IMPACCT Centre (Improving Palliative, Chronic and Aged Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, NSW, Australia.
South West Sydney Clinical School, University of New South Wales (UNSW), NSW, Australia.
Br J Clin Pharmacol. 2018 Nov;84(11):2491-2494. doi: 10.1111/bcp.13671. Epub 2018 Aug 12.
The treatment of symptoms in people with palliative diagnoses begins with meticulous clinical assessment with treatment choice(s) selected based on an understanding of the symptom aetiology and the evidence which underpins its treatment. Increasingly, the merits of palliative care have been established earlier in the disease trajectory where treatment outcomes may include increased survival and maintenance of function. There is strong public support for the availability of medicinal cannabis, particularly for people with palliative diagnoses. There are several areas where there is potential for symptom benefits through modulation of the endocannabinoid system, though clinical data to date has been inconclusive in key symptoms such as pain and nausea, and data from other settings such as chemotherapy-induced nausea and vomiting not readily extrapolated. Ideally exploration of medicinal cannabinoids should occur within a clinical trial to accelerate the evidence base to inform practice. In people with refractory symptoms, the consideration of unregistered products or off-label prescribing should be guided by the potential influences of pharmacokinetic, pharmacodynamic and drug-drug interactions, supported by an informed discussion with the patient, and regular review of net clinical benefit.
对于姑息诊断患者的症状治疗，首先要进行细致的临床评估，并根据对症状病因的了解以及治疗依据的证据来选择治疗方法。姑息治疗的益处越来越多地在疾病进程的早期得到确立，治疗结果可能包括延长生存时间和维持功能。公众强烈支持提供医用大麻，特别是对于姑息诊断患者。通过调节内源性大麻素系统，有几个领域可能对症状有好处，尽管迄今为止，在疼痛和恶心等关键症状方面的临床数据尚无定论，而且来自其他环境（如化疗引起的恶心和呕吐）的数据也不容易推断。理想情况下，医用大麻素的探索应该在临床试验中进行，以加速证据基础，为实践提供信息。对于难治性症状患者，应根据药代动力学、药效学和药物相互作用的潜在影响，在与患者进行知情讨论的基础上，并定期评估净临床获益，来考虑未注册产品或超说明书用药。
