Cannabis Patient Care - November 2021

Cannabis Patient Care November Issue

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9 october/november 2021 | cannabis patient care doctor focus seeking medical cannabis; are they talking to a doctor about their interest or use of medical cannabis; are they using it be- fore, during, or after treatment; what type of products are they using; how many products are they using; what was the source of their products? did a national sur- vey of the population going through, about to go through, or have gone through breast cancer. We learned a tremendous amount and we published that data, which reinforced the fact that people were suffering from symptoms which they could not find relief from with other medications. Q: What did you learn through your survey about which symptoms or side effects breast cancer patients were most able to find relief with or control with the use of medical cannabis? A: Dr. Weiss: The most common symptoms were pain, anxiety, insomnia, and nausea or vomiting. We also found that nearly 80% of cannabis users are using it during treatment. More and more people are using it and understanding its role. More patients are saying it's helpful with symptomatic management, and noting that nothing else was helpful in the same way. Q: Is there anything you would caution breast cancer patients about in regards to medical cannabis use? A: Dr. Weiss: There are a lot of claims on the web about cannabis being an anticancer therapy. I would say that the data showing that cannabis can slow the spread of cancer, that's all based on petri dishes, not people yet. We don't know if there is any basis for that from a scientific perspective. So, I would stick with traditional proven therapies, because we don't know if it's safe or effective. We don't know how it will interact with traditional therapies. Q: Do you ever suggest cannabis to patients who don't ask about it specifically? A: Dr. Weiss: Definitely. Breast cancer and most of these cancers affect women who are typically in charge of the family and who are usually very risk averse. They don't want to get into trouble. Dr. Marisa Weiss' 2020 ASCO Poster Coala-T-CBD Symptom Management. • Click to edit Master text styles – Second level • Third level – Fourth level » Fifth level • Click to edit Master text styles – Second level • Third level – Fourth level » Fifth level • Click to edit Master text styles – Second level • Third level – Fourth level » Fifth level • Click to edit Master text styles – Second level • Third level – Fourth level » Fifth level A significant proportion of breast cancer patients reported using cannabis during active treatment to manage a combination of symptoms associated with their cancer and its therapies. Although younger patients are somewhat more likely to use this form of palliative management, older patients are suffering from the same symptoms and their use is nearly as high. More research is needed on the personalization of safe and effective symptomatic management with medical cannabis for breast cancer patients of all ages, stages, and forms of treatment. 13% 14% 29% 35% 40% 49% 51% 53% 60% 62% 87% 86% 71% 65% 60% 51% 49% 47% 40% 38% Did not use medical cannabis during treatment Used medical cannabis during treatment A COALA-T-SURVEY OF BREAST CANCER PATIENTS' USE OF CANNABIS BEFORE, DURING AND AFTER TREATMENT Marisa C. Weiss, MD 1,2,3,4 , Meghan Buckley, MS 2 , Julianne Hibbs, MD 3 , Sam Meske, MS 2 , Adam Leitenberger 1 , Melissa Jenkins 1 , Terri W. McHugh 3, Nancye Green 5 , Sharon Larson 2 1, Ardmore, PA; 2 Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA; 3 Lankenau Medical Center, Wynnewood, PA; 4 Socanna, Narberth, PA; 5 Donovan/Green, New York, NY. Contact author: Most US states have legalized medical cannabis for symptom management in serious conditions, including cancer. It is not well-known which symptoms breast cancer patients seek to control with cannabis and when they utilize cannabis products relative to the timing of their specific multi-disciplinary cancer treatments. Members of the and Healthline communities were invited to participate in this survey between 12/16/2019 and 1/19/2020. Eligibility criteria included age ≥18 years, resident of the US and a breast cancer diagnosis within the past 5 years. Eligible respondent data were analyzed for the symptomatic profile of cannabis users. Symptoms were compared between patients under vs. over age 50 using a Chi-square test of independence. Medical cannabis users under age 50 were more likely to use cannabis to treat these symptoms overall compared to users over age 50, but the differences were not statistically significant. However, medical cannabis users under age 50 used cannabis significantly more than those over 50 to treat nausea/vomiting (58% vs 40%; p=0.010) and inflammation (34% vs 20%; p=0.021). Medical cannabis users with metastatic disease were more likely to use medical cannabis to treat chronic pain (60% vs 41%; p=0.017) than non-metastatic users. Post-surgery patients were most likely to use cannabis for nerve pain, and those who were beyond treatment were most likely to use cannabis for stress. Medical cannabis was found to be very to extremely helpful in treating the symptoms and side effects of breast cancer in 75%. Younger patients (<50) and those with non- metastatic disease reported higher helpfulness ratings. Targeted therapy for advanced/metastatic breast cancer (n=30) Chemotherapy (n=148) Anti-HER2 therapy (n=45) Hormonal therapy (n=140) Immunotherapy for advanced/ metastatic breast cancer (n=5*) Mastectomy alone (n=45) Radiation to the breast area (n=120) Radiation to other parts of the body (n=30) Lumpectomy (n=87) Mastectomy and reconstruction (n=63) Among the 832 respondents who completed screening, 725 met the eligibility criteria, and 612 (84%) completed the survey. The median age of respondents was 57 years (range, 27-84) and 85% had non-metastatic disease. About 42% of respondents reported they have used medical cannabis to treat symptoms or side effects of breast cancer. Medical cannabis users reported using cannabis to treat pain including acute and chronic joint and muscle aches, discomfort, stiffness, or nerve pain (78%), insomnia (70%), anxiety (57%), stress (51%), and nausea/vomiting (46%). Seventy-nine percent of users reported cannabis use during treatment, including 87% of those who received targeted therapy, 86% who received chemotherapy, 71% who received HER2 therapy, 65% who received hormonal therapy, and 49% who received radiation therapy to the breast. 5% 19% 35% 40% 1 3 2 4 5 1% Extremely Helpful Not at all Helpful INTRODUCTION METHODOLOGY RESULTS CONCLUSIONS ACKNOWLEDGEMENTS The COALA-T-Survey was led by Socanna, conducted by Outcomes Insights, and supported by a grant from Ananda Health/Ecofibre.

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