Health Outcomes of Medical Cannabis Use in End-Stage Cancer Patients Receiving Palliative Care: A Clinical Practice Study in the Medical Cannabis Clinic, Lampang Cancer Hospital
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Abstract
Objective: To evaluate the effectiveness and safety of medical cannabis use in end-stage cancer patients with palliative care. Methods: A preliminary study collected data retrospectively from the medical records of patients receiving care from the Medical Cannabis Clinic in Lampang Cancer Hospital from April 1, 2020 to April 30, 2022. Study outcomes included the functional performance of patients measured using the Palliative Performance Scale (PPS), symptom severity measured using the Edmonton Symptom Assessment System (ESAS), and health-related quality of life measured using the EQ-5D-5L. The outcomes were assessed before (week 0) and after the use of canabis extract (week 4). Results: A total of 20 patients were included in the study. The patients had a mean age of 60.95 ± 8.53 years and were mostly female (60%). Three formulations of cannabis extract were used: THC:CBD (1:1) in 9 patients, THC enriched 13 mg/ml in 9 patients, and THC enriched 17 mg/ml in 2 patients. After the four weeks of medical cannabis administration, median quality-of-life (interquartile range) significantly increased from 0.76 (0.45, 0.89) to 0.79 (0.61, 0.92) (P=0.017), while median pain score significantly decreased from 4 (2, 5.5) to 2 (2, 3) (P=0.01). In subgroup analyses according to each formulation, patients treated with the THC:CBD (1:1) significantly improved their quality of life from the median of 0.74 (0.64, 0.87) to 0.86 (0.74, 0.91) (P=0.011) and significantly reduced pain symptoms from the median of 4 (2, 6) to 2 (1, 3) (P=0.012). Only four patients had side effects from medical cannabis use. The most reported side effects were dry mouth (10%) and drowsiness (10%). Conclusion: Medical cannabis treatment tended to improve pain symptoms and quality of life in end-stage cancer patients with palliative care. Dry mouth and drowsiness were common and minor side effects.
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ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
References
Strategy and Planning Division, Office of the Perma- nent Secretary Ministry of Public Health. Thailand. Public health statistics A.D.2021 [online]. 2022 [cited Feb 10, 2023]. Available from: spd.moph.go.th/wp-content/uploads/2022/11/Hstatistic64.pdf
Department of Medical Services. Palliative and end of life care guidelines for the medical profession [online]. 2020 [cited Feb 10, 2023]. Available from: www.dms.go.th/backend//Content/Content_File/Prac tice_guidelines/Attach/25640114130713PM_aw%20คู่มือการดูแลผู้ป่วยแบบประคับประคอง_5.pdf
Cyr C, Arboleda MF, Aggarwal SK, Balneaves LG, Daeninck P, Néron A, et al. Cannabis in palliative care: current challenges and practical recommen dations. Ann Palliat Med. 2018; 7: 463-77.
The Narcotics Act (No. 7) B.E. 2019. Royal Gazette No. 136, Part 19A (Feb 18, 2019).
Notification of Ministry of Public Health. Re: prescribing the list of narcotics under category 5. 2022. Royal Gazette No. 139, Part special 35D (Feb 9, 2022).
Department of Medical Services. Guidance on cannabis for medical use (fifth edition) [online]. 2022 [cited Feb 2, 2023]. Available from: www.dms.go.th/ backend//Content/Content_File/Publication/Attach/25651122182642PM_Guidance%20Updated%20V5_update%2029092022_edited2.pdf
Kamkaen N, Treesak C. Medicinal cannabis for cancer. Journal of Chulabhorn Royal Academy. 2019; 1: 16-29.
Lucas CJ, Galettis P, Schneider J. The pharmacoki netics and the pharmacodynamics of cannabinoids. Br J Clin Pharmacol. 2018; 84: 2477-82.
Amin MR, Ali DW. Pharmacology of medical cannabis. Adv Exp Med Biol. 2019; 1162: 151-65.
MacCallum CA, Russo EB. Practical considerations in medical cannabis administration and dosing. Eur J Intern Med 2018; 49: 12-9.
Abrams DI, Guzman M. Cannabis in cancer care. Clin Pharmacol Ther. 2015; 97: 575-86.
Blake A, Wan BA, Malek L, DeAngelis C, Diaz P, Lao N, et al. A selective review of medical cannabis in cancer pain management. Ann Palliat Med. 2017; 6(Suppl 2): S215-s22.
Whiting PF, Wolff RF, Deshpande S, Di Nisio M, Duffy S, Hernandez AV, et al. Cannabinoids for medical use: A systematic review and meta-analysis. JAMA. 2015; 313: 2456-73.
