Treating the body and the mind to optimize quality of life in cancer
As cancer therapies improve, patients live longer. With these improvements in therapy comes a responsibility to optimize patient’s quality of life during and after cancer therapy. The present article published on the “Asco Educational Book” reviews three important topics: the mechanism underlying chemotherapy-induced peripheral neuropathy and how to prevent and manage this side effect, the controversial but effective use of cannabinoids for cancer and chemotherapy symptoms and the mind-body connection, with a focus on the negative emotions patients with cancer often experience [1]. The authors note that these issues may appear unrelated, but all address one common goal: treating the body and the mind to optimize quality of life during and after cancer therapy.
Prevention and treatment of chemotherapy-induced peripheral neuropathy
Peripheral neuropathy refers to the conditions that involve damage to the peripheral nervous system, when nerves that carry messages from the brain and spinal cord to the rest of the body are damaged.
It occurs in 30% to 40% of people receiving platinums, taxanes, proteasome inhibitors, and an increasing number of drugs. The damage may continue for months after the completion of chemotherapy. About half of the people may report symptoms even 6 years after chemotherapy. The fall risk is increased in patients with this neuropathy. Exercise and the protection of the extremities wrapping them in cold may reduce or prevent the neuropathy. If it develops, the oncologist, at times in collaboration with the pain manager, neurologist or palliative care specialist will administer the appropriate medications.
Medicinal effects of cannabis
Much of our knowledge regarding the clinical effects of cannabinoids comes from case reports and retrospective observational studies. Results are controversial. Problems include issues of clinical trial approval and design. It is not known whether the use of cannabis may be related with increased cancer risk development in the upper respiratory and digestive tract. The concomitant use of cigarette smoking by many of these patients makes research difficult in this area. A study with 15 head and neck cancer patients, who had received radiotherapy, the use of medical marijuana showed a subjective reduction of dysgeusia (altered taste) and xerostomia [2]. Six of those 15 patients were also using marijuana prior to their cancer diagnosis. The authors of the study concluded that patients with head and neck cancer use marijuana to alleviate the chronic effects of radiotherapy.
The authors of the review: “Care after chemotherapy: Peripheral neuropathy, Cannabis for Symptom Control, and Mindfulness” reported that a well-designed, randomized, placebo-controlled study, in Nevada, using a guana-based syrup with a THC:CBD ratio of 2:1, to evaluate the effectiveness of the syrup on chemotherapy-related nausea and vomiting is being conducted.
Effects of mindfulness on cancer recovery
Mindfulness is the practice of fully paying attention to the present and maintaining awareness, with nonjudgment, emotional balance, and openness. Studies have shown that mindfulness practices can help individuals to cope with disability or pain and reduce stress in people with chronic health problems. Mindfulness practices in oncology improved mood, coping with pain, nausea, fatigue, and sleep disturbance. Other studies also demonstrated improvement in immune function. The authors in the review published on the “Asco Educational Book” noted that there is a continued need for rigorous, high-quality studies to investigate mechanisms, effectiveness, and implementation.
References
[1] D Teoh, Smith TJ, Song M, Spirtos NM. Care after chemotherapy: Peripheral neuropathy, Cannabis for Symptom Control, and Mindfulness. American Society of Clinical Oncology, asco.org/ebook / 2018 ASCO Educational Book, ascopubs.org.
[2] DA Elliott, N Nabavizadeh, Romer JL, Chen Y. Medical marijuana use in head and neck squamous cell carcinoma patients treated with radiotherapy. Supportive Care in Cancer 2016;24:3517-3524.
