medical director of the provincial pain and symptom management/palliative care program, BC Cancer
Dr. Pippa Hawley.

As I mentioned last week, our previous study has shown that cannabis use during cancer treatment is widespread, either as a symptom management tool or as a treatment tool, despite there being little to no scientific evidence to support the latter.

Given its prevalence, we’d like to ensure patients are using cannabis-based products in the best ways possible, to reduce potential harm while also helping maximize the intended effect of alleviating symptoms and enhancing quality of life. We hope to gain a better understanding of how cannabis can aid treatment-related symptoms through a study we plan to launch in conjunction with the Canadian Cancer Clinical Trials Network early next year.

Understanding the best ways to use cannabis-based products for cancer-related pain

The study will be a patient-centred clinical trial that will test three varieties of cannabis-based oil extracts, and a placebo oil in connection to some major cancer treatment symptoms: including pain, nausea, sleep disturbance and anxiety.

The medicines will be oil extracts of the highest quality available. Studies have found that synthetic cannabinoids have been shown to be less effective than the naturally plant-derived products, as there are many active compounds in natural cannabis that have important functions, yet these remain poorly understood.

They also seem to work much better when combined than given separately and have shown to exhibit less side-effects, in addition to being more widely available and more cost-effective than the synthetic alternative.

The cannabinoid treatments will feature one high in THC content, another high in CBD content, one that is half of each, and a placebo. They will be flavoured to make them indistinguishable by taste, so that people can’t tell which is which in the study.

Patients will be allowed to experiment in a structured way to figure out which type of combination can work best for a particular symptom and how well they tolerate them in terms of side-effects, and their reactions closely monitored throughout.

The study will be the first of its kind and should provide us a better insight into the ways in which medical cannabis can improve the quality of life of patients.

Expanding the scope of cannabis as a symptom management tool

While the results of this study will allow us to identify which symptoms respond to which types of cannabinoids, additional research will be needed to understand with more precision the most effective dosage required for each symptom, depending on their severity.

This study will be implementing a novel “aggregate n-of-one” research method that is very patient-centred and will be able to be replicated for other studies, enabling researchers to build upon the knowledge that we will gain and further our collective understanding of the uses of cannabis-based products.

Indeed, one of the most prevalent issues we see when conducting patient-centred clinical trials is the exclusion of rural patients – those who aren’t readily able to visit research centres in-person to participate in studies. We hope to be able to conduct a portion of this study via mail to allow for more to participate wherever they might be, providing us with a more comprehensive and accurate perspective from many locations.

In addition, my hope is that by involving the Canadian Cancer Clinical Trials Network we will be able to expand the scope of the study across the country to include multiple regions and a diverse set of patients, allowing us to complete the study quickly, and get the results out to patients and the medical teams promptly, so we can offer patients evidence based practical guidance right away.

My hope for the future of pain and symptom management

I have worked in this field for over twenty years. I know that pain and symptom management can only become more sophisticated as we look ahead.

There are so many ways in which we can improve our understanding of the need to support advancements in this arena, and I feel we are only beginning to move the dial in this regard.

Indeed, helping manage pain and other symptoms with cannabis-based medicines is only a small piece of the puzzle that is developing an improved and better integrated system for 21st century palliative care at BC Cancer.

Research and education go hand-in-hand. As we conduct more research we will be able to provide others with evidence-based guidelines on how to best manage cancer-related symptoms throughout the whole cancer journey.

This is something we are in dire need of, and with continued support for research, I believe it’s something we can achieve.

Thank you for tuning in to my blog this month to learn about the efforts we are undertaking to improve the quality of life for cancer patients in BC and beyond.

Pippa