There are countless questions when it comes to medical cannabis and colorectal cancer: How can it help? How do you get it? Are there drug interactions with chemo? What are the side effects? Is it legal where I live?
There are countless questions when it comes to medical cannabis and colorectal cancer: How can it help? How do you get it? Are there drug interactions with chemo? What are the side effects? Is it legal where I live?
Please share this webinar with anyone who may be interested!
Watch all our webinars: https://www.youtube.com/playlist?list=PL4dDQscmFYu_ezxuxnAE61hx4JlqAKXpR
Webinar Information:
At this webinar you will learn:
• Basic facts about medical cannabis in Canada
• The role of medical cannabis for cancer patients
• How to access medical cannabis under the current Health Canada process
Presenter Information:
Dr. Paul Daeninck is an oncologist and palliative care consultant with CancerCare Manitoba and is an Assistant Professor at the University of Manitoba. He is the Chair of the Symptom Management and Palliative Care disease site group at CancerCare Manitoba and the President–elect of the Board of Directors of the Canadian Consortium for the Investigation of Cannabinoids (CCIC). He has a research and clinical interest in the use of cannabis and cannabinoids in patients with cancer and cancer-related conditions.
View the video: https://youtu.be/-QFcA4OrqEM
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Audio and slides for this presentation are available on YouTube: http://youtu.be/Q_wdfcJO3XE
Ann LaCasce, MD, MMSc, of Dana-Farber/Brigham and Women's Cancer Center Adult Lymphoma Program, talks about new clinical trials and treatments available for lymphoma patients. This presentation was originally given at the Lymphoma Research Foundation North American Forum on Sept. 28, 2013. http://www.dana-farber.org | http://www.lymphoma.org
Overview of clinical trials for metastatic triple-negative breast cancer by Sara M. Tolaney, MD, MPH, Associate Director and Associate Director of Clinical Research at Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute.
Learn about the latest treatment options for advanced triple-negative breast cancer. Nancy Lin, MD, a breast oncologist in the Susan F. Smith Center for Women's Cancers at Dana-Farber, discusses new research.
This presentation was originally given as part of the 2015 Metastatic Breast Cancer Forum, held at Dana-Farber Cancer Institute in Boston, Mass. on Oct. 17, 2015.
More information is available at http://www.susanfsmith.org.
There are countless questions when it comes to medical cannabis and colorectal cancer: How can it help? How do you get it? Are there drug interactions with chemo? What are the side effects? Is it legal where I live?
Please share this webinar with anyone who may be interested!
Watch all our webinars: https://www.youtube.com/playlist?list=PL4dDQscmFYu_ezxuxnAE61hx4JlqAKXpR
Webinar Information:
At this webinar you will learn:
• Basic facts about medical cannabis in Canada
• The role of medical cannabis for cancer patients
• How to access medical cannabis under the current Health Canada process
Presenter Information:
Dr. Paul Daeninck is an oncologist and palliative care consultant with CancerCare Manitoba and is an Assistant Professor at the University of Manitoba. He is the Chair of the Symptom Management and Palliative Care disease site group at CancerCare Manitoba and the President–elect of the Board of Directors of the Canadian Consortium for the Investigation of Cannabinoids (CCIC). He has a research and clinical interest in the use of cannabis and cannabinoids in patients with cancer and cancer-related conditions.
View the video: https://youtu.be/-QFcA4OrqEM
Follow our social media accounts:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Pinterest - https://www.pinterest.com/survivornetwork
YouTube - https://www.youtube.com/user/Survivornetca
Audio and slides for this presentation are available on YouTube: http://youtu.be/Q_wdfcJO3XE
Ann LaCasce, MD, MMSc, of Dana-Farber/Brigham and Women's Cancer Center Adult Lymphoma Program, talks about new clinical trials and treatments available for lymphoma patients. This presentation was originally given at the Lymphoma Research Foundation North American Forum on Sept. 28, 2013. http://www.dana-farber.org | http://www.lymphoma.org
Overview of clinical trials for metastatic triple-negative breast cancer by Sara M. Tolaney, MD, MPH, Associate Director and Associate Director of Clinical Research at Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute.
Learn about the latest treatment options for advanced triple-negative breast cancer. Nancy Lin, MD, a breast oncologist in the Susan F. Smith Center for Women's Cancers at Dana-Farber, discusses new research.
This presentation was originally given as part of the 2015 Metastatic Breast Cancer Forum, held at Dana-Farber Cancer Institute in Boston, Mass. on Oct. 17, 2015.
More information is available at http://www.susanfsmith.org.
Watch the recorded webinar at http://www.mainewellness.org/cannbis_in_cancer_treatment_webinar_recording
From prevention through treatment and remission, cannabis is a powerful tool in the fight against cancer–the government’s National Cancer Institute has even updated its information to reflect the plant’s anti-cancer properties!
