PDF(Pubmed)
Abstract：
Chemotherapy-induced nausea and vomiting (CINV) is a debilitating side effect of cancer treatment, affecting many patients. Cannabinoid agonists, such as nabilone and Δ9-tetrahydrocannabinol (THC), the main psychoactive component of Cannabis sativa L., have shown efficacy as antiemetics. Here, we report the case of Michael Roberts (MR), who we believe is the first British patient reimbursed by the National Health Service (NHS) England for the cost of medicinal cannabis flowers to manage CINV. Medical data were obtained from NHS records and individual funding request (IFR) forms. Patient-reported outcome measures (PROMs) were collected using validated questionnaires as part of the standard of care at the specialized private clinics where the prescription of medicinal cannabis was initiated. The patient presented with rectosigmoid adenocarcinoma with lung metastases. He received FOLFIRI (folinic acid, fluorouracil, and irinotecan) chemotherapy and underwent an emergency Hartmann\'s procedure with subsequent second-line FOLFOX (folinic acid, fluorouracil, and oxaliplatin) chemotherapy and lung ablation. MR reported severe nausea and vomiting associated with the initial FOLFIRI treatment. Antiemetics metoclopramide and aprepitant demonstrated moderated efficacy. Antiemetics ondansetron, levomepromazine, and nabilone were associated with intolerable side effects. Inhalation of THC-predominant cannabis flowers in association with standard medication improved CINV, anxiety, sleep quality, appetite, overall mood, and quality of life. Our results add to the available evidence suggesting that medicinal cannabis flowers may offer valuable support in cancer palliative care integrated with standard-of-care oncology treatment. The successful individual funding request in this case demonstrates a pathway for other patients to gain access to these treatments, advocating for broader awareness and integration of cannabis-based medicinal products in national healthcare services.
摘要：
化疗引起的恶心和呕吐（CINV）是癌症治疗的一种使人衰弱的副作用，影响许多患者。大麻素激动剂，例如纳比酮和Δ9-四氢大麻酚（THC），大麻的主要精神活性成分，已显示出作为止吐药的功效。这里,我们报道了迈克尔·罗伯茨(MR)的病例，我们认为，他是英国国家卫生服务（NHS）为管理CINV的药用大麻花费用报销的第一位英国患者。医疗数据来自NHS记录和个人资助请求(IFR)表格。使用经过验证的问卷收集患者报告的结果指标（PROM），作为开始处方药用大麻的专业私人诊所的护理标准的一部分。患者表现为直肠乙状结肠腺癌伴肺转移。他收到了FOLFIRI(亚叶酸，氟尿嘧啶,和伊立替康）化疗，并接受了紧急哈特曼手术，随后进行了二线FOLFOX（亚叶酸，氟尿嘧啶,和奥沙利铂）化疗和肺消融。MR报告与初始FOLFIRI治疗相关的严重恶心和呕吐。止吐药甲氧氯普胺和阿瑞吡坦显示出适度的疗效。止吐药昂丹司琼,左甲丙嗪,和纳比隆与不能容忍的副作用有关。吸入以THC为主的大麻花与标准药物改善CINV相关，焦虑,睡眠质量,食欲,整体情绪,和生活质量。我们的结果增加了现有证据，表明药用大麻花可能在癌症姑息治疗与标准治疗肿瘤治疗相结合中提供有价值的支持。在这种情况下，成功的个人资助请求证明了其他患者获得这些治疗的途径。倡导在国家医疗保健服务中更广泛地认识和整合大麻基医药产品。
