Abstract Context The use of the cannabis plant ( Cannabis sativa L.) for the palliative treatment of cancer patients has been legalized in multiple jurisdictions including Israel. Yet, not much is ...currently known regarding the efficacy and patterns of use of cannabis in this setting. Objectives To analyze the indications for the administration of cannabis among adult Israeli cancer patients and evaluate its efficacy. Methods Efficacy and patterns of use of cannabis were evaluated using physician-completed application forms, medical files, and a detailed questionnaire in adult cancer patients treated at a single institution. Results Of approximately 17,000 cancer patients seen, 279 (<1.7%) received a permit for cannabis from an authorized institutional oncologist. The median age of cannabis users was 60 years (range 19–93 years), 160 (57%) were female, and 234 (84%) had metastatic disease. Of 151 (54%) patients alive at six months, 70 (46%) renewed their cannabis permit. Renewal was more common among younger patients and those with metastatic disease. Of 113 patients alive and using cannabis at one month, 69 (61%) responded to the detailed questionnaire. Improvement in pain, general well-being, appetite, and nausea were reported by 70%, 70%, 60%, and 50%, respectively. Side effects were mild and consisted mostly of fatigue and dizziness. Conclusion Cannabis use is perceived as highly effective by some patients with advanced cancer and its administration can be regulated, even by local authorities. Additional studies are required to evaluate the efficacy of cannabis as part of the palliative treatment of cancer patients.
Background:
Chemotherapy-induced peripheral neuropathy (CIPN) is a common and dosage-limited oxaliplatin-related toxicity. To date, there are no successful interventions for CIPN prevention or ...treatment. A therapeutic role for cannabis in diabetic and HIV-related peripheral neuropathy and a protective role in CIPN have been suggested. We examined the effect of cannabis on oncologic patients with CIPN.
Methods:
Medical records of 768 consecutive patients treated with oxaliplatin and 5-fluorouracil-based combinations at a tertiary medical center from October 2015 to January 2018 were reviewed. Excluded patients were those with pre-existing neuropathy or patients who received fewer than two cycles of oxaliplatin treatment. CIPN grade, oxaliplatin cumulative dose, and neuropathy-free survival were evaluated. The patients were divided based upon the exposure to cannabis: prior to oxaliplatin (cannabis-first), cannabis following the initiation of oxaliplatin treatment (oxaliplatin-first), and no exposure (control).
Results:
In total, 513 patients met the inclusion criteria, of whom 248 were treated with cannabis and 265 served as controls. The cannabis-first group included 116 (46.7%) patients and the oxaliplatin-first group included 132 (53.3%) patients. Demographic parameters were comparable between groups. There was a significant difference in CIPN grade 2–3 between cannabis-exposed patients and controls (15.3% and 27.9%, respectively, p < 0.001). The protective effect of cannabis was more pronounced among cannabis-first patients compared to oxaliplatin-first patients (75% and 46.2%, respectively, p < 0.001). The median oxaliplatin cumulative doses were higher in the cannabis-first versus the oxaliplatin-first versus the control groups (545 mg/m2, 340 mg/m2, and 425 mg/m2 respectively, p < 0.001).
Conclusion:
The rate of neuropathy was reduced among patients treated with cannabis and oxaliplatin. This reduction was more significant in patients who received cannabis prior to treatment with oxaliplatin, suggesting a protective effect. A large prospective trial is planned.
Immune checkpoint inhibitors (ICIs) have revolutionized the prognosis of cancer. Diabetes mellitus (DM) has been shown to have a negative effect on patients treated with ICIs. Sodium-glucose ...cotransporter 2 inhibitors (SGLT2i) are effective antidiabetic therapies associated with reduced all-cause mortality and cardiovascular (CV) outcomes.
To evaluate the prognostic value of SGLT2i on all-cause mortality and cardiotoxicity among patients treated with ICIs.
We performed a retrospective analysis of patients diagnosed with cancer and type 2 DM (DM2) and treated with ICIs at our center. Patients were divided into two groups according to baseline treatment with or without SGLT2i. The primary endpoint was all-cause mortality and the secondary endpoint was MACE, including myocarditis, acute coronary syndrome, heart failure, and arrhythmia.
The cohort included 119 patients, with 24 (20%) patients assigned to the SGLT2i group. Both groups exhibited a comparable prevalence of cardiac risk factors, although the SGLT2i group displayed a higher incidence of ischemic heart disease. Over a median follow-up of 28 months, 61 (51%) patients died, with a significantly lower all-cause mortality rate in the SGLT2i group (21% vs. 59%, p = 0.002). While there were no significant differences in MACE, we observed zero cases of myocarditis and atrial fibrillation in the SGLT2i, compared to 2 and 6 cases in the non-SGLT2i group.
SGLT2i therapy was associated with a lower all-cause mortality rate in patients diagnosed with cancer and DM2 and treated with ICIs. Further studies are needed to understand the mechanism and evaluate its benefit on cardiotoxicity.
The COVID‐19 epidemic is transforming the most basic component of communication between patients and physicians: the face‐to‐face meeting. This commentary addresses the challenges unique to the ...oncologist conducting appointments via telemedicine.