Join us and special guest, Molly Stewart, of the Cancer Community Center, for a discussion of the scientifically-proven and real-life benefits of cannabis in cancer treatment, and to learn more about support services and resources for cancer patients and their families.
An overview of Clinical Trials for Metastatic HER2-positive Breast Cancer by Dr. Ian Krop, MD, PhD, Chief and Clinical Research Director, Breast Oncology Center at Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute
Kimberly Halla, MSN, FNP-C, Paula J. Anastasia, RN, MN, AOCN, and Nelli Zafman, MSN, CRNP, AOCNP prepared useful Practice Aids pertaining to PARP inhibitor therapy for this CNE activity titled, "Realizing the Promise of PARP Inhibitors in Solid Tumor Therapy: Guiding Oncology Nurses on the Advances and Challenges." For the full presentation, monograph, complete CNE information, and to apply for credit, please visit us at http://bit.ly/2EkO5Ij. CNE credit will be available until May 22, 2020.
Audio and slides for this presentation are available on YouTube: http://youtu.be/ozNSEND5PbE
Erica Mayer, MD, MPH, of the Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute, discusses triple-negative breast cancer and what makes it different from other forms of breast cancer. Mayer also talks about treatment options for triple-negative breast cancer and what you need to know about clinical trials for the disease.
What's the latest in breast cancer treatment and research? Erica Mayer, MD, MPH, a medical oncologist in the Susan F. Smith Center for Women's Cancers, shares the latest breast cancer news.
This presentation was originally given on Oct. 16, 2015, at the annual Young Women with Breast Cancer Forum, hosted by the Program for Young Women with Breast Cancer in the Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute, in Boston, Mass.
Learn more: http://www.susanfsmith.org
Audio and slides for this presentation are available on YouTube: http://youtu.be/NzJ_fvSxwGk
Sara Tolaney, MD, MPH, a breast oncologist with the Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute, gives an overview of phase I clinical trials and some of the new drugs being tested to treat breast cancer. This talk was originally given at the Metastatic Breast Cancer Forum at Dana-Farber on Oct. 5, 2013.
Slides and audio for this presentation are available on YouTube: http://youtu.be/NJ0HTrH-uog
Nancy Lin, MD, of the Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute, talks about the differences between various types of breast cancer, and the new therapies that are being developed to treat the disease. This presentation was originally given at the Metastatic Breast Cancer Forum held at Dana-Farber on Oct. 5, 2013. The program was sponsored by EMBRACE (Ending Metastatic Breast Cancer for Everyone).
Learn about the latest research and treatment for ER+ breast cancer. Erica Mayer, MD, MPH, medical oncologist with the Susan F. Smith Center for Women's Cancers, discusses new clinical trials and treatment options for this subset of breast cancer patient.
This presentation was originally given on Oct. 17, 2015, at the Metastatic Breast Cancer Forum, hosted by the Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute, in Boston, Mass.
Learn more: http://www.susanfsmith.org
Research increasingly shows that “energy balance” is important in breast cancer. Learn why exercise, weight, and diet are important for breast cancer patients.
Watch the recorded webinar at http://www.mainewellness.org/cannbis_in_cancer_treatment_webinar_recording
From prevention through treatment and remission, cannabis is a powerful tool in the fight against cancer–the government’s National Cancer Institute has even updated its information to reflect the plant’s anti-cancer properties!
Join us and special guest, Molly Stewart, of the Cancer Community Center, for a discussion of the scientifically-proven and real-life benefits of cannabis in cancer treatment, and to learn more about support services and resources for cancer patients and their families.
An overview of Clinical Trials for Metastatic HER2-positive Breast Cancer by Dr. Ian Krop, MD, PhD, Chief and Clinical Research Director, Breast Oncology Center at Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute
Kimberly Halla, MSN, FNP-C, Paula J. Anastasia, RN, MN, AOCN, and Nelli Zafman, MSN, CRNP, AOCNP prepared useful Practice Aids pertaining to PARP inhibitor therapy for this CNE activity titled, "Realizing the Promise of PARP Inhibitors in Solid Tumor Therapy: Guiding Oncology Nurses on the Advances and Challenges." For the full presentation, monograph, complete CNE information, and to apply for credit, please visit us at http://bit.ly/2EkO5Ij. CNE credit will be available until May 22, 2020.
Audio and slides for this presentation are available on YouTube: http://youtu.be/ozNSEND5PbE
Erica Mayer, MD, MPH, of the Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute, discusses triple-negative breast cancer and what makes it different from other forms of breast cancer. Mayer also talks about treatment options for triple-negative breast cancer and what you need to know about clinical trials for the disease.
What's the latest in breast cancer treatment and research? Erica Mayer, MD, MPH, a medical oncologist in the Susan F. Smith Center for Women's Cancers, shares the latest breast cancer news.
This presentation was originally given on Oct. 16, 2015, at the annual Young Women with Breast Cancer Forum, hosted by the Program for Young Women with Breast Cancer in the Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute, in Boston, Mass.
