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Cannabis in Palliative Medicine

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Cannabis in Medicine

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Abstract

Palliative care is a specialized medical care that focuses on quality of life for patients with serious illnesses. In the realm of palliative care and symptom management, there is growing interest in the role for cannabis-based medicine. There is some evidence to support the use of cannabinoids for the palliation of some symptoms and quality of life issues. Most notably, research supports the efficacy of cannabinoids for the treatment of chemotherapy-induced nausea and vomiting, though the evidence for phytocannabinoids is lacking. Moreover, cannabis use in the treatment of neuropathic pain is supported by several small high-quality studies. There is great interest in cannabis-based medicine to aid in the management of other symptoms such as anorexia, cachexia, insomnia, fatigue, anxiety, and delirium, among others that are prevalent in palliative care patients. Though there are limited studies for these various applications of cannabis, the data is not conclusive, and patients’ treatment goals must be carefully considered prior to the administration of medical cannabis. Further research is needed to better understand the possible benefits of medical cannabis as well as the safety, side effects, and drug interactions.

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Abbreviations

2-AG:

2-arachidonoylglycerol

5HT1A:

Serotonin 1A receptor

AAN:

American Academy of Neurology

AEA:

Anandamide

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

CACS:

Cancer-related anorexia-cachexia syndrome

CAPC:

Center to Advance Palliative Care

CB1:

Cannabinoid receptor 1

CB2:

Cannabinoid receptor 2

CBD:

Cannabidiol

CDC:

Center for Disease Control

CINV:

Chemotherapy-induced nausea and vomiting

CNS:

Central nervous system

CYP:

Cytochrome P450

ECS:

Endocannabinoid system

FEV1:

Forced expiratory volume

GAD:

Generalized anxiety disorder

HPA:

Hypothalamic-pituitary-adrenal

INR:

International normalized ratio

MDD:

Major depressive disorder

NNT:

Number needed to treat

NREM:

Non-rapid eye movement

NRS:

Numerical rating scale

PD:

Panic disorder

PTSD:

Post-traumatic stress disorder

QOL:

Quality of life

RCT:

Randomized control trial

REM:

Rapid eye movement

SAD:

Social anxiety disorder

SPST:

Simulated public speaking test

TCA:

Tricyclic antidepressant

THC:

Delta-9-tetrahydrocannabinol

VAS:

Visual analogue scale

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Authors and Affiliations

  1. Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA

    Fabienne Saint-Preux

  2. Department of Medicine, Division of Hematology-Oncology, Division of Geriatric-Palliative Medicine, Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA

    Arpit Arora & Arum Kim

  3. Department of Medicine, Division of Geriatric-Palliative Medicine, New York University School of Medicine, New York, NY, USA

    Derek Moriyama

  4. Department of Radiation Oncology, New York University Langone Health, New York, NY, USA

    Esther Kim

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  1. Fabienne Saint-Preux
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  5. Arum Kim
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Correspondence to Arum Kim .

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  1. Springs Rehabilitation PC, Colorado Springs, CO, USA

    Kenneth Finn

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Saint-Preux, F., Arora, A., Moriyama, D., Kim, E., Kim, A. (2020). Cannabis in Palliative Medicine. In: Finn, K. (eds) Cannabis in Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-45968-0_13

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