Long-term medical cannabis use and risk factors for diversion: Report on physician's guidance and patients' behaviour.

OBJECTIVES: Various jurisdictions have legalized cannabis for medical purposes. As with all psychoactive medications, medical cannabis carries a risk of diversion and accidental ingestion. These risks may be particularly high among long-term medical cannabis patients as safety practices may become less salient to patients once the treatment becomes part of everyday life. The current study examines whether patients who have used medical cannabis for longer periods differ from those who have used for shorter periods in terms of sociodemographic background and other key aspects of medical cannabis use. Furthermore, the study examines the relationship between length of medical cannabis treatment and risk factors related to storage and diversion. Finally, the study examines the extent to which oncologists provide information to their patients about safe storage and disposal. METHODS: One hundred twenty-one medical cannabis oncology patients were interviewed face-to-face and 55 oncologists participated in a survey about safe storage and disposal practices related to medical cannabis. RESULTS: Length of medical cannabis treatment was related to administration by smoking and using higher monthly dosages. In terms of risk for unsafe storage and diversion, length of medical cannabis was positively associated with using cannabis outside the home and having been asked to give away medical cannabis. Physicians did not report providing information to patients regarding safe storage and disposal practices in a regular manner. SIGNIFICANCE OF RESULTS: Results suggest that there is an ongoing risk of unsafe storage and diversion over the course of medical cannabis treatment. Oncologists may need to give more consistent and continued training in safe storage and disposal practices, especially among long-term medical cannabis patients.

Fortuitous administration of denosumab in breast carcinoma with osteoclastic giant cells.

Breast carcinoma with osteoclastic giant cells (OGCs) is a rare entity characterized by an admixture of giant cells and malignant epithelial cells within an inflammatory and vascular stroma. Denosumab is a monoclonal antibody that targets the pathway for osteoclast formation and activation, indicated for the prevention of skeletal-related events in patients with bone metastases, as well as for the treatment of giant cell tumor of bone. We report a patient who presented with aggressive bone recurrence of breast cancer 12 years after her original diagnosis, showing a transformed histology that included multinucleated OGCs, and that was refractory to traditional therapy. Misdiagnosed with a tumor-to-tumor metastasis of breast cancer to a giant cell tumor of bone, she was treated with denosumab for her presumed primary bone disease and had a remarkable clinical and radiological response. To the best of our knowledge, this is the first report of breast cancer with OGCs occurring initially in a metastasis while absent in the original tumor and the first description of its successful treatment with denosumab. This case sheds light on the development of giant cells in the tumor microenvironment and suggests the potential use of denosumab in the management of cancers with giant cell elements.

Medical students' attitudes towards participating in a palliative medicine course: A new specialty in Israel.

BACKGROUND: Palliative medicine is a growing field in Israel, and its training program is still in process. The current study aimed to evaluate students' attitudes regarding a course in palliative care established in a division of oncology. METHOD: Some 45 medical students in their 5th to 6th years participated in a one-week course on palliative care. At the end of each training week, students were asked to complete a questionnaire, evaluating their attitudes regarding different aspects of the program content, such as its importance and relevance to their training as physicians, as well as the contribution of specific parts of the program to their knowledge regarding palliative care. RESULTS: The overall satisfaction of the 45 students was high. The most contributory parts of the course were the multidisciplinary team and the complementary and alternative medicine. Participating in the staff meetings and accompanying physicians in their daily work were scored as the least contributory parts.Significance of resultsThis preliminary study demonstrated students' overall high satisfaction with the newly established palliative care course and their need for more practical skills. Future studies should investigate and evaluate educational programs in palliative care in order to establish suitable training for medical students.

Storage and disposal of medical cannabis among patients with cancer: Assessing the risk of diversion and unintentional digestion.

