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Strong reasons make strong actions: medical cannabis and cancer—a call for collective action

by Marc Kerba, MD MPA

Call it cannabis, not marijuana or weed.

It has been more than 17 years since the Canadian prohibitory regulations on the use of medical cannabis began to ease and more than 17 weeks (more than 6 months by the time of publication) since the Cannabis Act (Bill C-45) became law. Cannabis use for medical purposes has been part of the historical record and medical writings for millennia. However, it is only in the last 30 years that the workings of the human endocannabinoid system have been described and its receptors discovered. Amazing as all of those developments have been, the challenge of reintegrating cannabis into the science of modern medicine—and particularly care for patients with cancer—is a need whose time has come.

Surveys inform us that patients with cancer are using cannabis to manage symptoms related to cancer and cancer treatment. More concerning is that their use is for a medical need occurring outside the confines of modern cancer care, with patients accessing their cannabis from friends and family, and often from casual or unlicensed suppliers. Beliefs in the benefits of cannabis—for its yet unfounded therapeutic potential—are commonly held or supported by poor-quality evidence. Patients and their caregivers are inundated with media stories about a budding industry and its mergers and acquisitions while it grows to meet a need for what is regarded by some as overlooked and undertreated ailments. How should oncologists and the oncology team, trusted as the informed and compassionate advocates for their patients, reconcile the overwhelming public attention being given to this product—growing more, creating new routes of administration, and reaching for new uses—with the work needed to further the science of cannabis as it pertains to cancer care?

The onus is on us, the community of cancer care providers, to act.

Therapeutic and clinical developments in oncology are resulting in improvements in the survival of many patients. Costly immunologic therapies are promising and are being implemented for a variety of cancers. New science about the microbiome, about cancer detection, and about targeted therapies are being researched. And yet, contrasted against those celebrations of scientific ingenuity are the glaring gaps in the work pertaining to cannabis to settle unsubstantiated claims and anecdotal observations of this elixir for the ages. As clinicians and scientists, we must work to generate the needed evidence-based outcomes and to document or dispel the potential interactions and sequelae between cannabis and prescribed cancer treatments. “There are in fact two things, science and opinion, the former begets knowledge, the latter ignorance”.

The frameworks to lead this charge are ours to create. The current legal framework is focused on issues of access and control to regulate production, distribution, and sale. The medical framework for cannabis research is more tenuous, concentrated in silos of expertise as a result of the previous prohibitory environment. The study of cannabis is ripe for development, but even intra-institutional endeavors require help. The machinery of science requires some assembly and repurposing to address the new challenges.

If the current and future oncology landscape is a challenge for those working in cancer care, we must remember that patients deserve our compassion as they attempt to navigate this emotional journey with or without cannabis. More importantly, they need our support and deserve to see us take leadership in cannabis research. Oncologists who have expertise in both the clinical and scientific worlds must inform the necessary work. We must be the architects of its design, building bridges to industry and patients, while engaging our academic institutions.

“Coming together is a beginning, staying together is progress, and working together is success”.

This article was originally published in Current Oncology.  Please click here to view.


Love to Read? It’s good for you!

Power of Words

Together with Sharon Bray – teacher and author of two books on writing and health – CKN welcomes you to our new Writing Series where Sharon helps readers tap into the healing power of writing during difficult times.  As Sharon puts it, “Your stories matter. You are your stories. Our stories shape us and act as the lens through which we see the world. It’s through story that we make sense of our lives, reclaim our voices, and learn our words can touch others’ hearts.”  Follow along with this bi-monthly series with Sharon and please send us your stories….they matter to us.

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Therapeutic Song Writing in Healthcare: How Song Writing Promotes Creative-Self Expression

by Taylor Kurta

 

As a music therapy intern in an urban Toronto hospital setting, I have been learning to appreciate the unique narrative that each patient brings with them. In spending time with patients at the bedside during what are often prolonged and complicated admissions, I have had the privilege of listening to their stories and their struggles. My role at the hospital is to support these patients in contextualizing their experiences, and promote creative self-expression through music. I want to share a story of a particular patient who found comfort and confidence through therapeutic song writing. For confidentiality purposes, identifying details have been changed. I will refer to this patient as Karen.

 

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Navigating Your Life After Cancer

Power of Words

Together with Sharon Bray – teacher and author of two books on writing and health – CKN welcomes you to our new Writing Series where Sharon helps readers tap into the healing power of writing during difficult times.  As Sharon puts it, “Your stories matter. You are your stories. Our stories shape us and act as the lens through which we see the world. It’s through story that we make sense of our lives, reclaim our voices, and learn our words can touch others’ hearts.”  Follow along with this bi-monthly series with Sharon and please send us your stories….they matter to us.

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A Full Life and a Grateful Heart

by Marjorie McGibbon, RN BScN, Paediatric Oncology Patient Navigator

 

When you read the words Palliative Care, what did you think of?   For many years of my life, and even my nursing career, I thought of death.  And, it might still mean that to you.  But I want to share with you some thoughts to help you understand that it can mean so much more to all of us, and that there is a certain peace in acceptance of what it ultimately leads to:  End Of Life (EOL) care.  Years ago, and even recently, the palliative care team was associated with negative connotations:  “death squad,” “doom troops,” the list goes on.  Now, we are seeing a shift to a new approach and greater understanding of what these special caregivers can offer their patients, at any age and any stage of disease.

