Safety and effectiveness of medical cannabis as a complementary option for supportive cancer care: Results from the Cannabis Pilot Project.

12106 Background: Access to medical cannabis (MC) is a common request by patients and caregivers in supportive cancer care (SCC). However, healthcare professionals require more evidence on MC safety and effectiveness. Methods: The Cannabis Pilot Project (CPP) was implemented at the Cedars Cancer Centre of the McGill University Health Centre to evaluate MC as a complementary option for symptom control in SCC. Referral to the CPP was reserved for patients who were receiving SCC but had not obtained adequate symptom relief. An interdisciplinary team (physician, nurse and research coordinator) was established to systematically assess patients, prescribe and monitor MC treatments and record data on their safety and effectiveness. Patients were enrolled in the CPP between February 2018 and December 2019 and reassessed at intervals of one to six months. Results: Ninety-six cancer patients (mean age 60.0y (±13.9); 41 (42.7%) males) had at least one follow-up (FUP) and were included in the study. The main cancer types were breast (19.8%), lung (9.4%) and colorectal (9.4%). Adverse events (top three: drowsiness, low energy and nausea) were reported in 28% of patients, with 9% having to stop MC. Mean Brief Pain Inventory scores significantly improved between baseline, FUP-2 and FUP-3 for worst pain (5.4± SEM 0.3 vs 4.3±0.3 and 3.7±0.4) and average pain severity (4.2±0.2 vs 3.2±0.3 and 3.2±0.4). Anorexia improved (3.4±0.3 vs 2.2±0.4 and 1.7±0.4), as measured via the revised Edmonton Symptom Assessment System (ESAS-r). ESAS-r wellbeing improved significantly between baseline and FUP-1 (4.4±0.2 vs 3.7±0.2). Between baseline and each FUP, approximately a third of patients dropped their use of concurrent medications (including analgesics, antidepressants and anxiolytics), as measured by the Medication Quantification Scale. Conclusions: The CPP data support the safety and effectiveness of MC as a complementary option for improving pain control, appetite and quality of life in SCC.

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Prescreening of Patient-reported Symptoms using the Edmonton Symptom Assessment System (ESAS) in Outpatient Palliative Cancer Care

10.21203/rs.2.16484/v1 ◽

2019 ◽

Author(s):

Garden Lee ◽

Han Sang Kim ◽

Si Won Lee ◽

Eun Hwa Kim ◽

Bori Lee ◽

...

Keyword(s):

Palliative Care ◽

Cancer Care ◽

Severe Symptom ◽

Symptom Burden ◽

Symptom Assessment ◽

Assessment System ◽

Advanced Cancer Patients ◽

Edmonton Symptom Assessment System ◽

Patient Reported

Abstract Background: Although early palliative care is associated with a better quality of life and improved outcomes in end-of-life cancer care, the criteria of palliative care referral are still elusive. Methods: We collected patient-reported symptoms using the Edmonton Symptom Assessment System (ESAS) at the baseline, first, and second follow-up visit. The ESAS evaluates ten symptoms: pain, fatigue, nausea, depression, anxiety, drowsiness, dyspnea, sleep disorder, appetite, and wellbeing. A total of 71 patients were evaluable, with a median age of 65 years, male (62%), and the Eastern Cooperative Oncology Group (ECOG) performance status distribution of 1/2/3 (28%/39%/33%), respectively. Results: Twenty (28%) patients had moderate/severe symptom burden with the mean ESAS ≥5. Interestingly, most of the patients with moderate/severe symptom burdens (ESAS ≥5) had globally elevated symptom expression. While the mean ESAS score was maintained in patients with mild symptom burden (ESAS<5; 2.7 at the baseline; 3.4 at the first follow-up; 3.0 at the second follow-up; P =0.117), there was significant symptom improvement in patients with moderate/severe symptom burden (ESAS≥5; 6.5 at the baseline; 4.5 at the first follow-up; 3.6 at the second follow-up; P <0.001). Conclusions: Advanced cancer patients with ESAS ≥5 may benefit from outpatient palliative cancer care. Prescreening of patient-reported symptoms using ESAS can be useful for identifying unmet palliative care needs in advanced cancer patients.

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Impact of Palliative Care Unit Admission on Symptom Control Evaluated by the Edmonton Symptom Assessment System

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2005.04.007 ◽

2005 ◽

Vol 30 (4) ◽

pp. 367-373 ◽

Cited By ~ 50

Author(s):

Caterina Modonesi ◽

Emanuela Scarpi ◽

Marco Maltoni ◽

Stefania Derni ◽

Laura Fabbri ◽

...

