023] Open
Abstract
Cannabidiol (CBD) consumption in cancer patients is growing and there is a need to investigate how to detect cannabidiol-drug interactions (CDIs). However, CDIs and the clinical relevance between CBD, anticancer treatment, supportive care and conventional drugs is poorly studied especially in real-life settings. In 1 oncology day-hospital, a cross-sectional study in 363 cancer patients treated with chemotherapy revealed 20 patients (5.5%) who consumed CBD. In this study we aimed to explore the prevalence and clinical relevance of CDIs among these 20 patients. CDI detection used the Food and Drug Administration Drugs.com database and clinical relevance was assessed accordingly. Ninety CDIs with 34 medicines were detected (4.6 CDI/patient). The main clinical risks were central nervous system depression and hepatoxicity. The main CDIs were assessed as moderate and anticancer treatment do not seem to add to the risk. CBD discontinuation appears to be the most consistent management. Future studies should explore the clinical relevance of drug interactions with CBD in cancer patients.
Collapse
Affiliation(s)
- Marie Guedon
- Department of Pharmacy, CHU Reims, F-51100, Reims, France
| | | | - Mathias Brugel
- Department of Gastroenterology and Digestive Oncology, CHU Reims, F-51100, Reims, France
| | - Justine Clarenne
- Department of Pharmacy, CHU de Reims, BIOs, Université de Reims Champagne-Ardenne, F-51100, Reims, France
| | - Claire Carlier
- Oncology Day-Hospital, CHU Reims, F-51100, Reims, France
| | - Marine Perrier
- Department of Gastroenterology and Digestive Oncology, CHU Reims, F-51100, Reims, France
| | | | | | - Céline Mongaret
- Department of Pharmacy, CHU de Reims, BIOs, Université de Reims Champagne-Ardenne, F-51100, Reims, France
| | - Olivier Bouché
- Oncology Day-Hospital, CHU de Reims, BioSpecT, Université de Reims Champagne-Ardenne, F-51100, Reims, France
| | - Florian Slimano
- Department of Pharmacy, CHU de Reims, BioSpecT, Université de Reims Champagne-Ardenne, F-51100, Reims, France
| |
Collapse
|
7
|
Suárez-Jacobo Á, Díaz Pacheco A, Bonales-Alatorre E, Castillo-Herrera GA, García-Fajardo JA. Cannabis Extraction Technologies: Impact of Research and Value Addition in Latin America. Molecules 2023; 28:molecules28072895. [PMID: 37049659 PMCID: PMC10095677 DOI: 10.3390/molecules28072895] [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: 02/10/2023] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 04/14/2023] Open
Abstract
The Cannabis genus of plants has been widely used in different cultures for various purposes. It is separated into three main species: sativa, indica, and ruderalis. In ancient practices, the plant was used as a multipurpose crop and valued for its fiber, food, and medicinal uses. Since methodologies for the extraction, processing, and identification of components have become available, medical, and food applications have been increasing, allowing potential development in the pharmaceutical and healthy functional food industries. Although the growing legalization and adoption of cannabis for the treatment of diseases are key factors pushing the growth of its market, the biggest challenge is to obtain higher-quality products in a time- and cost-effective fashion, making the process of extraction and separation an essential step. Latin American countries exhibit great knowledge of extraction technologies; nevertheless, it is still necessary to verify whether production costs are economically profitable. In addition, there has been an increase in commercial cannabis products that may or may not be allowed, with or without quality fact sheets, which can pose health risks. Hence, legalization is mandatory and urgent for the rest of Latin American countries. In this article, the phytochemical compounds (cannabinoids, terpenes, and phenolic compounds), the current status of legalization, extraction techniques, and research advances in cannabis in Latin America are reviewed.
