Approximately one-third of the patients I see on a daily basis have cancer. Many are referred by local oncologists, integrative medicine doctors, and others; some are self-referred. When a patient is referred to me by an oncologist, typically they have already begun chemotherapy, radiation therapy, immunotherapy, etc., either individually or combined. Under my care, the goal is to help the patient minimize the many side effects of the drugs, most specifically, chemotherapy toxicity.
Although it’s been slow in coming, oncologists are just now beginning to give credence to the anti-cancer effects of cannabis. Fortunately, their attitudes are finally changing, and their viewpoints evolving. The change has brought about great learning opportunities for me and my team.
Some general guidelines:
Over the last decade I have learned what works well as found some medically contraindicated conditions that guide my medical cannabis consulting.
1. Whole-Plant Dosing Benefits: If cannabis can prevent, or at least greatly alleviate serious side effects, then a full therapeutic dose of chemotherapy can be administered without hesitation.
2. Contraindications: For the patients that are considering using cannabis simultaneously with their chemotherapy regimen, I have found it extremely beneficial to recommend low doses of whole plant CBD daily, for the purpose of preventing neuropathy. In general, once neuropathy sets in, the chemotherapy is stopped, or certainly greatly reduced. Even if the cancer is responding to the neurotoxic chemotherapy, most often, treatment must be discontinued.
3. The Benefit Acid Molecules: The analgesic and anti-nausea benefits received from cannabis use while undergoing chemotherapy are critical and of great value. We have found that by adding the acid molecules (CBD-Acid and THC-Acid) to the protocol, it helps tremendously without causing any psychoactive effects.
There are three types of groups I see that have presented great "proof of concept" patient examples:
Patient Group #1:
Approximately one year ago, I consulted with a patient who had previously responded well to a chemotherapy regimen that included two neurotoxic agents. Unfortunately, due to neuropathic pain that had developed from the effects of the chemo she was receiving at this time, her treatment was cut short and ultimately terminated. As a result, her tumor began growing again.
However, after a discussion with the patient’s oncologist, we began treating her with CBD, THC, CBD-Acid, and THC-Acid. Once treatment was underway, the patient’s pain was eliminated, she completed the full regimen, and she currently remains in remission while experiencing no residual neuropathic pain.
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The example typifies the situation facing a large number of cancer patients I see. Many go into remission, and we can never know exactly what helped. Perhaps it was the measured dosing of cannabis. Perhaps it was the chemotherapy. Perhaps it was BOTH.
Fortunately, by the time patients reach remission, most don’t really care. Until I read the article below, I had never thought of another option. However, there is now fairly solid data showing that CBD can in fact improve the effects of chemotherapy, and the article proposes a mechanism.
Patient Group Example #2
Another group of cancer patients I see are those that want to use cannabis in conjunction with multiple integrative modalities, but will not consider chemotherapy under any circumstance. Occasionally, these decisions can seem reasonable to some extent, and then there are times they just seem reckless.
Consider the following case example:
Within the last year or so, I consulted with a 40-year-old male who came in with his wife and two children. He had just been diagnosed with testicular cancer, and he wanted to use cannabis only, as his entire therapy. Testicular cancer has a greater than 95% cure rate with traditional therapy.
In my opinion, it would have been irresponsible for me to recommend a cannabis treatment plan. I told him I would work with him if he was receiving chemotherapy, but otherwise, I could not, in good conscience, give him a cannabis suggestion. Although this appeared to be relatively harsh, his wife allayed my fears. She literally began to cry and quietly exclaimed, “Thank God.” Having followed my advice, he persevered through the rough stuff, he is currently in full remission and remains on a cannabis maintenance program.
Patient Group Example #3
Finally, there is the group of patients who are simply lost. They come into my office and place in front of me an assortment of their various prescription medications (often including bottles of cannabis extracts.) I offer to go through their bags of medicine. In doing so, I observe that each bag has one thing in common: not only is it not helping the patient, routinely it is causing them some degree of harm.
For these patients, I rely on my role as a Board Certified Internist. There is rarely a reason to delay the use of cannabis, so we generally do get that started immediately.
In many instances, the patient’s mood, anxiety, pain, nausea, insomnia quickly improve, and we will often delay the issue of chemotherapy until the follow-up visit. Once the patient is feeling better, they and their family are in a much better position to make clear-headed, rational decisions.
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At the end of any consultation, I will always advise the patient, based entirely upon my sense of what is in their best interest. Most often, my patients are quite pleased (and relieved) that I have an opinion and that they have options, leaving them with a more educated and open perspective on chemotherapy. In most cases, these patients, many of whom do very well, are using cannabis together with integrative modalities.
It is my belief that any cancer patient receiving chemotherapy and radiation should be using cannabis; it will help make the therapy tolerable and also to help prevent chemotherapy toxicity. At best, it increases the general function of the chemotherapy and will allow toxic chemotherapy to be given with a much decreased risk of neurotoxicity.
Take-Home Message:
I conclude, as always, that cannabis has something to offer every cancer patient.
Research Articles with Reviewing
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6627455/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3969077/
