Abstract
Letters to the Editor
Development of the Promoting Resilience in Stress Management intervention as a disease-agnostic early palliative care intervention to build resilience resources among adolescents and young adults with serious illness and/or parents of children with serious illness. (page 1178)
Brief Reports
Study measuring inpatient admissions, emergency department use, and intensive care admissions to evaluate the association between the number of chronic conditions and hospital utilization at the end of life. (page 1260)
Fast Facts and Concepts
Voluntary Stopping of Eating and Drinking in the Terminally Ill #379 (page 1281)
Personal Reflection
I have heard people say that the “Mr. X's” of the world are imprisoned for some treacherous and unspeakable crime. These words are sometimes mentioned in an effort to suggest that the suffering Mr. X and others like him is less or nonimportant. The truth is that I'll never know why Mr. X was incarcerated, nor do I want to. (page 1285)
Case Discussions in Palliative Medicine
Palliative use of dexmedetomidine in 14-year old with a history of complex congenital heart disease in end-stage heart failure and difficulties related to the use of this medication during the course of her care. (page 1289)
Book and Media Reviews
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Recent Literature
(page 1294)
Benefits of Tetrahydrocannabinol versus Cannabidiol for Common Symptoms
David Casarett and colleagues compared patients' use of tetrahydrocannabinol (THC) and cannabidiol to their self-rated efficacy for common palliative care symptoms through an electronic record-based retrospective cohort study. Their preliminary results offer a unique view of real-world medical cannabis use, and identify several areas for future research. (page 1180)
National Survey of Hospices on Medical Cannabis Practices
A national online survey of 310 hospice professionals found overwhelming support for medical cannabis use in the hospice setting. The survey findings highlight important opportunities to support hospice providers and their patients through education and the development of policies around medical cannabis. (page 1208)
Cannabis Use in Pediatric Hospice
In a survey, researchers learned cannabis oil is widely used by children enrolled in hospice in the United Kingdom. They outline the need for clear guidelines on cannabis use for symptom management along with safe storage, administration, and monitoring. (page 1185)
Patterns of Use at a Cannabis Dispensary
The authors analyzed data from a medical cannabis licensee in New York State serving almost 12,000 people. Their patients with cancer (16%) were older and more likely to be female. The most common qualifying symptom for all patients was severe or chronic pain. Cancer patients were more likely to use the sublingual tincture of cannabis, whereas noncancer patients were more likely to use the vaporization form. Over time, across all patients there was an increase in THC daily dose by a factor of 0.20 mg per week. (page 1196)
Crossing State Lines: The Challenges of Access to Cannabis
This case report describes a six-year-old child with intractable seizures and severe neuropathic pain managed on medical marijuana (MM) in her home state of Colorado, where MM is medically legal. She traveled across state lines to access surgical care in Nebraska where MM is prohibited. This report describes the unique complexities of shared symptom management goals within state-specific care models. (page 1232)
Cannabis Hyperemesis Syndrome in Palliative Care
The author presents a case of cannabis hyperemesis syndrome in a person with advanced amyotrophic lateral sclerosis as well as a narrative synthesis of current literature on assessment and management to illustrate special considerations for palliative care patients. (page 1227)
Relationship of Cannabis Use with Patient-Reported Symptoms
Researchers describe their retrospective review of objectively measured THC and subjectively reported cannabis use, its demographic and clinical correlates, and patient-reported symptoms in 816 cancer patients in active treatment referred to a palliative care outpatient clinic. (page 1191)
Cannabis Use at a Rural Academic Palliative Care Clinic
A retrospective chart review of ∼300 patients at a rural palliative care clinic found a significant minority of patients (27%) used cannabis for a variety of symptoms. The authors argue for more detailed information about formulation use, methods of ingestion, perceived efficacy, side effects, cost, and standardization of clinical practices. (page 1224)
Marijuana for Glioma Patients
At a major cancer center in Florida, patients with malignant glioma reported considering the use of MM, and a third of them used MM products after their diagnosis. Most received recommendations from friends and family rather than a medical provider, and only half of users had obtained a physician's recommendation. Patients generally reported benefits from MM. (page 1202)
Dronabinol for Night Sweats
The authors present five patients with advanced cancer who were treated successfully with dronabinol for management of persistent symptomatic paraneoplastic night sweats. (page 1221)