Collapse
Affiliation(s)
- Ángela Suárez-Jacobo
- Tecnología Alimentaria, Centro de Investigación y Asistencia en Tecnología y Diseño del Estado de Jalisco, Zapopan 45019, Mexico
| | - Adrián Díaz Pacheco
- Unidad Profesional Interdisciplinaria de Ingeniería Campus Tlaxcala del Instituto Politécnico Nacional, Tlaxcala 90000, Mexico
| | - Edgar Bonales-Alatorre
- Centro Universitario de Investigaciones Biomédicas, Universidad de Colima, Colima 28045, Mexico
| | - Gustavo Adolfo Castillo-Herrera
- Tecnología Alimentaria, Centro de Investigación y Asistencia en Tecnología y Diseño del Estado de Jalisco, Zapopan 45019, Mexico
| | - Jorge Alberto García-Fajardo
- Subsede Noreste, Centro de Investigación y Asistencia en Tecnología y Diseño del Estado de Jalisco, Parque de Investigación e Innovación Tecnológica, Apodaca 66628, Mexico
| |
Collapse
|
8
|
Boyacıoğlu Ö, Korkusuz P. Cannabinoids as Prospective Anti-Cancer Drugs: Mechanism of Action in Healthy and Cancer Cells. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1410:145-169. [PMID: 36396926 DOI: 10.1007/5584_2022_748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Endogenous and exogenous cannabinoids modulate many physiological and pathological processes by binding classical cannabinoid receptors 1 (CB1) or 2 (CB2) or non-cannabinoid receptors. Cannabinoids are known to exert antiproliferative, apoptotic, anti-migratory and anti-invasive effect on cancer cells by inducing or inhibiting various signaling cascades. In this chapter, we specifically emphasize the latest research works about the alterations in endocannabinoid system (ECS) components in malignancies and cancer cell proliferation, migration, invasion, angiogenesis, autophagy, and death by cannabinoid administration, emphasizing their mechanism of action, and give a future perspective for clinical use.
Collapse
Affiliation(s)
- Özge Boyacıoğlu
- Department of Bioengineering, Graduate School of Science and Engineering, Hacettepe University, Ankara, Turkey
- Department of Medical Biochemistry, Faculty of Medicine, Atılım University, Ankara, Turkey
| | - Petek Korkusuz
- Department of Histology and Embryology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| |
Collapse
|
9
|
Dysgeusia in Patients with Breast Cancer Treated with Chemotherapy-A Narrative Review. Nutrients 2023; 15:nu15010226. [PMID: 36615883 PMCID: PMC9823517 DOI: 10.3390/nu15010226] [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: 11/03/2022] [Revised: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023] Open
Abstract
Breast cancer (BC) is the most common cancer worldwide. Chemotherapy (CT) is essential for the treatment of BC, but is often accompanied by several side effects, including taste alterations, due to different mechanisms. Although dysgeusia is usually underestimated by clinicians, it is considered very worrying and disturbing by cancer patients undergoing CT, because it induces changes in dietary choices and social habits, affecting their physical and psychological health, with a profound impact on their quality of life. Several strategies and therapies have been proposed to prevent or alleviate CT-induced dysgeusia. This review aimed to evaluate the available evidence on prevalence, pathophysiological mechanisms, clinical consequences, and strategies for managing dysgeusia in BC patients receiving CT. We queried the National Library of Medicine, the Cochrane Library, Excerpta Medica dataBASE, and the Cumulative Index to Nursing and Allied Health Literature database, performing a search strategy using database-specific keywords. We found that the literature on this topic is scarce, methodologically limited, and highly heterogeneous in terms of study design and criteria for patient inclusion, making it difficult to obtain definitive results and make recommendations for clinical practice.
Collapse
|
10
|
Abstract
PURPOSE OF REVIEW There have been many debates, discussions, and published writings about the therapeutic value of cannabis plant and the hundreds of cannabinoids it contains. Many states and countries have attempted, are attempting, or have already passed bills to allow legal use of cannabinoids, especially cannabidiol (CBD), as medicines to treat a wide range of clinical conditions without having been approved by a regulatory body. Therefore, by using PubMed and Google Scholar databases, we have reviewed published papers during the past 30 years on cannabinoids as medicines and comment on whether there is sufficient clinical evidence from well-designed clinical studies and trials to support the use of CBD or any other cannabinoids as medicines. RECENT FINDINGS Current research shows that CBD and other cannabinoids currently are not ready for formal indications as medicines to treat a wide range of clinical conditions as promoted except for several exceptions including limited use of CBD for treating two rare forms of epilepsy in young children and CBD in combination with THC for treating multiple-sclerosis-associated spasticity. SUMMARY Research indicates that CBD and several other cannabinoids have potential to treat multiple clinical conditions, but more preclinical, and clinical studies and clinical trials, which follow regulatory guidelines, are needed to formally recommend CBD and other cannabinoids as medicines.