Patients with cancer who have been treated with systemic anticancer therapy are at a significantly increased risk of mortality from COVID-19,3–6 and therefore should be considered as a high-priority ...group for COVID-19 vaccination. Because the pivotal vaccination study for BNT162b2 included only healthy individuals or those with stable chronic medical conditions,1 a major obstacle faced by the Ministry of Health and by the National Council for the Prevention Diagnosis and Treatment of Malignant Disease was an absence of data regarding the safety and efficacy of the vaccine in patients with cancer who have been or are being treated. The institutional policy of the Oncology Division at the Tel Aviv Sourasky Medical Center (TLVMC) and at the Oncology Unit at Bnei-Zion Medical Center was to allow and encourage vaccination for all patients with cancer being actively treated, regardless of treatment type. Because COVID-19 is particularly dangerous to these susceptible patients, vaccination was encouraged regardless of disease stage, performance status, or life expectancy. ...the decision to vaccinate patients in regions severely affected by the pandemic cannot wait for the accumulating data from well designed, prospective clinical trials. ...despite the absence of evidence, the March 5, 2021, update of the American Society of Clinical Oncology guidelines state that “At this time, patients undergoing treatment may be offered vaccination against COVID-19 as long as any components of the vaccine are not contraindicated”.
In Reply Wolf, Ido; Waissengrin, Barliz; Pelles, Sharon
The oncologist (Dayton, Ohio),
11/2020, Letnik:
25, Številka:
11
Journal Article
Recenzirano
This letter to the editor responds to recent advice related to delivering difficult news via telemedicine, further encouraging productive discussions on this challenging topic.
In Reply Wolf, Ido; Waissengrin, Barliz; Pelles, Sharon
The oncologist (Dayton, Ohio),
November 2020, Letnik:
25, Številka:
11
Journal Article
Recenzirano
This letter to the editor responds to recent advice related to delivering difficult news via telemedicine, further encouraging productive discussions on this challenging topic.
In Reply Wolf, Ido; Waissengrin, Barliz; Pelles, Sharon
The oncologist (Dayton, Ohio),
09/2020, Letnik:
25, Številka:
11
Journal Article
Recenzirano
This letter to the editor responds to recent advice related to delivering difficult news via telemedicine, further encouraging productive discussions on this challenging topic.
The SARS-COV-2 virus emerged in Israel in March 2020 and compelled restructuring of the Israeli health care system. Despite the paucity of data, it appears that oncology patients suffer from a higher ...risk of complications due to COVID-19 infection, including hospitalization in the intensive care unit (ICU) and death. A delicate balance exists between the oncologists' obligation to provide optimal and effective cancer treatment and the risks enveloping treatment that may place patients vulnerable to contraction of the virus. In an effort to reorganized oncological units, guidelines were published by the American and European oncology unions (ASCO, ESMO), including cancellation of frontal meetings, converting to telemedicine and changes in treatment protocols mitigating the exposure of patients to hospital visitations. Khoury et al. reported their experiences and challenges at Bnai Zion Hospital in Haifa during the first days of the pandemic, recounting the protection of staff, patients and reorganization of the oncological unit.
Introduction
The use of telemedicine in oncology practice is rapidly expanding and is considered safe and cost effective. However, the implications of telemedicine on patient‐physician interaction, ...patient satisfaction, and absence of the personal touch have not been studied to date. Following the spread of COVID‐19, telemedicine services were rapidly incorporated at the Oncology Division of Tel Aviv Medical Center. We aimed to evaluate patients' perspectives and preferences regarding telemedicine and to assess whether this virtual communication platform affects the patient‐physician relationship.
Methods
Between March 2020 and May 2020, adult cancer patients who conducted at least one successful telemedicine meeting were interviewed by trained medical personnel. The interview was based on validated patient satisfaction questionnaires and focused on patient‐physician interaction in relation to the last in‐patient visit.
Results
Of 236 patients, 172 (74%) patients agreed to participate. The study population comprised mainly patients with gastrointestinal malignancies (n = 79, 46%) with a median age of 63 years (range 21–88). The majority of patients were male (n = 93, 54%). Eighty‐nine (51.7%) patients were receiving active oncologic treatment, and 58 (33.7%) were under routine surveillance following completion of active therapy. Almost all had a sense of secured privacy (n = 171, 96%), the majority of patients affirmed that their concerns were met (n = 166, 93%) and perceived that eye contact with the treating physician was perceived (n = 156, 87%). Only a minority felt that the absence of physical clinic visits harmed their treatment (n = 36, 20%). Most patients (n = 146, 84.9%) wished to continue telemedicine services. A multivariate analysis revealed that higher satisfaction and visits for routine surveillance were both predictors of willingness to continue future telemedicine meetings over physical encounters (odds ratio OR = 2.41, p = .01; OR = 3.34, p = .03, respectively).
Conclusion
Telemedicine is perceived as safe and effective, and patients did not feel that it compromised medical care or the patient‐physician relationship. Integration of telemedicine is ideal for patients under surveillance after completion of active oncologic treatment. Physician communication skills workshops are warranted with implementing this platform.
Implications for Practice
During the COVID‐19 pandemic, telemedicine was rapidly implemented worldwide to facilitate continuity of quality care and treatment. Despite many potential setbacks, telemedicine has become a useful and safe tool for oncology practitioners to care for their patients. The use of telemedicine regarding patients' perspectives, emotions, and patient‐physician communication in daily oncology practice has not been studied to date. This study demonstrated telemedicine is perceived as safe and effective and does not compromise medical care or the patient‐physician relationship. Its use is ideal for surveillance after completion of active oncologic treatment. Physician communication skills workshops are warranted with implementing this platform.
The use of telemedicine in oncology practice is rapidly expanding; however, the implications for patient‐physician interaction and patient satisfaction have not been well studied. This article evaluates patients' perspectives and preferences regarding telemedicine and whether a virtual communication platform affects the patient‐physician relationship.
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