 

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A New Chapter

Aaron and his dad Terry

by Terry Edquist, Bereaved Father

 

My journey starts as most others do, getting married and raising a family. My wife and I had two wonderful sons. I was the breadwinner and she was the stay at home mom that she always wanted to be.  We were able to go to our sons’ school functions and sporting events… life was good. Just a normal couple, rough spots included, who never expected our lives would take such an unexpected turn.

 

Our eldest son Aaron had to have his appendix taken out at age 19. A simple, routine surgery, they do this all the time, our baby will be fine, we thought. The CAT scan revealed a mass in his liver, unrelated to his appendix. The local doctor didn’t have the expertise for dealing with the liver, so he recommended a doctor four hours away. Being scared now, but understanding the situation, we wanted the best for our son; a four hour trip was worth it. The doctor was a wonderful lady, she made us feel comfortable. We needed to trust somebody, so we put our faith in the doctor who exuded so much confidence. The day of surgery we were confident our baby would come home and we would return to our normal lives. The biopsy revealed the mass in his liver was cancerous. Our doctor, being a liver specialist, comforted us that she could remove the tumor and the liver would grow back. We agreed to have her do what she had to do, we trusted her.

The recovery went well, but because the tumor was cancerous, CAT scans were scheduled every 4 months to start. We were now going to the hospital’s cancer center. Wow who would have thought this! The first scan was ok. Great! Life will get back to the way it was, our baby will be fine.  The next scan broke our heart, the cancer was back. The doctor revealed the rare form of cancer our son had, and clinical trials were our only hope. We were scared again, but we trusted the experts to make our son well. Two years, another major surgery to remove another tumor and three clinical trials later, we were told they had run out of options. They recommended another cancer hospital with more clinical trials and expertise. So off to the next hospital my son and I went.

We had transferred all the information from the last hospital, to the new cancer center. We were greeted, introduced to the head of the cancer center, and the doctor who would be in charge of my son’s treatment. Again I had to trust someone, they exuded confidence and not having much choice, I trusted they would make our son better. They started a new trial, we had to wait and see if this would work or not. It didn’t so we did a repeat on a new trial. In the meantime, our son had more surgeries. Our son always made it through these trials, tribulations, and setbacks. We still had confidence that he could beat this.

I had researched other cancer centers and found one that had a doctor who knew of this disease, as rare as it was. So we made the decision to try this one. Little did we know the hour glass was running out of time. This whole process was taking time, which we thought we had; we were six and a half years in already. This hospital was 15 hours away, so only my son and I were able to go. My wife stayed home, took care of our other son, animals, bills, etc. We all were scared, but we had to play the cards dealt us. I called my wife everyday with any news and to assure her that I loved her and everything would be ok. God wouldn’t take our son! Two weeks passed, and they were doing what they could.

Then our world changed. I was called to a private meeting room to be told there was nothing else they could do for our son. On one hand, I never thought that day would come, but on the other hand I remember being told at the start this treatment could only give him six months. I made the dreaded call to my wife to give her the news. I was in New York, she was in Michigan, I couldn’t hold her or our other son. The best thing that happened was a friend drove out my wife and son. It is also hard to believe that fifteen of my son’s friends came to say good bye. It was truly a sight to see and comforting to us. But God called our son, with his mom and dad by his side. The journey is far from over, really a new phase has started. It’s been almost four years, we still love him and miss him terribly.

Aaron (left) and Zach at Cancercon

What did I learn from this journey? The bond of a mother to their child, was something I could never imagine. I now know and my love for my wife has grown. She was a real trooper through this. To be blunt, life does go on. It hasn’t been easy, but if you don’t try to move on it will consume you. If it’s a baby step, so be it. You will have bad days, but keep pushing forward.

What would I do differently? No one expects their child to die, but cancer is a killer. You do hear success stories, but what about us? I wish we had advised my son to create a living will, trust, or medical power of attorney, it would have made things simpler. Our son had frozen his sperm prior to his treatments, just in case he lost his fertility. We had no legal right to it, because there was nothing in writing. The same with organ donation. We wanted to give the gift of sight to someone from our son. Yet again, because we had nothing in writing, I had to jump through hoops after our son died, just to be able to donate his eyes. You need to have that talk if it is age appropriate. Do not forget the other siblings, they are hurting too. Our other son still struggles not only with his brother’s death, but with why no one ever asked how he was doing. It didn’t dawn on any of us, that while we were focused on the sick kid, there was another confused and hurting child. Please remember to not leave anyone out, there are other ones that are hurting also.

So we have started this new chapter in our life, without our son/brother. The days go by like pages in a book. We choose to celebrate his life the best way we can every day. We also realize and accept, that not every day will be sunny, there will be stormy days. You will find a way to get through an ordeal like this. You just have to take it day by day. From my family to yours, prayers and find your peace.

 


 

My name is Terry Edquist, I live in Niles, Michigan with my wife of thirty one years; Tracie. We have one son Zachery, who just got married and left our nest. I have worked as a quality engineer in a steel mill for the last 20 years. I also am the caregiver to my 95 year old father. I go to the Stupid Cancer summit every year, to try and let parents and caregivers know they are not alone. I do this in honor and memory of my son, Aaron. Locally I have spoken to many parents who have lost a child, regardless of how. It is something no one ever imagined would happen, but it does. It gives me a sense of closure in helping those that are starting a chapter in their life, they never dreamed was possible.

 


 

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