Cannabis use in early medical intervention in cancer patients can have many positive benefits such as helping to reverse vomiting, anorexia, and increasing one’s appetite. Cannabis can help to eliminate the need for opioids and also helps to increase mood. This type of treatment is plant derived and there are many different ways that cannabis can be taken- from inhalation to ingestion. Cannabis can be used for a multitude of other ailments as well, and should further research become available for physicians, may be seen in future illnesses and ailments as a first line defense. It is known that Canada was one of the first of a growing number of countries to legalize botanical Cannabis for medical purposes.
Cannabis, or marijuana, is now legal for adult recreational and/or medicinal use in most of the United States, with 60% of the United States population residing in these states. California was the first state to approve medicinal cannabis in 1996. Over the past 2 decades, half of the states, accounting for 86% of the US population, have acquired cannabis as medicine. Medical cannabis, also known as medical marijuana, which intends to relieve symptoms and potentially to modulate disease, must be distinguished from recreational cannabis, which intends to deliver a psychotomimetic state of “high”. Medical cannabis can be dispensed in a dried botanical format that might be smoked, vaporized, brewed as tea, or cooked as edible food products.
The 4 principles of the ethical practice of medicine are respect for autonomy, beneficence, non-maleficence and justice. Oncology nurses may have a special interest in assisting patients with using cannabis as a palliative treatment, because patients with cancer should be offered early palliation in support of better cancer treatment outcomes. Nurses are ethically obligated to ensure patients’ autonomy, and the ethical standards for nurses require that high-quality care be provided to all patients, including those who use cancer for palliation. To understand and define medicinal cannabis use, oncology nurses need to start at the basic, molecular level to recognize the physiology of how cannabis works in the body. THC is the primary psychoactive component of cannabis. THC acts via the dopaminergic system to increase dopamine production. It works primarily as a weak partial agonist on CB1 and CB2 receptors, with well-known effects on pain, appetite, digestion, emotions and thought processes.
127 our experts are availableright now
Beyond its association with symptom management, including pain and nausea control, some research studies have discovered that cannabis may cut tumor and growth size . “Some patients with tumors in their brains or leptomeningeal regions from HER2-positive breast cancer have been reporting surprisingly good results when using THC-rich cannabis alongside conventional treatments like radiotherapy”. In a study in Israel, after using medical marijuana, approximately 60% of patients reported improvements for pain, insomnia, vomiting and anorexia. Study patients were frequently able to decrease their dose of conventional medications; in the case of opioids, approximately 50% continued to take the same dose, 10% decreased the dose, and 36% ceased taking them completely.
Although the main use of cannabinoids in patients with cancer and palliative patients has been symptom management, there could be other roles for these molecules in the treatment of malignancies. However, cannabis has not been studied clinically as a treatment for malignancy. Less than 30% of oncologists feel knowledgeable enough about medical marijuana to make concrete recommendations, even though 70% believe medical marijuana to be helpful to cancer patients. With only 30% of physicians feeling comfortable enough to prescribe medical marijuana, how is the patient going to know if they are making a good decision if they are under the care of the other 70%? The acute side effects of cannabis are generally perceived as relaxing and pleasurable, with an increased sense of well-being and euphoria.
There are also possible adverse effects that could come from the patient taking a form of medical marijuana, such as: acute impairment of memory, coordination, and judgement, as well as possible chronic effects such as cannabis abuse disorder, cognitive impairment, and chronic bronchitis, as well as the possibility of increased risk for motor vehicle accidents. If a patient is experiencing side effects, the following possibilities exist: a different strain or variety may be needed; the patient may need to focus on starting low and going slow with dosing; the patient may need to understand that, over time, tolerance may develop and side effects may lessen, as well as that using cannabis with other cannabinoids, primarily CBD, helps to manage side effects related to THC.
In conclusion, patients in an oncology setting need to be informed of all of their options. Many oncologists just aren’t well versed in medical marijuana use and treatment and will stick with what they know as far as treatments go. As Abrams says, “Unfortunately, when it comes to supporting the use of cannabis in clinical situations, we are frustrated by a dearth of convincing evidence. Data from gold-standard prospective randomized controlled clinical trials are virtually nonexistent.” The science of cannabis use for cancer treatment and palliation is still emerging, but as the body of evidence grows, nurses may be on the front lines of facilitating patients choices with this palliative medicine.
Cannabis can alleviate a lot of symptoms that the user is suffering from, but also has what could be a confusing dosing system. As stated by Abrams, “using an analogy to the way cannabis dispensaries work, a physician would write a recommendation for treating depression, and the dispensary would inquire, “do you want paroxetine, bupropion or sertraline? What dose? How many?” An imperfect system for sure, but that is the way it currently works for medical marijuana.” If the patient is not familiar with how to dose themselves with medical marijuana, then they could get the wrong type or dose and incorrectly administer the drug. However, with further research and data, oncologists could make this a treatment of choice for patients who are suffering with this debilitating disease.
Works Cited
- Abrams, DI. “Using Medical Cannabis in an Oncology Practice.” Oncology (2016): 397-404.
- Brigden, Malcolm and Dean England. “Medical marijuana and community oncology practice: the good, the bad, and the potentially ugly.” Oncology Exchange (2018): 10-16.
- Clark, Carey S. “Medical Cannabis: The oncology nurse’s role in patient education about the effects of marijuana on cancer palliation.” Clinical Journal of Oncology Nursing (2018): 6.
- Maida, V. and P.J. Daeninck. “A user’s guide to cannabinoid therapies in oncology.” Current Oncology (2016): 398-406.
- Pirschel, Chris. “Understanding Medical Cannabis in Cancer Care.” ONS Voice (2018): 18-22.
