Dronabinol for the Treatment of Paraneoplastic Night Sweats in Cancer Patients: A Report of Five Cases.

Background: Night sweats significantly impact the quality of life for cancer patients and are often resistant to treatment. Cannabinoids have been shown to modulate cytokine activity and produce hypothermia in animal models, suggesting that they may be a promising candidate for palliation of night sweats in patients with oncologic disease. Objective: Assess efficacy of the oral cannabinoid, dronabinol, for palliation of night sweats in cancer patients. Design: A retrospective record search identified five cancer patients who had tried oral dronabinol for palliation of their night sweats between 2013 and 2016 and subjectively reported on its efficacy. Setting/Subjects: A convenience sample of five patients from the outpatient consultative palliative medicine program at Stanford Medical Center was chosen from a search of past records. Patients were included if they had a cancer diagnosis and complained of night sweats that subjectively interfered with their quality of life. All agreed to try oral dronabinol for palliation of their night sweats. Measurements: Patients self-reported the effect of oral synthetic dronabinol on their night sweats. Results: Treatment of five patients with advanced cancer with synthetic orally administered dronabinol resulted in the successful management of persistent symptomatic paraneoplastic night sweats. Conclusion: Dronabinol and/or medicinal cannabis are promising therapies for palliation of night sweats in cancer patients.

Malignancy in the setting of the anti-synthetase syndrome.

Malignancy and interstitial lung disease (ILD) are 2 conditions associated with dermatomyositis (DM) that are responsible for a significant portion of the morbidity and mortality related to this disease; however, they rarely occur in the same patient. The antisynthetase syndrome consists of several characteristics, including ILD, arthritis, Raynaud phenomenon, "mechanic's hands," and positive antibodies to tRNA synthetases, which have each been negatively associated with cancer. When patients with DM present with such characteristics, clinicians may be falsely reassured that a thorough malignancy screen is unnecessary. We describe a patient who presented with the antisynthetase syndrome and was subsequently found to have colon cancer. Removal of the cancer led to resolution of the myositis and lung disease, but the patient's rash and arthritis persisted and ultimately required immunosuppressive therapy. We provide a review of the literature describing the concurrence of both this syndrome and ILD alone, with malignancy. We conclude that a thorough and expedited age-appropriate malignancy work up is indicated in all patients with a new diagnosis of DM, despite the presence of disease characteristics that are usually not associated with cancer.

Involving communities in community assessment.

Focus groups provide an effective means of incorporating the perspectives of "hidden" populations in assessments of community health needs and assets. A series of focus groups was conducted with specifically targeted segments of a community to develop a comprehensive picture of community health. The authors describe the focus group process, major findings, and the use of focus group results in a highly multicultural community. Despite differences in age, length of residence, and ethnicity, the focus groups were remarkably similar in the issues raised. The majority of participants viewed the multicultural nature of the community as an asset but voiced some of the difficulties of living in a multiethnic and multilanguage environment. Similar areas of concern in the community arose from all of the focus groups, including housing and other environmental issues and problems of access to health care. Focus group findings have been used to initiate activity addressing identified community problems. Focus group participation had the added benefit of increasing community members' participation in other community endeavors.