Age-related Patterns of Medical Cannabis Use: A Survey of Authorized Patients in Canada.

Objective: An increasing number of Canadians are registering as authorized users of medical cannabis. Older patients comprise a growing subset of this population; however, relatively little information exists around age-related patterns of medical cannabis use. Methods: The Canadian Cannabis Patient Survey (CCPS) is a large cross-sectional survey of authorized medical cannabis patients in Canada. This publication summarizes the results of the CCPS 2021, with a focus on age-related outcomes and the elderly sub-population. Results: The survey was completed by 2,697 patients. The mean age of participants was 54.3 years of age and the proportion of female respondents was 49.1%. Among older patients, pain was the most common symptom, while anxiety was the most common symptom reported by younger patients. Older patients exhibited a significant preference for oral administration over inhalation of medical cannabis when compared to younger patients, respectively (p>0.05). Among patients taking prescription opioids, most of whom were older patients, 54% reported a decrease in use concurrent with medical cannabis. Conclusions: Older patients comprise a growing subset of medical cannabis patients, which is also reflected in CCPS participants over time. This patient population exhibits different patterns of use compared to their younger counterparts, preferring high CBD orally ingested formulations, which they use primarily to treat pain-related illnesses/symptoms. Overall, study participants reported that cannabis had a high degree of efficacy in alleviating their illness/symptoms, and many reported a reduction in their use of prescription opioids, alcohol, tobacco, and other substances.

A small clinical trial of vaporized cannabis for PTSD: suggestive results and directions for future study.

The last few decades have seen increasing interest in the use of cannabis for post-traumatic stress disorder (PTSD). Recent attempts to evaluate the clinical efficacy of cannabis for PTSD were inconclusive and generalizability was limited by undesirable features of the study drug. The present clinical trial evaluated the effects of a commercially available chemovar that was delivered by vaporization. The study was designed as a randomized placebo-controlled cross-over study with three conditions; however, only five individuals completed the trial, and analysis of the placebo effect was not possible. Results identified positive changes consistent with medium-sized within-subject effects for cannabis in the treatment of PTSD. Positive trending results and high patient need mandate future studies of cannabis for the treatment of PTSD.

Shifts in medical cannabis use in Canada during the COVID-19 pandemic. / Changements observés au Canada dans la consommation de cannabis à des fins médicales pendant la pandémie de COVID-19.

INTRODUCTION: The COVID-19 pandemic has had widespread secondary negative health impacts including loss of material security and exacerbation of mental illness in at-risk populations. While increases in the nonmedical use of certain substances, including cannabis, have been observed in samples of the Canadian population, no research has documented COVID-concurrent shifts in medical cannabis use in Canada. METHODS: Data were derived from the 2021 Canadian Cannabis Patient Survey, an online survey administered in May 2021 to people authorized to use medical cannabis recruited from one of two Canadian licensed medical cannabis producers. McNemar tests assessed for changes in past 3-month medical cannabis frequency from before to during the pandemic. We explored correlates of increasing frequency of cannabis use since before the pandemic in bivariable and multivariable logistic models. RESULTS: In total, 2697 respondents (49.1% women) completed the survey. Daily medical cannabis use increased slightly but significantly from before the pandemic (83.2%) to during the pandemic (90.3% at time of survey; p < 0.001). Factors significantly associated with increasing frequency of medical cannabis use included female gender, younger age, pandemic-related job loss, primary cannabis use to manage mental health, prescription drug use and nonmedical cannabis use (p < 0.05). CONCLUSION: There were slight shifts towards higher frequency of medical cannabis use after the onset of the COVID-19 pandemic. While short- and long-term impacts of cannabis use on pandemic-related mental distress are unknown, clinicians working with patients who use medical cannabis should be aware of possible changes in use patterns during the pandemic.

Healthcare provider and medical cannabis patient communication regarding referral and medication substitution: the Canadian context.