Collapse
|
11
|
Khalsa JH, Bunt G, Blum K, Maggirwar SB, Galanter M, Potenza MN. Review: Cannabinoids as Medicinals. CURRENT ADDICTION REPORTS 2022; 9:630-646. [PMID: 36093358 PMCID: PMC9449267 DOI: 10.1007/s40429-022-00438-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2022] [Indexed: 12/04/2022]
Abstract
Purpose of review
There have been many debates, discussions, and published writings about the therapeutic value of cannabis plant and the hundreds of cannabinoids it contains. Many states and countries have attempted, are attempting, or have already passed bills to allow legal use of cannabinoids, especially cannabidiol (CBD), as medicines to treat a wide range of clinical conditions without having been approved by a regulatory body. Therefore, by using PubMed and Google Scholar databases, we have reviewed published papers during the past 30 years on cannabinoids as medicines and comment on whether there is sufficient clinical evidence from well-designed clinical studies and trials to support the use of CBD or any other cannabinoids as medicines. Recent findings Current research shows that CBD and other cannabinoids currently are not ready for formal indications as medicines to treat a wide range of clinical conditions as promoted except for several exceptions including limited use of CBD for treating two rare forms of epilepsy in young children and CBD in combination with THC for treating multiple-sclerosis-associated spasticity. Summary Research indicates that CBD and several other cannabinoids have potential to treat multiple clinical conditions, but more preclinical, and clinical studies and clinical trials, which follow regulatory guidelines, are needed to formally recommend CBD and other cannabinoids as medicines.
Collapse
Affiliation(s)
- Jag H. Khalsa
- Division of Therapeutics and Medical Consequences, Medical Consequences of Drug Abuse and Infections Branch, National Institute on Drug Abuse, NIH, Special Volunteer, 16071 Industrial Drive, Gaithersburg, MD 20877 USA
- Department of Microbiology, Immunology, and Tropical Medicine, The George Washington University School of Medicine, Ross Hall Room 502A, 2300 I Street, Washington, NWDC 20037 USA
- Drug Addiction and Co-occurring Infections, Aldie, VA 20105-5572 USA
| | - Gregory Bunt
- Samaritan Day Top Village, NYU School of Medicine, 550 First Ave, New York, NY 10016 USA
| | - Kenneth Blum
- Center for Behavioral Health & Sports, Western University Health Sciences, Pomona, CA USA
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Division of Nutrigenomics, Precision Translational Medicine, LLC, San Antonio, TX USA
- Division of Nutrigenomics, Institute of Behavior & Neurogenetics, LLC, San Antonio, TX USA
- Department of Psychiatry, University of Vermont, Burlington, VT USA
- Department of Psychiatry, Wright University Boonshoff School of Medicine, Dayton, OH USA
| | - Sanjay B. Maggirwar
- Department of Microbiology, Immunology, and Tropical Medicine, The George Washington University School of Medicine, Ross Hall Room 502A, 2300 I Street, Washington, NWDC 20037 USA
| | - Marc Galanter
- Department of Psychiatry, NYU School of Medicine, 550 First Avenue, Room NBV20N28, New York, NY 10016 USA
| | - Marc N. Potenza
- Departments of Psychiatry and Neuroscience and the Child Study Center, Yale School of Medicine, 1 Church Street, Rm726, New Haven, CT 06510 USA
| |
Collapse
|
12
|
Hanganu B, Lazar DE, Manoilescu IS, Mocanu V, Butcovan D, Buhas CL, Szalontay AS, Ioan BG. Controversial Link between Cannabis and Anticancer Treatments-Where Are We and Where Are We Going? A Systematic Review of the Literature. Cancers (Basel) 2022; 14:cancers14164057. [PMID: 36011049 PMCID: PMC9406903 DOI: 10.3390/cancers14164057] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 12/02/2022] Open
Abstract
Simple Summary In the field of oncology, preclinical research has shown that cannabis and cannabinoids modulate signaling pathways involved in cell proliferation, migration, invasion, angiogenesis, programmed cell death, and metastasis. Based on these findings, as medical cannabis becomes legal in more and more countries, cancer patients and their families are increasingly interested in the potential benefits of herbal medicine as an element of complementary and alternative medicine in their treatment. Although its clinical efficacy has been demonstrated in preclinical studies, clinical trials with cancer patients are lacking. To draw clear conclusions, we await the results of further prospective and randomized studies on this clinically relevant topic. Abstract Background and Objectives: Cannabinoids are currently used in cancer patients primarily for their pain-relieving and antiemetic properties. The aim of our review was to synthesize all available data of studies evaluating the therapeutic efficacy of cannabis in combination with oncological treatments in cancer patients and to explore ongoing studies with different goals and medical areas registered in the field of oncology worldwide. Materials and Methods: This study was performed in accordance with the PRISMA guidelines. A search using MEDLINE/PubMed database was performed between 1 January 2006 and 1 March 2022. Search terms included the following: cannabidiol, cannabis, CBD, dronabinol, endocannabinoids, medical marijuana, nabiximols, nabilone, THC, and cancer. All studies that examined the efficacy of cannabis administered during oncological treatments, regardless of cancer localization, subtype, and sample size, were considered eligible. Results: In three studies, cannabis was administered to patients with glioblastoma, and in two other studies, cannabis was used in combination with immunotherapy in various cancer subgroups. The results of the clinical trials in cancer patients are not sufficient to draw conclusions at this time. Interestingly, several other studies addressing the systemic effects of cannabinoids in cancer patients are currently listed in the U.S. National Library of Medicine’s registry on the ClinicalTrials.gov website. However, only one of the registered studies examined the efficacy of cannabinoids as a potential option for systemic cancer treatment. Conclusions: Although cannabis is touted to the public as a cancer cure, clinical trials need to clarify which combinations of chemotherapeutic agents with cannabinoids are useful for cancer patients.
