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Cannabis-Based Medications: The Future Co-analgesics of Choice for Cancer Patients?

      Objectives

      To provide further evidence on the safety, efficacy and versatility of medical cannabis (MC) in cancer pain management and to support the case for the development of cannabis-based medications as co-analgesic drugs.

      Methods

      A retrospective chart review was conducted to determine the impact on pain severity, symptom burden and health related quality of life (HRQoL) in adult cancer patients. Patients were assessed, prescribed and followed at a specialized MC clinic. Data collected at baseline and 3-month follow-up visits utilized the Brief Pain Inventory-Short Form (BPI-SF), revised Edmonton Symptom Assessment Scale (ESAS-r) and EQ-5D-5L.

      Results

      Eighty-one consecutive patients (mean 58.6 years, 35.8% male) experiencing unrelieved cancer pain at baseline (BPI-SF score ≥ 4/10) were included with Gastrointestinal (18.5%), breast (17.3%) and lung (13.6%) as the most frequent cancer primaries. Cannabinoid products with a 1:1 ratio of Tetrahydrocannabinol (THC) and Cannabidiol (CBD) were most frequently prescribed (26%) and a treatment plan of combined oral and inhaled administration was most common (44.5%). BPI scores for “average pain”, “worst pain” and “pain interference” significantly improved after 3 months of treatment (Wilcoxon signed-rank test, p<0.0001). Furthermore, improvements of HRQoL were impactful; ESAS-r scores for pain, depression and anxiety decreased significantly respectively from 4.0 ± 2.6 to 3.1 ± 2.5 (mean ± SD; p=0.001); from 3.6 ± 2.3 to 1.9 ± 1.8 (p=0.001) and from 4.7 ± 2.6 to 3.9 ± 3.1 (p=0.026). On the EQ-5D-5L, patients reported ameliorated mobility (p< 0.0001), self-care (p< 0.0001) and pain/discomfort (p=0.003). Overall, 27.1% of subjects experienced one or more mild or moderate side effects, all were resolved via a supportive follow-up program.

      Conclusions

      Considering widely identified shortcomings of conventional analgesic treatments, adjunctive and complementary options are required. Pain reduction and improved HRQoL can be safely achieved utilizing MC warranting the development of co-analgesic cannabis-based medications.