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Background: Although studied in a few randomized controlled trials, the efficacy of medical cannabis (MC) for chronic pain remains controversial. Using an alternative approach, this multicentre, questionnaire‐based prospective cohort was aimed to assess the long‐term effects of MC on chronic pain of various aetiologies and to identify predictors for MC treatment success. Methods: Patients with chronic pain, licensed to use MC in Israel, reported weekly average pain intensity (primary outcome) and related symptoms before and at 1, 3, 6, 9 and 12 months following MC treatment initiation. A general linear model was used to assess outcomes and identify predictors for treatment success (≥30% reduction in pain intensity). Results: A total of 1,045 patients completed the baseline questionnaires and initiated MC treatment, and 551 completed the 12‐month follow‐up. At 1 year, average pain intensity declined from baseline by 20% [−1.97 points (95%CI = −2.13 to −1.81; p < 0.001)]. All other parameters improved by 10%–30% (p < 0.001). A significant decrease of 42% [reduction of 27 mg; (95%CI = −34.89 to 18.56, p < 0.001)] from baseline in morphine equivalent daily dosage of opioids was also observed. Reported adverse effects were common but mostly non‐serious. Presence of normal to long sleep duration, lower body mass index and lower depression score predicted relatively higher treatment success, whereas presence of neuropathic pain predicted the opposite. Conclusions: This prospective study provides further evidence for the effects of MC on chronic pain and related symptoms, demonstrating an overall mild‐to‐modest long‐term improvement of the tested measures and identifying possible predictors for treatment success. [ABSTRACT FROM AUTHOR]

With recent advances in mapping the genetic mutations involved in breast cancer and the availability of genetic testing, it has become necessary to explore the psychological consequences of women who have tested positive for the gene mutations involved in breast cancer (BReast CAncer gene one and two, BRCA1/2). Findings regarding psychological consequences of positive results in genetic testing for breast cancer are ambiguous and insufficient. The aim of the current study was to explore the relationship between experience of the death of a relative due to breast cancer, perception of the illness, distress, and well-being among BRCA1/2 mutation women carriers. Forty asymptomatic carriers who attended BRCA1/2 clinics in Israel completed self-administered questionnaires assessing socio-demographic variables, illness perception, and well-being. It was found that experiencing the death of a relative as a result of breast cancer was significantly correlated with illness perception. Carriers who experienced the death of a relative perceived breast cancer as having a stronger identity (i.e. as having severe symptoms), dire consequences, and as being uncontrollable in comparison to carriers who had not experienced the death of a relative. Nevertheless, psychological distress and well-being were not found to be significantly correlated to either an experience of death of a relative as a result of breast cancer or to illness perception. Implications and limitations are discussed in light of these findings. Among these is the need to consider the illness perception of healthy BRCA carriers women. [ABSTRACT FROM PUBLISHER]

Objective: To evaluate patterns of opioid handling as well as their associated -variables., Design: A transversal study., Setting: Institutional care., Participants: One hundred cancer pain patients aged 18 and above at diagnosis., Interventions: Open and dichotomous questions related to opioid handling and a depression-anxiety scale., Main Outcome Measure(s): The percentage of patients who properly handled opioids., Results: Of those surveyed, 42.1 percent of patients reported receiving opioid storage instructions, 73 percent did not receive any instructions related to proper opioid return/disposal, and 39 percent wrongly discarded them. The mean of patients with anxiety symptoms was 6.95 and of depression symptoms was 8.19. The Hebrew Version of the Hospital and Anxiety Scale total mean was 15.1. A significant relationship among patients with poor disposal habits was also found., Conclusions: Despite being aware of opioid's danger, patients' attitudes evidenced a poor safety responsibility. We believe that this might be due to the high percentage of disinformation and the influence of psychological symptoms on patients' decision-making.

Cancer treatment-related toxicities often require dose reductions and delays. Herbal medicine use is prevalent among cancer patients. Though evidence is lacking regarding benefits in treatment outcomes and immunity, a large body of evidence supports the use of herbals for reducing treatment-induced toxicities. We present three cases where herbal medicine provided relief from side effects of anti-cancer treatment, enabling the completion of treatment protocols. In the first case, a 79 year-old female patient with metastatic breast cancer developed flushing and excessive sweating from Tamoxifen treatment. Herbal medicine reduced symptoms significantly, enabling the continuation of treatment with partial disease resolution. In the second case, a 69 year-old male with esophageal cancer terminated treatment on the adjuvant treatment protocol because of severe nausea and vomiting, diarrhea, peripheral neuropathy and fatigue. Herbal medicine reduced symptom severity and chemotherapy was reinstituted. In the third case, a 58 year-old female patient with advanced metastatic colon cancer was referred by her oncologist for treatment with herbal medicine for alleviation of fatigue and weakness, flushing and palpitations, mouth ulcers and dyspnea. Despite significant symptom reduction, with completion of treatment regimens, her disease progressed and she subsequently succumbed to the disease. In summary, the above cases illustrate potential benefits of herbal medicine in the reduction of cancer treatment-related symptoms, enabling patients to complete their anti-cancer treatment regimen. Further research examining the efficacy and safety of herbal compounds is needed, in light of potential toxicity and negative interactions with conventional treatment.