BACKGROUND: Increasingly more jurisdictions worldwide are legalizing medical cannabis. Major concerns related to such policies are that improper storage and disposal arrangements may lead to the diversion and unintentional digestion of cannabis. These concerns are particularly acute among patients with cancer because they take home medical cannabis for extended periods and have high rates of treatment termination and mortality shortly after the onset of treatment with medical cannabis. Therefore, leftover cannabis is potentially particularly prevalent, and potentially improperly stored, in households of current and deceased patients with cancer. The current study investigated the risk of medical cannabis diversion and unintentional digestion among oncology patients treated with medical cannabis and caregivers of recently deceased patients who were treated with medical cannabis. METHODS: A total of 123 oncology patients treated with medical cannabis and 37 caregivers of deceased oncology patients treated with medical cannabis were interviewed regarding practices and the information received concerning the safe storage and disposal of medical cannabis, as well as experiences of theft, diversion, and unintentional digestion. RESULTS: High rates of suboptimal storage were reported and caregivers were found to be particularly unlikely to have received information regarding the safe storage and disposal of medical cannabis. Few incidences of theft, diversion, and unintentional digestion were reported. CONCLUSIONS: Oncologists and other health care providers have an important, yet unfilled, role to play with regard to educating patients and caregivers of the importance of the safe storage and disposal of medical cannabis. Interventions designed to alert patients treated with medical cannabis and their caregivers to the problem of diversion, along with strategies to limit it, have the potential to limit diversion and unintentional exposure to medical cannabis. Cancer 2016;122:3363-3370. © 2016 American Cancer Society.

Long-lasting stable disease with mTOR inhibitor treatment in a patient with a perivascular epithelioid cell tumor: A case report and literature review.

Perivascular epithelioid cell tumor (PEComa) of the small intestine is extremely rare, and there is no established treatment at the present time. In 10% of patients with PEComas, genetic alterations of tuberous sclerosis complex have been reported. These genetic alterations activate mechanistic target of rapamycin (mTOR) in AMP-activated protein kinase and Ras/mitogen-activated protein kinase pathways, resulting in high mTOR activity. Since 2007, several cases of treatment with mTOR inhibitors in advanced PEComa have been reported. The current study presents the case of a patient with small bowel PEComa that metastasized to the brain and lungs. Following resection of the brain metastasis, the patient was treated with everolimus, a mTOR inhibitor, resulting in improvement if the patient's quality of life and a long period of stable disease. In conclusion, the use of mTOR inhibitors as a first-line treatment option in advanced PEComa patients appears to be reasonable, according to the increasing evidence from data observed from reported cases with this rare malignancy.

A preliminary report on innovative group therapy in an oncology in-patient department: a patient-family-staff community meeting.

OBJECTIVE: The Community Meeting (CM) is a unique form of group therapy applied from Psychiatry to an Oncology in-patient department. It is designed to answer the needs of in-patients and family members for open communication and empathic interaction and to serve as a model for effective coping. METHODS: A weekly staff-patient-family open group was held, with facilitation based on an integrative crisis intervention model. After each CM, the staff meets to discuss implications. RESULTS: Frequent themes include patient and caregiver concerns about cancer, treatments, communication and coping difficulties. Subjective impressions of participants indicate positive outcomes. The CM seems to enhance positive interactions and perceived quality of care. It helps staff to identify distress, serves as a managerial tool and promotes collaboration among staff. CONCLUSIONS: The CM is a unique method for addressing the burdens of in-patient oncology members. A structured study is needed to substantiate these descriptive outcomes.

Treatment of lower extremity edema by subcutaneous drainage in palliative care of advanced cancer patients.

BACKGROUND: Lower extremity edema is a problem in patients with advanced cancer, causing decreased physical function and reduced movement. METHODS: Eight patients with advanced cancer were treated by subcutaneous needles inserted in the inner and outer sides of the ankles and attached to an enclosed drainage bag, or by creating subcutaneous tracts in both ankles. RESULTS: All patients lost weight after 24 hours. A total of 4 patients reported enhanced mobilization and 5 patients had significant improvement of mobilization that improved their quality of life. CONCLUSIONS: Subcutaneous drainage can improve edema in the lower limbs or the lower body segment, contributing to patient comfort at his end-of-life period. A prospective study with better evaluation of patient quality of life is ongoing in our center.