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cannabis patient care
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vol. 2 no. 3 cannapatientcare.com
advocate focus
"I think products that contain CBD, whether that's a cannabis prod-
uct that also has THC where one of my patients would have to go to
a dispensary to get it, or it's a pure CBD-containing product that they
can get at the grocery store or online, I've personally seen it benefit
a fair number of my patients in terms of things ranging from insom-
nia, hot flashes, body aches, symptoms related to some of the endo-
crine therapies that we ask patients to take," she said. "And then, for
our patients who are struggling with more advanced stages of cancer
and more end of life issues, the comfort and anxiety control and re-
lief that CBD containing products can offer is also, I think, apparent in
the practical evidence that we've gained over time."
Patients have to choose their CBD products carefully from the
many offerings out there that may not be reliable, or that have
been contaminated by bad processing chemicals. "It's like anything
else in the supplement industry," Dr. Borges said. "I view cannabis
as a part of the supplement industry. So let the buyer beware."
CBD has just been another plant-based supplement available to
her patients for a long time, she added. "I wouldn't say that I'm an
advocate, as opposed to I've seen it benefit my patients, so I rec-
ommend it to them, just like I would recommend grape seed ex-
tract (12) or other things that we know can offer them benefit as
they struggle with their side effects."
What is most important to her is that she wants her patients
to be on endocrine therapy, because some of those drugs reduce
the risk of ever developing a recurrence or metastasis of their
breast cancer by 50–75%. "So these are crucial drugs for some-
body's wellness after a breast cancer diagnosis. They have to be
on these drugs for five years, and they're not easy to take," Dr.
Borges said.
There are prescription drugs that can be used to help patients
with side effects of the endocrine therapy, but Dr. Borges said very
few patients are readily accepting of using a prescription drug.
"Some of these breast cancer patients are 30 year old women and
they don't want to be taking drugs to manage the side effects of the
drug that's going to have side effects. So, if we can have a more pa-
tient-facing, lower risk alignment with how they prefer to manage
their care, which also helps me keep them on the endocrine therapy
that I know is crucial for reducing the risk of ever having a more ad-
vanced stage of breast cancer, it's kind of a win-win," she said.
Colorado offers benefits to breast cancer patients by the sheer
volume of dispensaries across that state. "A patient can't literally
drive down the street without seeing a dispensary, so it's pretty ac-
cessible," said Dr. Borges. "CBD is going to handle five of their side
effects, like appetite stimulations, which is a big deal in many pa-
tients. So a compound that's going to fix five different things would
be where I would choose to leave my recommendation, because
they'll try it, and they'll benefit from it."
She added that she thinks the most important thing for her work
with patients is to have an open conversation about what is impor-
tant to them in co-managing their care. "There is a control issue.
You have to give patients authority and control over a part of their
care and help them understand what's going to be safe and not
safe for them to engage in," Dr. Borges said. "They are very much
looking to try and take some control back after a cancer diagnosis
that has really removed a tremendous amount of the control that
most of us take for granted in our day to day lives."
Conclusion
Dr. Noreika said that she, like everyone else, is hopeful that
there are substances out there that "on the whole, do have their
burdens," but are potentially safe for individual patients in certain
circumstances. "How amazing would it be if it also improves that
underlying reason about how your cancer acts," Dr. Noreika said.
"I think I have all the hope in the world. We're always looking for
things that are going to improve the quality of life for our patients.
"We do want to be careful that we don't get too hopeful because
we want to be clear-eyed about what we're seeing, and make sure
we don't jump on a bandwagon that's later going to be identified
that caused harm or more burden to our patients," Dr. Noreika said.
"I'm looking forward in the future to kind of see more of the re-
search, potentially having it be more easily accessible, and, in prac-
tice, to see where it might fit into the patient's treatment profile."
As legalization efforts continue to have their impact, perhaps
a sort of "mathematization" Internet of Everything (IoE [13]) sys-
tems-based approach to biology will help devise better therapies us-
ing plant-based substances such as cannabis and help science un-
derstand more about how it works for breast cancer patients.
This transformation of biology, this new understanding of
how cells work inside the human body, has already begun and
will help maximize the benefits of drug therapy and minimize
the side effects. Medical science can go from in vitro (doing
tests with cells in a dish or molecules in a test tube) and in vivo
(doing tests with cells in living things) to in silico biomedicine
(using a computer with advanced models for simulations to test
theories faster and more efficiently) (14).
References
(1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7693730/.
(2) https://www.ncbi.nlm.nih.gov/books/NBK425757/.
(3) https://pubmed.ncbi.nlm.nih.gov/24937161/.
(4) https://www.breastcancer.org/treatment/comp_med/types/medical-marijuana.
(5) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2360617/.
(6) https://www.sciencedirect.com/science/article/abs/pii/S0304383509002523?via%3Dihub.
(7) https://www.safeaccessnow.org/cancer.
(8) https://casetext.com/case/conant-v-walters.
(9) https://www.vanorml.org/faqs.
(10) https://nationalmedicalmarijuanacard.com/medical-marijuana-
card/richmond-virginia/danielle-m-noreika.
(11) http://sensiblecolorado.org/history-of-co-medical-marijuana-laws/.
(12) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2728696/.
(13) https://www.cisco.com/c/dam/en_us/about/business-insights/
docs/ioe-value-at-stake-public-sector-analysis-faq.pdf.
(14) A. Steele, "Ageless – The New Science of Getting Older Without Getting
Old," page 232 (2020) https://andrewsteele.co.uk/ageless/.