Collapse
Affiliation(s)
- Bianca Hanganu
- Department of Forensic Medicine, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Diana Elena Lazar
- Department of Oncology, Municipal Hospital “St. Hierarch Dr. Luca”, 601048 Onesti, Romania
- Correspondence: ; Tel.: +40-747-693-883
| | - Irina Smaranda Manoilescu
- Department of Forensic Medicine, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Veronica Mocanu
- Department of Morpho-Functional Sciences (Pathophysiology), “Grigore T. Popa” University of Medicine and Pharmacy, 16, Universitatii Street, 700115 Iasi, Romania
| | - Doina Butcovan
- Department of Morpho-Functional Sciences (Morphopathology), “Grigore T. Popa” University of Medicine and Pharmacy, 16, Universitatii Street, 700115 Iasi, Romania
- Department of Pathology, “Prof. George Georgescu” Institute of Cardiovascular Diseases, 50, Carol I Avenue, 700503 Iasi, Romania
| | - Camelia Liana Buhas
- Department of Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Andreea Silvana Szalontay
- Department of Psychiatry, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Beatrice Gabriela Ioan
- Department of Forensic Medicine, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
| |
Collapse
|
13
|
Manyau MC, Changadzo KP, Mudziti T. Perceptions and prevalence of marijuana use among cancer patients managed at an outpatient department in Zimbabwe: A brief report. J Oncol Pharm Pract 2022:10781552221118026. [PMID: 35944143 DOI: 10.1177/10781552221118026] [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: 11/15/2022]
Abstract
BACKGROUND Globally, marijuana is becoming an acceptable complementary medicine for symptom management in cancer. At the time that the study was conducted, Zimbabwean laws only allowed for the cultivation of marijuana for medical and scientific use. As of 18 July 2022, the national medicines regulator released a circular allowing the licensing, distribution, and use of cannabidiol-based products. Anecdotes indicate there is medical marijuana use among Zimbabwean patients with cancer. We sought to determine the prevalence, patterns of use and perceptions of medical marijuana among patients with cancer. METHODS A cross-sectional survey was used to determine patterns and perceptions of marijuana use among outpatient patients with cancer. The study included adults attending the outpatient oncology clinic at Parirenyatwa Hospital Radiotherapy Treatment Center. RESULTS Fifty participants with a median age of 50.5 years (IQR: 41-58) completed the questionnaire, and 28.0% of them were male. The prevalence of marijuana use in the sample was 24.0% (95% CI 13.9-38.2). Most marijuana users were male (83.3%, p < 0.001). The rate of medical marijuana use among users was 66.7%. Participants were generally neutral concerning the benefits of marijuana and how it should be regulated. Just under 50% indicated that they would be open to using it if it were legal. CONCLUSIONS AND RECOMMENDATIONS The prevalence of marijuana use in the sample was comparable to other jurisdictions. Perceptions toward medical marijuana were generally neutral. Consequently, for medical marijuana and/or cannabidiol-based products to become acceptable in the Zimbabwean context, there is need for the dissemination of evidence-based information on their benefits.
Collapse
Affiliation(s)
- Maudy Cp Manyau
- Department of Pharmacy and Pharmaceutical Sciences, 37595University of Zimbabwe, Harare, Zimbabwe
| | - Kudzanai P Changadzo
- Department of Pharmacy and Pharmaceutical Sciences, 37595University of Zimbabwe, Harare, Zimbabwe
| | - Tinashe Mudziti
- Department of Pharmacy and Pharmaceutical Sciences, 37595University of Zimbabwe, Harare, Zimbabwe
- Newlands Clinic, Harare, Zimbabwe
| |
Collapse
|
14
|
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: 11] [Impact Index Per Article: 5.5] [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.