Learn more: http://www.susanfsmith.org
Audio and slides for this presentation are available on YouTube: http://youtu.be/NzJ_fvSxwGk
Sara Tolaney, MD, MPH, a breast oncologist with the Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute, gives an overview of phase I clinical trials and some of the new drugs being tested to treat breast cancer. This talk was originally given at the Metastatic Breast Cancer Forum at Dana-Farber on Oct. 5, 2013.
Slides and audio for this presentation are available on YouTube: http://youtu.be/NJ0HTrH-uog
Nancy Lin, MD, of the Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute, talks about the differences between various types of breast cancer, and the new therapies that are being developed to treat the disease. This presentation was originally given at the Metastatic Breast Cancer Forum held at Dana-Farber on Oct. 5, 2013. The program was sponsored by EMBRACE (Ending Metastatic Breast Cancer for Everyone).
Learn about the latest research and treatment for ER+ breast cancer. Erica Mayer, MD, MPH, medical oncologist with the Susan F. Smith Center for Women's Cancers, discusses new clinical trials and treatment options for this subset of breast cancer patient.
This presentation was originally given on Oct. 17, 2015, at the Metastatic Breast Cancer Forum, hosted by the Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute, in Boston, Mass.
Learn more: http://www.susanfsmith.org
Research increasingly shows that “energy balance” is important in breast cancer. Learn why exercise, weight, and diet are important for breast cancer patients.
This presentation and our commentary and responses to your questions may contain forward-looking statements, including comments concerning drug development programs, evaluation of potential opportunities, the level of corporate expenditures, the assessment of our technology by potential corporate partners, capital market conditions, timing of events, cash consumption and other subjects. Information concerning factors that could cause actual results to differ materially from those set forth in our regulatory filings from time to time.
This presentation will review the current research around medical marijuana and discuss the issues around the recent legalization of recreational use. We will explore common clinical questions regarding marijuana use including testing and concurrent controlled substance use.
Please share this slideshow with anyone who may be interested!
In this webinar:
● Marijuana for Medical Purposes Regulations (MMPR)
● Statistics on cannabis usage and results of the CCSN medical cannbis survey
● Differences between licensed producers and dispensaries
● Basic information on medical cannabis usage, adverse effects, potential use and contraindications
● Cannabis varieties
● How to legally access medical cannabis
Contact the presenter:
● Kaivan Talachian: ktalachian@canntrust.ca
View the YouTube video:
http://youtu.be/ZB9-z-pqqTc
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Twitter - https://twitter.com/survivornetca
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This downloadable slidedeck, presented in a regional grand rounds series, focuses on increasing awareness about current and emerging treatment options for patients with newly diagnosed and recurrent ovarian cancer.
Comprehensive Report on The Cannabis Extract MovementTheHempSolution
A comprehensive review of evidence that cannabis extracts can treat many cancers and other diseases. Features information from patients, caregivers, researchers, doctors, dispensaries, and corporations. Includes medical documentation of terminal cancer patients in full remission.
Throughout 2015 the Canadian Cancer Survivor Network (CCSN) will offer a series of webinars designed to provide you with information to help build your knowledge and understanding of medical marijuana use in Canada.
The first webinar in this series features a presentation and Q&A session with Dr. Paul Daeninck , MD, MSc, FRCPC.
Dr. Murphy presents slides discussing general screening trends in the US, including how the US compares to other countries, different screening modalities, and differences in screening by:
-Age
-Gender
-Geography
-Race/Ethnicity
Looking to kick start your physical activity? Hoping to learn about how body movement can be a huge benefit for CRC patients and survivors? Curious about Climb for a Cure? Join this interactive webinar featuring Karia Coleman, MSK, personal trainer and athletic strength coach, and Fight CRC advocates as they discuss the importance, challenges, and joys of physical activity.
From bowel frequency, pain, and more, many colorectal cancer treatments lead to digestive side effects. Join this webinar with Dr. Cathy Eng to learn all about the digestive system, the side effects that are common due to CRC treatment, and how to manage those side effects.
Maine recently passed major colorectal cancer (CRC) policy at the state level. Join us to listen to their story and learn what worked well for CRC state advocacy!
Indiana just passed major colorectal cancer (CRC) policy this year. Join us to listen to their story and learn what worked well for CRC advocacy in Indiana!
Kentucky was one of the first states in the US to pass major colorectal cancer (CRC) policy. Join us to listen to their story and learn what worked well for CRC state advocacy!
Join Fight CRC in a webinar about biomarkers. In this session, Dr. Chris Lieu will focus the discussion on the NTRK biomarker, in addition to ctDNA, and Next-Generation Sequencing.
Join us as Eden Stotsky-Himelfarb, BSN, RN from Johns Hopkins Medicine discusses how to manage after a colorectal cancer diagnosis. In this session, she will cover understanding diagnoses, shared decision making, managing mental health, talking to family and colleagues, and more.
