Cannabis in palliative care: current challenges and practical recommendations

Abstract

Pain and symptom control challenges are common in palliative care, and the search for other therapeutic strategies is ongoing. Unfortunately, patients and their caregivers are receiving little information or support from healthcare providers regarding the increasingly popular cannabinoid-based medicines (CBM). Clinicians, meanwhile, feel understandably perplexed by the discrepancy between the available evidence and the rapid interest in which patients and their families have demonstrated for CBM. There is an urgent need to address the many challenges that are delaying the appropriate integration of CBM into clinical practice, notwithstanding the obvious need for a solid general knowledge of pharmacology, mechanism of action and available clinical evidence supporting its use. The authors will address these challenges and provide practical recommendations regarding patient assessment for the use of CBM. The authors will also make suggestions regarding patient expectations in order to define clear objectives, review the necessary precautions prior to initiating treatment, aid in selecting the appropriate strain and route of administration as well as establishing proper titration and monitoring protocols. The authors will also discuss the lesser known but potentially therapeutic psychoactive effects of cannabis. As this class of therapeutic agents are likely to play a major role in palliative medicine in the near future, clinicians would benefit from familiarizing themselves with CBM and we can expect that patients and their caregivers will appreciate receiving support in their search for safe and effective therapeutic alternatives.

“Guarding their practice”: a descriptive study of Canadian nursing policies and education related to medical cannabis

“…While evidence on medical cannabis is in its nasceny, it is a rapidly evolving area of healthcare research [20] that NPs must be knowledgeable about to inform their practice. Clinical guidelines are beginning to be developed [18, 21] and will provide an important starting point in educating NPs about such concepts as self-titration, safer routes of administration, and minimizing side effects of cannabis use. In addition, the growing number of clinical trials on cannabis and cannabinoids also provide preliminary direction in terms of dosing and treatment plans [22] that may help guide NPs caring for patients interested in using medical cannabis.…”

Future Aspects for Cannabinoids in Breast Cancer Therapy

“…Therefore, both CBs have been recommended for therapy-resistant nausea and vomiting caused by chemotherapy. Moreover, dronabinol proved to be effective in improving anorexia in patients with AIDS and may also benefit patients with an advanced stage of cancer for proper nutrition [95].…”

Medical cannabis in supportive cancer care: lessons from Canada

“…Listed below is a summary of the shared knowledge and clinical experiences from our team of multidisciplinary healthcare practitioners and researchers to support the integration of medical cannabis in supportive cancer care: goals, such as relieving cancer-related symptoms or side effects from oncologic treatments (i.e., chemotherapy, radiotherapy, etc. ); & Choose the product (i.e., THC-rich, CBD-rich, THC/CBD 1:1 ratio, nabilone, nabiximols), route of administration (i.e., oral, inhaled, topical), and initial dosage, in collaboration with an interdisciplinary team that has a solid knowledge of the pharmacokinetics and side effects of these products [16]; & Educational sessions encourage patient and physician participation; & Adverse events are often dose-related; titration should be monitored closely; & Practical guidelines are still lacking; however, recommendations in these types of settings have begun to emerge in the literature [17]; & Only the development of well-designed clinical trials will eventually determine the true efficacy of medical cannabis treatments. Encourage development of medical cannabis research at every opportunity.…”