There has been a lot of angst and hype in Australia regarding the prescribing of medicinal Cannabis for patients with refractory advanced cancer related symptoms and Chemotherapy induced Nausea (CINV) . As one of the first Australian prescribers in Cancer patients of imported products I will present 2 cases of successful selection, application via Special access scheme category B, prescribing, dose adjustment and daily monitoring to significantly improve symptom management in a cancer patients who did not meet the inclusion criteria for current RCT in Cannabis for Chemotherapy induced nausea and vomiting.
The role of medicinal cannabis in cancer care is developing rapidly. The first case demonstrates effective evaluation of the patient and prescribing and dose adjustment for CINV in a patient receiving disease modifying therapy for local pancreatic cancer. Symptoms improved dramatically, weight was maintained throughout chemo-radiotherapy and nausea well managed . Validated measures were used to monitor nausea. The second case demonstrates the prescribing and tolerability of medicinal cannabis in the patient with advanced cancer with persisting anorexia , nausea and profound weight loss and the potential role in treating common symptom clusters seen in advanced cancer.
N=1 data in the form of case reporting can assist in collection of data as this field evolves whilst the gold standard remains the Randomised Control Trial. The skills of palliative care and supportive care training and experience in balancing benefit and side effect of medications to improve quality of life can be applied in this new field coupled with knowledge of the products available, their potential role as a therapeutic agent, potential adverse side effects and interactions will presented. Medicinal Cannabis and it's potential role in Supportive Cancer Care for the patient with refractory symptoms will be discussed.