Bar-Lev Schleider L, Mechoulam R, Lederman V, Hilou M, Lencovsky O, Betzalel O, et al. Prospective analysis of safety and efficacy of medical cannabis in large unselected population of patients with cancer. Eur J Intern Med. 2018; 49: 37-43.
Johnson JR, Burnell-Nugent M, Lossignol D, Ganae-Motan ED, Potts R, Fallon MT. Multicenter, double-blind, randomized, placebo-controlled, parallel-group study of the efficacy, safety, and tolerability of THC:CBD extract and THC extract in patients with intractable cancer-related pain. J Pain Symptom Manage. 2010; 39: 167-79.
Lichtman AH, Lux EA, McQuade R, Rossetti S, Sanchez R, Sun W, et al. Results of a double-blind, randomized, placebo-controlled study of nabiximols oromucosal spray as an adjunctive therapy in advanced cancer patients with chronic uncontrolled pain. J Pain Symptom Manage. 2018; 55: 179-88.
Meiri E, Jhangiani H, Vredenburgh JJ, Barbato LM, Carter FJ, Yang HM, et al. Efficacy of dronabinol alone and in combination with ondansetron versus ondansetron alone for delayed chemotherapy-induced nausea and vomiting. Curr Med Res Opin. 2007; 23: 533-43.
Chow R, Valdez C, Chow N, Zhang D, Im J, Sodhi E, et al. Oral cannabinoid for the prophylaxis of chemotherapy-induced nausea and vomiting-a systematic review and meta-analysis. Support Care Cancer. 2020; 28: 2095-103.
Thanasitthichai S, Simasatikul C, Srisubat A, Krong kaew W, Kunin B, Seedadard R, et al. Safety and efficacy evaluation of the 1st legalized pharmaceu tical grade medical cannabis for palliative care in Thailand. Journal of the Department of Medical Services. 2020; 45: 116-22.
Srisubat A, Thanasithichai S, Thaiyakul A, Konlae aid S, Arunratanachot W, Imsuwanasri T, et al. Outcomes of THC enriched in advanced staged cancer patients. Journal of the Department of Medical Services. 2020; 45: 208-14.
Kraikosol W, Chaocharoen A, Laemluang P, Musiga wong N, Kwankhao P. Effects and safety of cannabis sublingual Oil THC 1.7% w/v formula in patients with end stage cancers in medical cannabis clinic, Chao phya abhiabhubejhr hospital. Journal of the Department of Medical Services. 2021; 46: 50-9.
Lueangchiranothai P, Palawong S, Kamol T. Effectiveness of cannabis extract at medical cannabis clinic in Lampang Hospital. Journal of Thai Traditional Alternative Medicine Review 2021; 19: 20-33.
Chewaskulyong B, Sapinun L, Downing GM, Intaratat P, Lesperance M, Leautrakul S, et al. Reliability and validity of the Thai translation (Thai PPS Adult Suandok) of the Palliative Performance Scale (PPSv2). Palliat Med 2012; 26: 1034-41.
Suandok Palliative Care Maharaj Nakorn Chiang Mai Hospital. Palliative Performance Scale for adult Suandok [online]. [cited Feb 2, 2023]. Available from: web.lpnh.go.th/lphc/file/pps.pdf.
Chinda M, Jaturapatporn D, Kirshen AJ, Udomsub payakul U. Reliability and validity of a Thai version of the edmonton symptom assessment scale (ESAS-Thai). J Pain Symptom Manage. 2011; 42: 954-60.
Department of Family Medicine, Ramathibodi Hospital. ESAS (Edmonton Symptom Assessment System) Thai version [online]. [cited Feb 2, 2023]. Available from: www.rama.mahidol.ac.th/fammed/sit es/default/files/public/pdf/esas_thai.pdf.
Sonsa-ardjit N, Sakthong P. Reliability and validity of the Thai version of EQ-5D-5L questionnaire on patients with chronic disease. Chulalongkorn Medical Journal 2015; 59: 489-501.
Pattanaphesaj J. Health-Related Quality of Life Measure (EQ-5D-5L): Measurement property testing and its preference-based score in Thai population [dissertation]. Bangkok; Mahidol University; 2014.
Evenepoel M, Haenen V, De Baerdemaecker T, Meeus M, Devoogdt N, Dams L, et al. Pain prevalence during cancer treatment: a systematic review and meta-analysis. J Pain Symptom Manage. 2022; 63: e317-e35.
Haroutounian S, Ratz Y, Ginosar Y, Furmanov K, Saifi F, Meidan R, et al. The effect of medicinal cannabis on pain and quality-of-life outcomes in chronic pain: A prospective open-label study. Clin J Pain. 2016; 32: 1036-43.