Keyword(s):

Palliative Care ◽

Symptom Control ◽

Symptom Assessment ◽

Assessment System ◽

Palliative Care Unit ◽

Edmonton Symptom Assessment System

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Palliative care consultation team: symptom relief in first 48 hours of hospitalization

Revista Brasileira de Enfermagem ◽

10.1590/0034-7167-2019-0391 ◽

2020 ◽

Vol 73 (6) ◽

Author(s):

Magda Aparecida dos Santos Silva ◽

Marcio Augusto Diniz ◽

Ricardo Tavares de Carvalho ◽

Toshio Chiba ◽

Cibele Andrucioli de Mattos-Pimenta

Keyword(s):

Palliative Care ◽

Pain Relief ◽

Symptom Relief ◽

Symptom Assessment ◽

Assessment System ◽

Point Reduction ◽

Palliative Care Consultation ◽

Symptom Intensity ◽

Consultation Team ◽

Care Consultation

ABSTRACT Objective: To compare the relief of symptoms provided by palliative care consultation team (PCCT) compared to the traditional care team (TC), in patients with advanced cancer in the first 48 hours of hospitalization. Method: Allocated to PCCT Group and TC Group, this study assessed 290 patients according to the Edmonton Symptom Assessment System (ESAS) within the first 48 hours of hospitalization. The main outcome was a minimum 2-point reduction in symptom intensity. Results: At 48 hours, the PCCT Group had a 2-point reduction in the mean differences (p <0.001) in pain, nausea, dyspnea, and depression; and TC Group, on nausea and sleep impairment (p <0.001). Multiple Logistic Regression found for the PCCT Group a greater chance of pain relief (OR 2.34; CI 1.01-5.43; p = 0.049). Conclusion: There was superiority of the PCCT Group for pain relief, dyspnea and depression. There is a need for more studies that broaden the understanding of team modalities.

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Developing pathways for cancer rehabilitation in tertiary oncology centers: Initial observations at the McGill University Health Centre.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.17 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 17-17

Author(s):

Sabrina Cesare ◽

Irina Uscatescu ◽

Jonathan di Tomasso ◽

Lorella Ciutto ◽

Kevin Yu-Chueh ◽

...

Keyword(s):

Cancer Patients ◽

Handgrip Strength ◽

Health Centre ◽

Symptom Assessment ◽

Well Being ◽

Assessment System ◽

Cancer Rehabilitation ◽

Targeted Interventions ◽

Mcgill University ◽

Clinically Significant

17 Background: No definitive rehabilitation pathways exist for cancer patients. To address this gap, the Cancer Rehabilitation interdisciplinary team at the McGill University Health Centre has developed three program paths (e.g., Restorative, Supportive, and Cachexia) to meet the various specialized and personalized needs of cancer patients. Methods: A consecutive cohort of patients referred to the Cancer Rehabilitation Clinic between January 1st and June 30th, 2014 was considered. We examined the following baseline characteristics: handgrip strength (HGS), the abridged Patient Generated-Subjective Global Assessment (aPG-SGA) and Edmonton Symptom Assessment System (ESAS) self-reported questionnaires. Results: Of the 54 patients evaluated (57.4% male), 20 (mean age: 47.4 yrs), 8 (59.9 yrs) and 26 (64.6 yrs) were assigned to the restorative, supportive and cachexia streams, respectively. The most common cancer diagnoses were gastrointestinal (15%), gynecological (13%), breast (12%) and lung (12%). Table 1 contains baseline aPG-SGA, ESAS and HGS scores. Conclusions: Our preliminary data confirm clinically significant differences in muscle strength across the 3 streams for both males and females, as well as significant differences in nutritional, appetite and well-being scores between the patients in the restorative and cachexia pathways. Our data confirm the need of personalized and targeted interventions to achieve or maintain optimal performance and quality of life in cancer survivors with different disease and treatment characteristics. [Table: see text]

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Growing Healing Touch as supportive cancer care in western New York.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.5_suppl.176 ◽

2017 ◽

Vol 35 (5_suppl) ◽

pp. 176-176

Author(s):

Suzanne M Hess ◽

Lynda M. Beaupin

Keyword(s):

New York ◽

Cancer Care ◽

Symptom Relief ◽

Physical Symptom ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Healing Touch ◽