BACKGROUND: Patients use medical cannabis for a wide array of illnesses and symptoms, and many substitute cannabis for pharmaceuticals. This substitution often occurs without physician oversight, raising patient safety concerns. We aimed to characterize substitution and doctor-patient communication patterns in Canada, where there is a mature market and national regulatory system for medical cannabis. METHODS: We conducted an anonymous, cross-sectional online survey in May 2021 for seven days with adult Canadian federally-authorized medical cannabis patients (N = 2697) registered with two global cannabis companies to evaluate patient perceptions of Primary Care Provider (PCP) knowledge of medical cannabis and communication regarding medical cannabis with PCPs, including PCP authorization of licensure and substitution of cannabis for other medications. RESULTS: Most participants (62.7%, n = 1390) obtained medical cannabis authorization from their PCP. Of those who spoke with their PCP about medical cannabis (82.2%, n = 2217), 38.6% (n = 857) reported that their PCP had "very good" or "excellent" knowledge of medical cannabis and, on average, were moderately confident in their PCP's ability to integrate medical cannabis into treatment. Participants generally reported higher ratings for secondary care providers, with 82.8% (n = 808) of participants rating their secondary care provider's knowledge about medical cannabis as "very good" or "excellent." Overall, 47.1% (n = 1269) of participants reported substituting cannabis for pharmaceuticals or other substances (e.g., alcohol, tobacco/nicotine). Of these, 31.3% (n = 397) reported a delay in informing their PCP of up to 6 months or more, and 34.8% (n = 441) reported that their PCP was still not aware of their substitution. Older, female participants had higher odds of disclosing cannabis substitution to their PCPs. CONCLUSION: Most of the surveyed Canadian medical cannabis patients considered their PCPs knowledgeable about cannabis and were confident in their PCPs' ability to integrate cannabis into treatment plans. However, many surveyed patients substituted cannabis for other medications without consulting their PCPs. These results suggest a lack of integration between mainstream healthcare and medical cannabis that may be improved through physician education and clinical experience.

Transcriptome Wide Analysis of Magnetic Resonance Imaging-targeted Biopsy and Matching Surgical Specimens from High-risk Prostate Cancer Patients Treated with Radical Prostatectomy: The Target Must Be Hit.

BACKGROUND: The most suspicious lesions on multiparametric magnetic resonance imaging (MRI) may be representative of final pathology. OBJECTIVE: We connect imaging with high-precision spatial annotation of biopsies and genomic cancer signatures to compare the genomic signals of the index lesion and biopsy cores of adjacent and far away locations. DESIGN, SETTING, AND PARTICIPANTS: Eleven patients diagnosed with high-risk prostate cancer on MRI/transrectal ultrasound-fusion biopsy (Bx) and treated with radical prostatectomy (RP). Five tissue specimens were collected from each patient. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Whole transcriptome RNA-expression was profiled for each sample. Genomic signatures were used to compare signals in MRI invisible versus visible foci using Pearson's correlation and to assess intratumoral heterogeneity using hierarchical clustering. RESULTS AND LIMITATIONS: Ten RP and 27 Bx-samples passed quality control. Gene expression between RP and index Bx, but not adjacent benign samples, was highly correlated. Genomic Gleason grade classifier features measured across the different samples showed concordant expression across Bx and RP tumor samples, while an inverse expression pattern was observed between tumor and benign samples indicating the lack of a strong field-effect. The distribution of low and high Prostate Imaging Reporting and Data System (PI-RADS) samples was 10 and 11, respectively. Genomics of all low PI-RADS samples resembled benign tissue and most high PI-RADS samples resembled cancer tissue. A strong association was observed between PI-RADS version 2 and Decipher as well as the genomic Gleason grade classifier score. Clustering analysis showed that most samples cluster tightly by patient. One patient showed unique tumor biology in index versus secondary lesion suggesting the presence of intrapatient heterogeneity and the utility in profiling multiple foci identified by MRI. CONCLUSIONS: MRI-targeted Bx-genomics show excellent correlation with RP-genomics and confirm the information captured by PI-RADS. Sampling of the target lesion must be precise as correlation between index and benign lesions was not seen. PATIENT SUMMARY: In this report, we tested if targeted prostate sampling using magnetic resonance imaging-fusion biopsy allows to genetically describe index tumors of prostate cancer. We found that imaging genomics correlated well with final prostatectomy provided that the target is hit precisely.

Ability of a Genomic Classifier to Predict Metastasis and Prostate Cancer-specific Mortality after Radiation or Surgery based on Needle Biopsy Specimens.