Some colorectal cancer treatments lead to side effects of the skin. In this webinar, Dr. Nicole LeBoeuf will discuss these specific side effects. She will talk about why they occur, how to prepare for them, and how to manage them.
Hear about the latest breaking colorectal cancer research! Fight CRC will be joined by Dr. Axel Grothey who will spend the hour detailing the research presented at the 2020 Gastrointestinal (GI) Cancers Symposium hosted by the American Society of Clinical Oncology.
Anticipating the end of life and making decisions about medical care at this time can be difficult and distressing for people with cancer and their loved ones. However, it is incredibly important to plan for the transition to end-of-life care.
In this webinar, we will discuss questions to ask when considering an end to curative treatment, what to expect with hospice and end-of-life care, a new medical care team, advance directives and healthcare proxies, options for pain, the role of caregivers and loved ones, and more.
In this webinar, Dr. Angela Nicholas, Dr. Chris Heery, and Wenora Johnson discuss all things clinical trials. Dr. Nicholas, a family practitioner and caregiver to her late husband, John MacCleod will dive into her experience searching for clinical trials along with advice to those currently searching, or planning on searching in the future. Dr. Heery, Chief Medical Officer for Precision Biosciences will spend time dispelling myths around clinical trials and challenges to enrollment, and Wenora Johnson, a stage III colon cancer survivor will describe the process and her point of view curating trials in the Fight CRC trial finder.
In this webinar, Dr. Popp will discuss everything you need to know about palliative care! This is an important webinar for colorectal cancer patients and their loved ones.
eeling worn out and exhausted all the time? You may be experiencing cancer-related fatigue. Tune in to this webinar to learn what cancer-related fatigue is, how to spot it, and how to manage it.
In this webinar, Dr. Azad discusses colorectal cancer recurrence. She addresses things to do to help reduce the risk of recurrence, in addition to what steps should be taken if colon or rectal cancer returns.
Join Fight CRC and Dr. Scott Kopetz to learn about the latest breaking colorectal cancer research from the American Society of Clinical Oncology 2019 Annual Conference.
May 2019 – What You Need to Know About Chemotherapy Induced Neuropathy WebinarFight Colorectal Cancer
Neuropathy is a common side effect for colorectal cancer patients. It is a side effect that can be incredibly challenging to manage, and can affect daily living. Join this informative webinar to learn all about neuropathy—why it happens, how to prepare for it, and methods to try and reduce its effects. This is an important webinar for all survivors and patients! Dana will speak from both the medical professional and patient angle, as she is a colon cancer survivor herself!
A cancer diagnosis and cancer treatment can be traumatic. An experience with cancer can lead to serious psychological distress that should be addressed. In this webinar, Schuyler Cunningham, Clinical Social Worker, talks about what trauma is, how to identify it, and what steps to take next.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
2. TODAY’S WEBINAR
SPEAKER(S)
Lisa M. Holle, PharmD, BCOP, FHOPA
QUESTIONS
Ask a question in the panel on the RIGHT SIDE
of your screen
WEBINAR ARCHIVE
FightCRC.org/webinar
TWEET ALONG
Follow along via Twitter – use the hashtag
#CRCWebinar
4. FIGHTCOLORECTALCANCER
DISCLAIMER
The information and services provided
by Fight Colorectal Cancer are for
general informational purposes only.
The information and services are not
intended to be substitutes for
professional medical advice,
diagnoses or treatment.
If you are ill, or suspect that you are
ill, see a doctor immediately. In an
emergency, call 911 or go to the
nearest emergency room.
Fight Colorectal Cancer never
recommends or endorses any specific
physicians, products or treatments for
any condition.
5. LisaM.Holle,PharmD,BCOP,
FHOPA
Bio: Dr. Holle is an Associate Clinical Professor of
Pharmacy Practice in the Department of Pharmacy
Practice at the UConn School of Medicine. Her current
research interests include those which evaluate the
impact of oncology pharmacy practice services on patient
care, adherence to and patient education/understanding
of appropriate use of orally administered oncology
medications. Ongoing and future projects will focus on
the patient-related outcomes of oncology pharmacy
practice care within a team-based approach and
pharmacist-led education and cancer risk-
assessment/screening in the community pharmacy
setting. Past research has included the impact of drug
shortages on cancer care; collaborative cancer therapy
and supportive care clinical trials in the hematopoietic
stem cell and oncology setting; and quality improvement
research related to oncology medication safety.
6. Clearing the Air:
The Role of Medical Marijuana in
Cancer Patients
Lisa M. Holle, PharmD, BCOP, FHOPA
Associate Clinical Professor, School of Pharmacy
Associate Professor, School of Medicine
lisa.holle@uconn.edu
7. What is Medical Marijuana?
• Cannabis – produced from Cannabis sativa/indica/ruderalis
– Marijuana – flower/leaves
– Hashish – blocks of resin
• Cannabinoids – exhibit drug-like effects
– Endogenous cannabinoids
– Phytocannabinoids – produced by Cannabis sativa and
indica species
– Synthetic cannabinoids
• Medical marijuana – use of phytocannabinoids or synthetic
cannabinoids
Parmer J, et al. Res Soc Admin Pharm. 2015. [published ahead of print]
8. Medical Marijuana History
Western
Medicine
Marihuana
Tax Act
Narcotic
Schedule
I
Compass-
ionate
Use
Synthetic
drugs
Medical
Use
CBD Oral
Solution
FDA
approved
CBD, cannabidiol.