Energy Medicine ◽

Supportive Cancer Care ◽

Energy Field

176 Background: Healing Touch (HT) is a specific energy medicine modality that incorporates several techniques to balance the human energy field to help promote healing. It is a safe and non-invasive therapy that complements traditional, standard care and is recognized by NIH’s National Center for Complementary and Integrative Health. HT was first introduced to cancer survivors at our NCI-designated Comprehensive Cancer Center in 2013. We demonstrate HT is well-received and easy to integrate into traditional cancer care. Methods: A Certified Healing Touch Practitioner taught pediatric survivors and families HT techniques, as well as trained staff and volunteers to participate in the pilot program and to offer HT sessions throughout the year. Results: See Table. Qualitative analysis of participant’s feedback indicate benefits in the following themes: 1. Physical Symptom Relief 2. Emotional Issue Relief 3. Spiritual/Grief Support 4. Recommendation to Other Patients. Conclusions: Healing Touch is an energy medicine modality that is easy to teach, simple to integrate into routine cancer care, and beneficial for caregivers and survivors alike. [Table: see text]

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Pre‐screening of patient‐reported symptoms using the Edmonton Symptom Assessment System in outpatient palliative cancer care

European Journal of Cancer Care ◽

10.1111/ecc.13305 ◽

2020 ◽

Vol 29 (6) ◽

Author(s):

Garden Lee ◽

Han Sang Kim ◽

Si Won Lee ◽

Yu Rang Park ◽

Eun Hwa Kim ◽

...

Keyword(s):

Cancer Care ◽

Symptom Assessment ◽

Assessment System ◽

Edmonton Symptom Assessment System ◽

Patient Reported

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Population-based standardized symptom screening: Cancer Care Ontario’s Edmonton Symptom Assessment System and performance status initiatives.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.30_suppl.56 ◽

2014 ◽

Vol 32 (30_suppl) ◽

pp. 56-56

Author(s):

Sean Molloy ◽

Jose Pereira ◽

Esther Green ◽

Deborah Jane Dudgeon ◽

Doris Howell ◽

...

Keyword(s):

Health Care ◽

Cancer Care ◽

Symptom Management ◽

Symptom Assessment ◽

Assessment System ◽

Evidence Based ◽

Care Providers ◽

Symptom Screening ◽

Patient Reported ◽

Evidence Based Guidelines

56 Background: The goal of the collaborative is to improve the quality and consistency of physical and emotional symptom management across the cancer journey. Objectives are: (a) promote the adoption of electronic symptom assessment using a standardized tool and (b) increase the clinical use of evidence based guidelines to effectively manage patient identified symptoms. Methods: The actions taken for this initiative are to manage cancer symptoms through a patient reported measurement tool; improve the quality of symptom management through the uptake of symptom management guides and algorithms for care; and drive improvement through the adoption of an electronic symptom assessment platform The following aims were established for this work: (1) Aim for symptom screening and assessment (70% of ambulatory cancer clinic patients are screened for symptom severity using ESAS at least once/month) (2) aim for symptom management (evidence from chart audits show intervention as per evidence based guidelines for patients reported symptom scores) (3) aim for patient satisfaction (90% of target population indicates that their health care team took their scores into consideration when developing a care plan) and (4) aim for evidence of use (90% of patients state that their doctor or nurse spoke with them about their symptom screen). Results: 60% of cancer patients are screened each month representing over 28,000 people. Six of fourteen cancer regions are above the provincial target of 70%, with some close to 90%. 92% of patients felt ESAS was important to complete to help health care providers know how they are feeling. Conclusions: Cancer Care Ontario has been able to drive improvements in symptom management through the implementation of system wide electronic symptom assessment. For other jurisdictions interested in adopting this approach, the following areas are critical for success. (a.) Leadership at all levels of the system; (b.) clinical tools at the point of care; (c) engagement of patients in the design of care; (d) communications support to spread information to all stakeholders; and (e) using to data to drive performance improvement and accountability.

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Comparison of prevalence of pain symptoms and completion rates using a patient-reported outcomes (PRO) tool of pain in palliative and curative patients.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.29_suppl.78 ◽

2015 ◽

Vol 33 (29_suppl) ◽

pp. 78-78

Author(s):

Sabrina Yeung ◽

Catherine Brown ◽

Andrea Perez Cosio ◽

Yvonne Leung ◽

Mindy Liang ◽

...