BACKGROUND: Decipher is a validated genomic classifier developed to determine the biological potential for metastasis after radical prostatectomy (RP). OBJECTIVE: To evaluate the ability of biopsy Decipher to predict metastasis and Prostate cancer-specific mortality (PCSM) in primarily intermediate- to high-risk patients treated with RP or radiation therapy (RT). DESIGN, SETTING, AND PARTICIPANTS: Two hundred and thirty-five patients treated with either RP (n=105) or RT±androgen deprivation therapy (n=130) with available genomic expression profiles generated from diagnostic biopsy specimens from seven tertiary referral centers. The highest-grade core was sampled and Decipher was calculated based on a locked random forest model. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Metastasis and PCSM were the primary and secondary outcomes of the study, respectively. Cox analysis and c-index were used to evaluate the performance of Decipher. RESULTS AND LIMITATIONS: With a median follow-up of 6 yr among censored patients, 34 patients developed metastases and 11 died of prostate cancer. On multivariable analysis, biopsy Decipher remained a significant predictor of metastasis (hazard ratio: 1.37 per 10% increase in score, 95% confidence interval [CI]: 1.06-1.78, p=0.018) after adjusting for clinical variables. For predicting metastasis 5-yr post-biopsy, Cancer of the Prostate Risk Assessment score had a c-index of 0.60 (95% CI: 0.50-0.69), while Cancer of the Prostate Risk Assessment plus biopsy Decipher had a c-index of 0.71 (95% CI: 0.60-0.82). National Comprehensive Cancer Network risk group had a c-index of 0.66 (95% CI: 0.53-0.77), while National Comprehensive Cancer Network plus biopsy Decipher had a c-index of 0.74 (95% CI: 0.66-0.82). Biopsy Decipher was a significant predictor of PCSM (hazard ratio: 1.57 per 10% increase in score, 95% CI: 1.03-2.48, p=0.037), with a 5-yr PCSM rate of 0%, 0%, and 9.4% for Decipher low, intermediate, and high, respectively. CONCLUSIONS: Biopsy Decipher predicted metastasis and PCSM from diagnostic biopsy specimens of primarily intermediate- and high-risk men treated with first-line RT or RP. PATIENT SUMMARY: Biopsy Decipher predicted metastasis and prostate cancer-specific mortality risk from diagnostic biopsy specimens.

Completeness of ultrasound reporting impacts time to biopsy for benign and malignant thyroid nodules.

BACKGROUND: The objective was to evaluate reporting of guideline-recommended elements for thyroid ultrasound (US), and to determine whether element reporting was associated with the time to cytological and/or surgical diagnosis. METHODS: US reports of adults who underwent thyroid surgery for benign (n = 106) or malignant (n = 105) thyroid nodules between 2009 and 2014 were retrospectively reviewed for inclusion of 11 elements. RESULTS: On average 5.1 elements of 11 (46.4%) were included in US reports of all nodules. The setting of the US (academic versus community center) also influenced the number of elements reported (6.3 in academic versus 4.9 in community, p < 0.001). A higher number of reported elements were significantly associated with fewer days between US and FNAB, FNAB and OR, and US and OR (p < 0.001, p = 0.007, and p < 0.001, respectively). CONCLUSIONS: Under-reporting of guideline-recommended US elements is associated with delayed cytological diagnosis and surgical treatment of thyroid nodules.

Papillary thyroid carcinoma: prognostic significance of cancer presentation.

BACKGROUND: The objective of this study was to evaluate whether the clinical presentation of papillary thyroid carcinoma (PTC) has prognostic significance. METHODS: Retrospective evaluation was carried out of sequential, primary presentation, >1 cm diameter, PTC cases treated at a single center. PTC cases were grouped into 3 groups: (1) incidental detection by imaging, (2) incidental detection by physical examination, and (3) detection because of complaints related to a thyroid mass. The MACIS (metastasis, age, completeness of resection, invasion, and size) system was used to determine cancer prognosis for each group. RESULTS: Of the 168 PTC cases, 28 patients (17%) were in group 1, 60 patients (36%) were in group 2, and 80 patients (47%) were in group 3. Overall, 53% of differentiated thyroid cancers were detected incidentally. The difference in the proportion of patients in each MACIS score groups among the 3 clinical presentation categories, and for each component of the MACIS score, was not statistically significant (P = .36). CONCLUSION: The manner in which PTC initially clinically presents has no relationship with cancer prognosis.