11 Dec Palliative care for oncology patients
The landscape of veterinary medicine is continually evolving with palliative care gaining prominence. According to the Australian Veterinary Palliative Care Advisory Council (AVPCAC), ‘Palliative care is a newly emerging field within veterinary medicine. It refers to the ideals of ensuring patient comfort, providing access to specialised end-stage healthcare and supporting caregivers through the difficulties of end-of-life decision-making. When curative treatment is not always possible or considered to be in the patient’s best interests, palliative care provides a formalised avenue for comfort-focused care and invites us all to participate in more effective end-of-life communication with clients in an attempt to reduce or relieve suffering.’
In parallel, the use of cannabidiol (CBD) is emerging as a potential solution for palliative care, especially for oncology patients. Medicinal cannabis, already utilised in human palliative care, is gaining the attention of pet parents seeking alternatives for their ailing pets. With an increasing number of inquiries from pet owners, it’s essential that veterinarians equip themselves with appropriate responses to address this topic.
CBD holds substantial promise for cancer, palliative and hospice patients primarily through effective symptom management, specifically addressing pain, discomfort and side effects of treatments.
The International Association for Animal Hospice and Palliative Care defines palliative care as ‘the active total care of patients with a life-limiting illness,’ emphasising the goal to achieve ‘best quality of life for patients and their families. Palliative care can go on as long as it is needed, for months and even for years.’ While the distinction between hospice and palliative care is not as clearly defined for animals, it describes the management of palliative patients in the last phases of incurable disease.
As emphasised already, palliative care’s ultimate goal is to enhance the quality of life and comfort for patients, addressing physical pain and emotional distress. When incorporated into an oncology patient’s management, CBD should be thought of as palliative and not curative despite the emerging anticancer properties being discovered. The majority of research to date reports an increase of CB1 and CB2 receptors in different cancer types. The main beneficial effects of cannabinoids (endogenous or exogenous) against tumour cells is through receptor agonists which appear to promote apoptotic cell death in certain cancer cells.
While more research and studies are conducted around the anticancer properties of CBD the potential is promising. Our current understanding and possible anticancer mechanisms of CBD include:
- Anti-proliferative – slowing down various cancers
- Pro-apoptosis – assisting in programmed cell death
- Anti-metastatic – preventing spread
- Anti-angiogenic – blocking development of new blood vessels to tumour cells.
Research continues in both human and animal health, but cannabis medicine certainly promises to be an effective anti-cancer agent selectively killing cancer cells and protecting the health of others.
For the meanwhile however, the real focus and benefits of using CBD are in symptom management and overall improved quality of life through:
- Reducing pain and inflammation: CBD interacts with the endocannabinoid system and other receptors, regulating physiological processes that mitigate pain and inflammation. CBD’s ability to modulate the inflammatory response through CB2 receptors and decrease the release of excitatory neurotransmitters through CB1 receptor activation is noteworthy.
- Alleviating anxiousness and stress: CBD’s interaction with the endocannabinoid system, serotonin and dopamine receptors can contribute to anxiety reduction. Specific terpenes, such as limonene and linalool, are known for their anxiolytic properties, and may further enhance CBD’s effectiveness.
- Improving appetite and minimising nausea: CBD’s potential to alleviate nausea and improve poor appetite makes it an essential consideration for palliative and hospice patients who require a steady nutrient-rich diet. The cannabinoid receptors in the hypothalamus play a crucial role in triggering the brain’s motivational or reward-based aspect of eating.
- Assisting sleep: CBD can aid in managing canine cognitive decline and the associated disrupted sleep-wake cycle. CBD is a potent antioxidant and neuroprotectant and is understood to aid in free radical scavenging. CBD’s ability to reduce pain and anxiety helps with promoting better sleep and contributing to overall wellbeing for the palliative patient.
In the realm of palliative care, CBD offers a valuable adjunct to conventional treatments, particularly in managing side effects and improving the overall wellbeing of the patient. It has the potential to reduce the reliance on polypharmacy, alleviate client confusion, and combat patient refusal. It may be a final option when other treatment options have reached their limits or when cost or time constraints make euthanasia seem the only alternative.
Open conversations with clients about CBD use are crucial, emphasising that it is legal only through veterinary prescription. Discouraging obtaining CBD from unauthorised sources is important, considering the potential risks associated with THC, additives like xylitol and other contaminants.
CBD, with its few to minimal side effects, presents a compassionate option for end-of-life care. While not curative, it provides a means to control symptoms such as pain, nausea, anorexia and anxiety. When faced with the perception that there is nothing more that can be done, CBD may indeed be the answer.