National Cancer Institute. Available at: http://www.cancer.gov/about-
cancer/treatment/cam/hp/cannabis-pdq#section/_5 . Accessed March 24, 2019.
1840s 1937 1951 1970 1971-1990 1986 1980s-90s 2018
9. Medical Marijuana. ProCon.org. Available at:
https://medicalmarijuana.procon.org/view.resource.php?resourceID=000881. Accessed
March 24, 2019.
10. Differences in State Medical
Marijuana Programs
• Laws very greatly
• Approved conditions
• Possession amounts/cultivation allowed
• Registration processes
• Allow dispensaries (does not allow dispensaries OR, NE,
MI, HI)
• Pharmacist oversight of dispensaries (AK, CT, MN, NY,
OK, PA); marijuana pharmacies (LA, UT)
• Specify conditions in which it can be used
• Recognize patients from other status (AZ, AR, ME, MI,
NE, NH, OK, RI)
Medical Marijuana. ProConorg. Available at:
https://medicalmarijuana.procon.org/view.resource.php?resourceID=000881. Accessed 5 Jan 2019.
12. What Are The Different Types
Recreated from Turgeman I, et al. Expert Opin Invest Drugs. 2018 (in press): DOI:
10.1080/13543784.2019.1561859.
Cannabis Plant
(sativa, indica, ruderalis)
Phytocannabinoid
THC
CBD
Cannabinol
Tetrahydro-
cannabivarin
Cannabigerol
Terpenoid
Limonen
Terinolen
Pinene
Flavonoid
Canna-
flavin A
Orientin
Quercetin
• Anandamide
• 2-arachidononyl-
gylcerol
Endogenous
Cannabinoid
System
• Classical
•Nabilone
•Dronabinol
• Nonclassical
•JWH-018
•Methanadmide
•AM4030
Synthetic
Cannabinoids
13. What Effects Does it Have?
Recreated from Turgeman I, et al. Expert Opin Invest Drugs. 2018 (in press): DOI:
10.1080/13543784.2019.1561859.
• Cannabinoids in
marijuana
– Delta-9-
tetrahydrocannabidiol
(THC)
– Cannabidiol (CBD)
14. Biologic Effects
Guzman M. N Rev Cancer. 2003;3:745-755.
CB1 – central and peripheral neurons; CB2 – immune system.
15. How You Can Take Medical Marijuana
Bowels DW, et al. Crit Rev Oncol/Hematol. 2012;83:1-10; Kramer JL. CA Cancer J
Clin. 2015;65:109-122.
• Inhalation
• Oral
• Rectal
• Sublingual
• Transdermal
• Ophthalmic
• Intrathecal
• Intravenous
16. What About CBD Oil?
• 2014 United States
Farm Act
– Classified industrial
hemp as containing <
0.3% THC
– Allowed to be sold in all
50 states
– Other ingredients?
– Regulated?
17. FDA Approved Synthetic Products
• Dronabinol (Marinol®)
– Synthetic THC
– CINV failing other treatments
– Weight loss and anorexia with AIDS
– Schedule III
• Nabilone (Cesamet®)
– Synthetic THC-mimetic
– CINV failing other treatments
– Schedule II
CINV, chemotherapy-induced nausea and vomiting; FDA, US Food and Drug
Administration.
Bowels DW, et al. Crit Rev Oncol/Hematol. 2012;83:1-10; Kramer JL. CA Cancer J Clin.
2015;65:109-122.
18. Approved Oral Products
Nabiximols (Sativex®)
• THC + CBD extract
• Multiple sclerosis and
cancer pain
• Not available in US
Cannabidiol (Epidiolex®)
• Plant-derived oral CBD
solution
• June 2018: FDA approved
• Treatment of seizures
associated with Lenox-
Gastaut syndrome or
Dravet syndrome in
patients > 2 years
• September 2018 – DEA
Schedule 5
• CT: Schedule 2
FDA, US Food and Drug Administration Approved. Drug Enforcement Agency.
Available at: https://www.dea.gov/press-releases/2018/09/27/fda-approved-drug-
epidiolex-placed-schedule-v-controlled-substance-act. Accessed March 24, 2019.
