World Cancer Day 2021
Dr. Paul Daeninck MD MSc FRCPC
I am honoured to be asked to write this guest post in recognition of World Cancer Day 2021 for the CAPT blog. Being a medical oncologist and palliative medicine consultant for close to 25 years has provided me with a number of memorable encounters with wonderful people with cancer diagnoses. My goal is always to ensure the best care possible, no matter the type of cancer or the prognosis.
The treatment of cancer and its symptoms has evolved greatly over the years I have been in practice. Cancer medicine is more precise in its diagnosis and treatment, resulting in better overall survival since my training in the 1990s. I recall from that time the frustrating feeling having to tell patients and their families that we did not have much (or any) treatment to offer. That frustration led me to seek out more information and training in palliative and supportive care measures in order to incorporate these principles in my delivery of care to people who have cancer. I no longer tell patients there are no options, because cancer care doesn’t stop when the chemotherapy or immunotherapy is no longer effective. And there is always something I can offer them, from medications to reduce the pain to being quietly present and holding their hand.
Quality of life and preservation of function are key for people with cancer. To achieve their individual goals, people will endure long stretches of pain, nausea, anxiety and fatigue due directly to the cancer. Our treatments (chemotherapy, surgery and radiation), provided with the intent to cure or control malignancy, can also contribute to poor quality of life. Faced with these challenges, patients and their families often seek out alternatives to mainstream medical therapies to try to gain some control over what may become a chaotic situation. An abundance of treatments, therapies, concoctions, and compounds are available either by word of mouth or now through access to the internet and social media. While most have yet to show proven benefit, some options have become complementary and improve our patients’ cancer experience.
Over the past two decades, I have helped increase awareness of medical cannabinoids (products isolated from the Cannabis plant) by educating the public and medical professionals. Although these compounds were used medicinally by ancient cultures (Chinese and Indian pharmacopeia dating back to 3000 BCE describe routine use of cannabis), they have only emerged as useful supportive measures for the past few decades. The stigma of using “medical marijuana” and its legal restrictions prevented its widespread use in most Western countries. Researchers like Dr. Donald Abrams from University of California San Francisco have been advocating for studies utilizing cannabinoids since the 1980s, fighting legislation, poor funding and institutional ignorance.
We now know through the persistence of researchers, clinicians and advocates that cannabinoid-based medicine (CBM) can be utilized to reduce the nausea and vomiting associated with chemotherapy and radiation. It can help treat pain, and for many patients, reduce their need for other pain medications such as opioids that result in distressing side effects. CBM can help patients obtain that rejuvenating sleep they need to give them the strength to deal with another day of cancer. People using cannabis products once again have an appetite and enjoy the taste of food. Discoveries in the lab with cancer cells and animal models are now translating into preliminary clinical trials that hold the hope of potentiating cancer therapies and reducing side effects. Imagine, we may soon be using cannabis and CBM to aid in the treatment of cancer!
Our clinic team at CancerCare Manitoba is fortunate to participate in a newly opened multi-centre clinical trial under the leadership of Dr Pippa Hawley at the BC Cancer Agency. The study will examine the benefits of cannabis extracts on specific symptoms caused by cancer or its treatment. These include pain, nausea, insomnia and anxiety. Our hope is this study will provide more evidence to support the routine use of such products in patients, at doses that do not cause ill effects and improve their quality of life.
One of my greatest pleasures is seeing the changes patients experience following their use of CBM. Our clinic team will guide patients and families through the process of obtaining cannabis products from Health Canada-approved medical suppliers and work with them to find the effective dose. Many patients feel empowered to take other steps to improve their cancer experience such as dietary changes or increasing physical activity. This also extends to cancer survivors who find benefit in the use of CBM to reduce the physical effects of cancer and its treatment as they return to their lives, albeit in a new normal state.
Instilling hope for people with cancer is essential for them to help confront this often devastating diagnosis. Knowing that we have effective options for treatment and supportive measures such as cannabinoid-based medicines can mean the difference between a poor experience versus a better quality of life for people with cancer.
Dr. Paul Daeninck is a medical oncologist and palliative medicine consultant working with CancerCare Manitoba and the Winnipeg Region Palliative Care Program. He is an Assistant Professor in the Department of Medicine at the Rady College of Medicine, University of Manitoba.
He has served with several Canadian organizations, including the Canadian Partnership Against Cancer, the Canadian Society of Palliative Care Physicians, and the Canadian Consortium for the Investigation of Cannabinoids (CCIC). He currently is Co-Chair of the Examination Committee, Palliative Medicine Sub-specialty of the Royal College of Physicians and Surgeons of Canada.
Dr. Daeninck has authored or co-authored several research papers and textbook chapters. He serves as a reviewer for Canadian granting agencies and several medical journals. He is actively involved in education of medical professionals, including medical students and physician assistants. He has ongoing research interests in several aspects of palliative medicine.
His interest in the clinical use of cannabinoids goes back to 2000, when he joined the CCIC and began working with others having a similar interest. He has taught many health care professionals locally and nationally about cannabinoids, and has regularly presented at the annual Cannabinoids in Clinical Practice symposium, as well as numerous local, national and international conferences.
On a personal note, he is married and has 2 children. He enjoys traveling with his family, cycling, and reading biographies and history. He has a passion for watch collecting, and would be happy to share his enthusiasm, if you have the time…