Collapse
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
| |
Collapse
|
15
|
Abstract
OPINION STATEMENT Cannabinoids have been purported as having a wide range of therapeutic uses although currently, there is minimal evidence to support these claims. Patients with advanced cancer experience many distressing symptoms, with some turning to medicinal cannabis to help alleviate these. Focus has fallen on cannabidiol (CBD) as a potential treatment for a variety of symptoms in advanced cancer due to the lack of psychoactive side effects and the potential molecular mechanisms of action associated with this cannabinoid. Many cannabinoid products are easily available in the community, and more countries are legalizing or allowing over the counter products. Studies show that CBD is generally well tolerated, but there are many potential drug interactions that have not been well studied. Few studies have specifically looked at the role of CBD in treating cancer symptoms, with most focusing on combination cannabinoid products. There are currently many unknowns associated with CBD, including which symptoms it might be best for, appropriate dosing, and route of administration. This is especially important in advanced cancer where patients often have significant organ dysfunction and frailty that could impact on the pharmacology of CBD. A small pilot study has shown promise for a role of CBD in the psychological symptoms associated with advanced cancer. Further research is currently underway to further clarify the role of CBD in this setting and to understand how best it might help our patients. Currently we advocate that CBD be used in supervised clinical trials, so that efficacy and adverse effects can be closely monitored.
Collapse
|
16
|
Cannabinoid Formulations and Delivery Systems: Current and Future Options to Treat Pain. Drugs 2021; 81:1513-1557. [PMID: 34480749 PMCID: PMC8417625 DOI: 10.1007/s40265-021-01579-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 12/24/2022]
Abstract
The field of Cannabis sativa L. research for medical purposes has been rapidly advancing in recent decades and a growing body of evidence suggests that phytocannabinoids are beneficial for a range of conditions. At the same time impressing development has been observed for formulations and delivery systems expanding the potential use of cannabinoids as an effective medical therapy. The objective of this review is to present the most recent results from pharmaceutical companies and research groups investigating methods to improve cannabinoid bioavailability and to clearly establish its therapeutic efficacy, dose ranges, safety and also improve the patient compliance. Particular focus is the application of cannabinoids in pain treatment, describing the principal cannabinoids employed, the most promising delivery systems for each administration routes and updating the clinical evaluations. To offer the reader a wider view, this review discusses the formulation starting from galenic preparation up to nanotechnology approaches, showing advantages, limits, requirements needed. Furthermore, the most recent clinical data and meta-analysis for cannabinoids used in different pain management are summarized, evaluating their real effectiveness, in order also to spare opioids and improve patients' quality of life. Promising evidence for pain treatments and for other important pathologies are also reviewed as likely future directions for cannabinoids formulations.
Collapse
|
17
|
Neben-Wittich MA. Medical Cannabis to Treat Symptoms From Head and Neck Radiation Therapy. Pract Radiat Oncol 2021; 11:313-316. [PMID: 34479659 DOI: 10.1016/j.prro.2021.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 11/25/2022]
Abstract
I am a head and neck radiation oncologist in a tertiary care practice in Minnesota. I am credentialed in the state of Minnesota to certify patients for medical cannabis. Over the last 6 years, I have certified select patients for medical cannabis as part of management of their cancer-related symptoms and effects of treatment. In this paper, I review my approach to incorporating medical cannabis into the management of patients with head and neck cancer.
Collapse
|
18
|
Zheng JY, Mixon AC, McLarney MD. Safety, Precautions, and Modalities in Cancer Rehabilitation: an Updated Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021; 9:142-153. [PMID: 34178432 PMCID: PMC8214054 DOI: 10.1007/s40141-021-00312-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Providing rehabilitation to patients with cancer can be challenging due to the medical complexity associated with the illness and its treatments. This article provides the reader with a summary of frequently encountered medical conditions in the cancer population and associated safety considerations and precautions. An update on treatment modalities commonly used for symptom management is also presented. RECENT FINDINGS Cancer and cancer treatments can cause changes in multiple organ systems. Special considerations and precautions are necessary to provide safe and effective rehabilitation. Physical modalities can be used as monotherapy or adjunct to treatment for common cancer-related side effects with recent studies noting benefit with a variety of modalities. SUMMARY Detailed assessment of the cancer patient is necessary before implementing a rehabilitation program. Understanding cancer and side effects of treatments, including newer options, are necessary to provide safe care.
Collapse
Affiliation(s)
- Jasmine Y. Zheng
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, 1800 Lombard St, 1st Floor, Philadelphia, PA 19146 USA
| | - Alyssa C. Mixon
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, 1800 Lombard St, 1st Floor, Philadelphia, PA 19146 USA
| | - Mitra D. McLarney
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, 1800 Lombard St, 1st Floor, Philadelphia, PA 19146 USA
| |
Collapse
|