19. How Your Body Absorbs It
Dosage Form Absorption
Peak
Level
Factors Impacting
Absorption Bioavailability
Inhalation Quick fast,
rapid
delivery to
brain
22 min Depth of inhalation,
frequency of puffs,
breath hold
Varies: 2-56%
Heavy: 23-27%
Occasional:
10-14%
Oral Slow 1-2 h;
up to 8 h
Degradation of drug in
stomach and first-pass
10-20%
Oral-mucosal/
buccal
Fast 30 min High first-pass
metabolism
10-20%
Rectal Fast 15 min Low first-pass
metabolism
20-40%
Transcutaneous Slow 2 hr; up
to 48 h
Transport across skin
layers; no first-pass
metabolism
10%
Oberbarnscheidt T, et al. J Addict Res Ther. 2017;S11:012.
Crosses placenta and into breast milk.
20. How Your Body Digests It
• Metabolism
– Liver metabolism
– Other metabolism: brain, intestine, lung
• Drug Interactions
– Medications that cause drowsiness/dizziness
– Many potential interactions
CBD, cannabidiol; CYP450, cytochrome P450; THC, delta-9-tetrahydrocannabinoid.
MacCallum CA, et al. Eur J Inter Med. 2018;49:12-19; Epidiolex [package insert]. Carlsbad, CA:
Greenwich Biosciences, Inc: 2018.
23. Cancer Treatment
• Multiple pathways explored in preclinical models
• Phase I refractory glioblastoma
• Case report: astrocytomas
• Case report: acute lymphoblastic leukemia
• In progress
– Phase II placebo-controlled THC:CBD preparation +
temozolomide in glioblastoma – safe; survival advantage
– Phase II nabiximols + temozolomide in glioblastoma
– Two phase I dexananibol – advanced solid tumors and
brain cancers
– Retrospective review of immunotherapy + cannabis
effects
CBD, cannabidiol; THC, delta-9-tetrahydrocannabinoid.
Turgeman I, et al. Expert Opin Invest Drugs. 2018 (in press): DOI:
10.1080/13543784.2019.156185.
24. Immunotherapy and Cannabis
• Retrospective review of nivolumab-treated patients at
Ramban Health Care Campus; Haifa, Israel
• N=140 patients (nivolumab, 89; nivolumab + cannabis,
51)
• Advanced melanoma, non-small cell lung cancer, renal
cell carcinoma
• Results
– Cannabis only factor which reduced reduced response rate
(nivolumab, 37%; combination, 15.9%
– Cannabis did not affect overall or progression-free survival
Taha T, et al. Ann Oncol. 2017;28(5):1545PD.
26. Nausea and Vomiting
• 30 studies published
– Smoked THC
– Synthetic cannabinoids
– Nabiximols
• Meta-analysis found compared with placebo
– Significantly more effective for nausea and
vomiting
• Not evaluated with current antiemetic
regimens
27. Cancer-Associated Pain
Study Design Patients Therapy Results
Noyes
1975
RCT/DB/PC Cancer
pain
N=10
Dronabinol
5mg, 10mg
15mg and
20mg vs
placebo
15 and 20 mg - substantial analgesic effects;
antiemesis and appetite stimulation; 20 mg = 120
mg codeine
Johnson
2010
RCT/DB/PC Cancer
pain
N=177
Nabiximols vs
THC 2.7 mg
oromucosal
spray vs
placebo
• Significantly improved mean pain score; > 30%
reduction in pain from baseline score for
THC/CBD product
• No change for THC product
• No change in mean opioid dose or
breakthrough doses
Portenoy
2012
RCT/DB/PC Cancer
pain
N=360
Nabiximols
(low, medium,
high dose) vs
placebo
• Better pain control and sleep disruption with
low dose compared with placebo
• Adverse events dose related
Lynch
2014
RCT/PC CIN
N=16
Nabiximols vs
placebo
• No statistical difference on numeric pain rating
• 5 responders decreased 2.6 on 11-pt scale
CBD, cannabidiol; DB, double-blind; PC, placebo-controlled; RCT, randomized controlled trial; THC,
delta-9-tetrahydrocannabinoid. Noyes R, et al. Clin Pharmacol Therp. 1975;18;84-89; Noyes R, et
al. J Clin Pharmacol. 1975;15:139-143; Johnson JR, et al. J Symptom Manage. 2010;39:167-178;
Portenoy RK, et al. J Pain. 2012;13:438-449; Lynch ME, et al. J Symptom Manage. 2014;47:166-
173.
28. Anorexia/Weight Gain
• Appetite increase: 49%
• Weight gain: 3%Dronabinol 2.5 mg
po BID + placebo
• Appetite increase: 75%
(P=.0001)
• Weight gain: 11% (P=.02)
• Improved QOL and toxicity
Megestrol 800 mg
po daily + placebo
• Appetite increase: 66% (P=.17)
• Weight gain: 8% (P=.43)
Dronabinol 2.5 mg
BID + Megestrol
800 mg po daily
Randomized,
double-blind,
parallel group
N=469
Advanced
cancer
Weight loss
QOL, quality of life.
Jatoi A, et al. J Clin Oncol. 2002;20:567-573; Strasser F, et al . J Clin Oncol. 2006;24:3394-3400.