Keyword(s):

Brief Pain Inventory ◽

Symptom Assessment ◽

Assessment System ◽

Assessment Tools ◽

Completion Rates ◽

Curative Intent ◽

Wide Range ◽

Patient Reported ◽

Prevalence Of Pain ◽

Pain Symptoms

78 Background: Regular self-reporting of symptoms using validated computerized assessment tools can improve individualized symptom management. Yet there are concerns that palliative patients who may benefit most from such self-reporting may be reluctant to adopt such approaches or have barriers to proper reporting. We compared actual prevalence and completion rates of a PRO-tool between patients being managed with a palliative (PAL) or curative intent (CUR). Methods: A pain PRO-tool was administered cross-sectionally using tablet technology across outpatient clinics in a comprehensive cancer centre. Questions were adapted from the Brief Pain Inventory (BPI) and Edmonton Symptom Assessment System (ESAS), recording responses on pain severity and interference in life. PRO-tool completion rates and prevalence of pain symptoms were compared between CUR and PAL. Results: Of 200 patients, 82 were PAL and 118 were CUR; median age was 60 (21-86) years; 48% were female. A greater proportion of PAL were found with gastrointestinal, gynecological and lung cancers than CUR (p = 0.04). Each question had greater than 95% completion rates for both groups, capturing a wide range of scores. 16% of PAL reported no pain as their worst pain in the last 24 hours as opposed to 31% of CUR (p = 0.02). 82% (PAL) and 68% (CUR) reported their average pain as being at least “some pain” (p = 0.03), and there were no differences in the proportion of patients reporting interference with their general activity between PAL and CUR (p > 0.05). Presence of current pain was equivocal when assessed via the ESAS adapted question (76% PAL vs 66% CUR, p = 0.16), but was significantly different when assessed using the BPI adapted question (72% PAL vs 56% CUR; p = 0.02). Conclusions: A Pain PRO-tool was completed with similarly high rates in PAL and CUR patients. As expected, prevalence of recent and current pain was high in both groups, and in some instances, higher in PAL than CUR patients. These results suggest that a Pain PRO-tool could be implemented with ease in the palliative setting, and would capture pain comprehensively.

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The Quebec Cannabis Registry: a pharmacovigilance and effectiveness study on the use of medical cannabis in cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.12109 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 12109-12109

Author(s):

Antonio Vigano ◽

Michelle Canac-Marquis ◽

Rihab Gamaoun ◽

Pierre Beaulieu ◽

Andrée Neron ◽

...

Keyword(s):

Cancer Patients ◽

Repeated Measures ◽

Brief Pain Inventory ◽

Symptom Assessment ◽

Well Being ◽

Population Based ◽

Pain Severity ◽

Medical Cannabis ◽

Edmonton Symptom Assessment Scale ◽

Symptom Assessment Scale

12109 Background: The Quebec Cannabis Registry (QCR) was launched in 2015 to allow physicians to prescribe medical cannabis (MC) in the province of Quebec, Canada. This study aimed to investigate the safety and effectiveness of MC in cancer patients using pharmacovigilance data prospectively collected for up to 24 months. Methods: Patients were enrolled in the QCR between May 2015 and October 2018 and followed every 3 months. Study outcomes included adverse events (AE), pain severity and interference (Brief-Pain Inventory), wellbeing (Revised-Edmonton Symptom Assessment Scale) and overall health scale (EQ5D5L) at baseline and at each follow-up (F-UP). Significance of changes over time were assessed using repeated-measures ANOVA. Results: Out of the 2991 patients enrolled in the QCR, 358 (12.8%) were cancer patients (mean age 57.7 (± 14.6); 171 (47.8%) males). The main cancer types were breast (16.2%), lung (11.7%), leukemia (11.5%) and colorectal (11.2%). MC was prescribed primarily for pain (72.1%), anxiety (4.7%), nausea (4.5%), anorexia (3.9%), and insomnia (3.1%). A total of 13 patients (3.6%) reported AE with only three being serious (one unrelated to MC: stroke; and two possibly related: diarrhea, from CBD oil overdose and pneumonia from smoking MC). Mean scores significantly (p < 0.05) improved between baseline and 3 months F-UP for pain severity (4.8 ± 1.5 vs 4.1 ± 1.8), pain interference (4.6 ± 1.8 vs 3.8 ± 1.7), and the overall health scale (60 ± 21 vs 71 ± 18). Well-being scores also significantly improved between baseline and 6 months F-UP (4.4 ± 2.1 vs 3.5 ± 2.8). Conclusions: Population-based data shows that cancer patients can benefit safely and effectively from MC as a complementary treatment, when prescribed and monitored under medical-nursing supervision.

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