29. Anorexia & Cachexia
Increased appetite:
• Cannabis extract: 73%
• THC: 58%
• Placebo: 69%
No significant differences in:
• Appetite
• QOL
• Toxicity
Cannabis extract
(THC 2.5 mg
CBD: 1 mg)
(n=66)
THC 2.5 mg
(n=65)
Adult patients
Advanced cancer
Cancer-related
anorexia and/or
cachexia
ECOG PS < 2
R
A
N
D
O
M
I
Z
E
D
2:2:1
ECOG, Eastern Cooperative Oncology Group; CBD, cannabidiol; THC, delta-9-
tetrahydrocannabinoid.
Strasser F, et al. J Clin Oncol. 2006;24:3394-3400.
Placebo
(n=33)
30. Cannabinoids for Insomnia
• Meta-analysis of 19 placebo-controlled studies
– Cannabis-products evaluated for other indications
and evaluated sleep
– Nabiximols: 13 studies
– THC/CBD capsules: 2 studies
– Smoked THC: 2 studies
– Dronabinol: 1 study
– Nabilone: 1 study
• Greater average improvement in
– Sleep quality
– Sleep disturbance
CBD, cannabidiol; CI, confidence interval; THC, delta-9-tetrahydrocannabinoid.
Whiting PF, et al. JAMA. 2015;313:2456-2473.
31. Depression and Anxiety
• No studies specific in cancer patients
• Meta-analyses of indications
– No well designed trials evaluating depression
– Depression as an outcome: no difference found
compared with placebo
– Positive for individuals with social anxiety and
anxiety in chronic pain patients
Whiting PF, et al. JAMA. 2015;313:2456-2473.
32. Adverse Effects of
Cannabis-Based Medications
Most Common Common Rare
Drowsiness/fatigue Euphoria Orthostatic hypotension
Dizziness Blurred vision Toxic psychosis/paranoia
Dry mouth Headache Depression
Cough/phlegm/ bronchitis
(smoking only)
Ataxia/dyscoordination
Anxiety Tachycardia (after
titration)
Nausea Hyperemesis
Cognitive effects Diarrhea
MacCallum CA, et al. Eur J Inter Med. 2018;49:12-19.
• Schizophrenia/bipolar disorder, long-term cognitive dysfunction
33. COMPASS Study
•Nonserious AEs: 88.4% vs 85.2%
•Cannabis: nervous system, GI, respiratory
•Serious adverse effects: 13% (cannabis)
vs 19%
•Deaths: 0% vs 1%
Primary objective
Assess risk of adverse
events
•No significant change in pulmonary
function tests
•No difference in neurocognition at 1
year
•No changes in liver, renal, or endocrine
labs
•Significant reduction in average pain
intensity at 1 yr: change, 0.92 vs 0.18
•QOL; 2.36 points greater with cannabis
Secondary objective
Pulmonary function
Neurocognitive
function
Other safety
Effect on pain and QOL
AE; adverse events; QOL, quality of life; THC; delta-9-tetrahydrocannabinoid.
Ware MA, et al. J Pain. 2015;16:1233-1241.
Prospective,
cohort study
Jan 2004-April
2008
Adults chronic
non-cancer
pain using
cannabis
(12.5% THC),
any delivery
system vs
control
population
34. Cannabinoid Hyperemesis Syndrome
• Recurrent paroxysmal episodes of nausea/vomiting in chronic users
• Mitigated by frequent hot bathing/showering
• Complications: acute renal failure, electrolyte depletion,
pnuemomediastinum
• Acute treatment
– Replace fluids
– Medications
• Antiemetic
• Anxiolytics
• Antiphsycotics
• Capsaicin topical
– Hot showers
• Long-term treatment
– Stop cannabis use
N/V nausea and vomiting; 5HT3; 5-hydroxytryptamin or serotonin.
Richards JR, et al. Pharmacother. 2017;37:725-734; Health Canada.
https://www.canada.ca/content/dam/hc-sc/documents/services/drugs-
medication/cannabis/information-medical-practitioners/information-health-care-professionals-
cannabis-cannabinoids-eng.pdf. Accessed March 24, 2019.
35. Contraindications
• Allergy to any cannabinoid
• Past history of psychotic disorder
• Active or unstable cardiovascular disease
Caution
• Pregnant or nursing women
• Potential for dependence/abuse
• Driving
Canadian Consortium for the Investigation of Cannabinoids. Available at www.ccic.net.
Accessed March 24, 2019.
37. What are Legal Implications?
State laws allow
US Dept Justice stance
Patient benefits
Schedule I
Institution stance
Medical association stance
Hill. JAMA. 2015;313:2474-2480.
38. When to Use?
• Qualifying condition
• Multiple failed trials of first- and second-line
pharmacotherapies
• Failed trial of FDA approved cannabinoid
• No active substance, psychiatric, unstable
mood or anxiety disorder
Hill. JAMA. 2015;313:2474-2480.
39. State Medical Marijuana Programs
• Provider certifies patient
with qualifying condition
• Patient registers, some
states allow caregivers
• Go to dispensary to
purchase product
Department of Consumer Protection Medical Marijuana Program. Available at:
https://portal.ct.gov/DCP/Medical-Marijuana-Program/Medical-Marijuana-
Statistics. Accessed March 24, 2019.
40. CT Qualifying Conditions - Adults
Amyotrophic lateral sclerosis HIV/AIDS Post herpetic neuralgia
Cachexia Intractable HA syndrome Psoriasis (severe)
Cancer Multiple sclerosis Psoriatic arthritis
Cerebral palsy Muscular dystrophy Rheumatoid arthritis severe
Complex regional pain
syndrome
Hydrocephalus with
intractable HA
Terminal illness requiring end-
of-life care
Crohn’s disease Neuropathic facial pain Sickle cell disease
Cystic fibrosis Osteogenesis imperfecta Ulcerative colitis
Epilepsy Parkinson disease Uncontrolled intractable
seizure disorder
Glaucoma PTSD Wasting syndrome
Damage to spinal cord with
intractable spasticity or
irreversible cord injury
Fibromyalgia
(spasticity/neuropathic
pain)
Post laminectomy syndrome
with chronic radiculopathy
Department of Consumer Protection Medical Marijuana Program. Available at:
https://portal.ct.gov/DCP/Medical-Marijuana-Program/Qualification-
Requirements. Accessed March 24, 2019.
41. CT Qualifying Conditions - Children
Cerebral palsy
Cystic fibrosis
Irreversible spinal cord injury with objective neurological indication of intractable
spasticity
Muscular dystrophy
Osteogenesis imperfecta
Severe epilepsy
Terminal illness requiring end-of-life care
Uncontrolled intractable seizure disorder
Department of Consumer Protection Medical Marijuana Program. Available at:
https://portal.ct.gov/DCP/Medical-Marijuana-Program/Qualification-
Requirements. Accessed March 24, 2019
42. Dispensaries in CT
• CT licensed pharmacists
• Similar restrictions/requirements as pharmacy
• Security system
• Qualified patients and
caregivers allowed in facility
• No compounding
• Review PMP
Department of Consumer Protection Medical Marijuana Program. Available at:
https://portal.ct.gov/DCP/Medical-Marijuana-Program/Dispensary-Facility.
Accessed March 24, 2019.
43. Dispensary Pharmacist’s Role
• Complete an initial patient
assessment
– What symptoms require relief?
– Naïve vs experienced user
– Patient’s lifestyle
• Help patient select product
– Strain, dosage form, delivery device
– Variations on time to effect, adverse
effects
• Equip patient with tools to self-
assess efficacy of product
• Report any adverse events that may
occur
44. Medical Marijuana in Hospitals
• Pharmacologic implications
• Legal challenges
• Federal compliance for funding/licensure
• Acquisition of product
• Other considerations
– No smoking policy
– Training
– Monitoring/outcomes
• Typical policies
– Not allowed for inpatients
45. How Your Healthcare Provider Should
Monitor Your Use
• Changes in
– Medical condition/symptoms
– Physical or psychosocial function
– Medication list
• Efficacy of treatment
• Adverse effects
• Liver function tests?
• Safety of use (possible diversion, driving/equipment
use)
• Goals of treatment
• Progress towards goals
Medical Board of California. Available at:
https://www.mbc.ca.gov/Publications/guidelines_cannabis_recommendation.pdf.
Accessed 6 January 2019; Epidiolex [package insert]. Carlsbad, CA: Greenwich Biosciences,
Inc: 2018..
46. What You Need To Know
• Registration process
• Variability of quality and concentration of cannabis
• Dosing and dosage forms (start low and go slow)
• Potential risks of cannabis
– Adverse effects
– Pregnancy/lactation
– Drug interactions
• Financing, travel
• Safeguards to prevent diversion
• Symptom inventory chart
Medical Board of California. Available at:
https://www.mbc.ca.gov/Publications/guidelines_cannabis_recommendation.pdf.
Accessed 6 January 2019.
47. Summary
• THC and CBD are primarily responsible for medicinal
effects
• Limited data supports medical marijuana use in cancer
and associated symptoms; yet many patients have benefit.
This may be due to the lack of well designed studies
• Most side effects are transient and can be treated by
adjusting doses
• Patient certification process can be facilitated by
dispensary staff
48. Resources
• Centers for Disease Control:
https://www.cdc.gov/marijuana/index.htm
• NIH: https://nccih.nih.gov/health/marijuana
• Health Canada:
https://www.canada.ca/en/health-
canada/topics/cannabis-for-medical-
purposes.html
50. Q
&
A
SNAP A #STRONGARMSELFIE
In 2018, up to $55,000 will be donated thanks to our
sponsors: Bayer, Fujifilm, Myriad Genetics and Taiho
Oncology!
Flex a “strong arm” & post it to Twitter or Instagram using the
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