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From Science to Practice: Managing CINV and Pain in Breast Cancer Patients

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Release Date: July 9, 2007.
Termination Date: July 9, 2008.

Estimated time for completion of this activity: 1 hour

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This independent CME activity is supported by an educational grant from
Valeant Pharmaceuticals
North America


William J. Gradishar, MD, FACP Director,
Breast Medical Oncology
Northwestern University
Feinberg School of Medicine
Robert H. Lurie Comprehensive
Cancer Center
Chicago, Illinois
Kristen Fessele, RN, MSN, AOCN
Associate Director, Human
   Research Services
The Cancer Institute of
   New Jersey
New Brunswick, New Jersey
Judith A. Luce, MD
Clinical Professor of Medicine
University of California,
   San Francisco
San Francisco General Hospital
   Department of Medicine
San Francisco, California
Vincent Maida, MD
Assistant Professor
University of Toronto
Division of Palliative Medicine
William Osler Health Centre
Toronto, Ontario, Canada

This CME/CE activity has reached its termination date and no longer offers continuing education credit. Please note that expired CME/CE activities may not contain the most up-to-date information available.

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Looking at Breakthrough Nausea/Vomiting and Cancer-Related Pain: The Cannabinoid Experience

This presentation examines the prevalence of chemotherapy-induced nausea and vomiting (CINV) and pain in breast cancer patients, the impact of these events on refusal/delay of chemotherapy, and specific problems in managing acute, delayed, and breakthrough CINV. Discussion of treatment options encompasses current and novel products for managing CINV and pain, including neuromodulation/cannabinoids.
—Vincent Maida, MD

Case Study #1: Breakthrough CINV with Anthracycline-Based Therapy
A patient receiving anthracycline-based chemotherapy for early-stage breast cancer is experiencing delayed CINV that significantly impacts her quality of life. High-risk features of this case and the use of cannabinoids for delayed CINV are discussed.
–William J. Gradishar, MD, FACP

Case Study #2: Anticipatory CINV and Opioid-Refractory Pain
A patient receiving chemotherapy for acute metastatic breast cancer has cancer pain refractory to three-tiered-approach pain therapy, including opioids. Both pain management and chemotherapy are contributing to nausea and vomiting, and the combination of these with her pain has caused her to become despondent. Bone pain and the anorexigenic effects of opioids, as well as treatment strategies for this patient, are highlighted.
–Judith A. Luce, MD

Case Study #3: Noncompliance as a Result of CINV and Pain
A stable metastatic breast cancer patient has become less compliant with chemotherapy as a result of the disruptive effect of CINV on her daily activities. She is also troubled by opioid-induced sedation that interferes with her ability to care for her child. This case explores the impact of poor compliance on outcomes, the problems of opioid-induced nausea/vomiting and sedation, and the use of cannabinoids to reduce opioid dosing.
–Kristen Fessele, RN, MSN, AOCN



This CME activity is designed for clinicians involved in the treatment of breast cancer patients.


The goal of this activity is to provide clinicians involved in the treatment of breast cancer patients with state-of-the-science information on the management of CINV and pain.


  • By evaluating the mechanisms of action of adjuvant antiemetics and other emerging agents, employ overall management strategies for specific patients requiring antiemetic therapy in the management of CINV to improve compliance with therapy.

  • Evaluate the data suggesting a potential role of adjuvant cannabinoids in the future in relieving pain in breast cancer patients with difficult-to-control symptoms to improve patient quality of life.



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Projects In Knowledge is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

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Projects In Knowledge designates this educational activity for a maximum of 1.0 AMA PRA Category 1 CreditTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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The Disclosure Policy of Projects In Knowledge requires that presenters comply with the Standards for Commercial Support. All faculty are required to disclose any personal interest or relationship they or their spouse/partner have with the supporters of this activity or any commercial interest that is discussed in their presentation. Any discussions of unlabeled/unapproved uses of drugs or devices will also be disclosed in the course materials.

For complete prescribing information on the products discussed during this CME activity, please see your current Physicians' Desk Reference (PDR) .

Kristen Fessele, RN, MSN, AOCN, has an ownership interest in Genomic Health. Ms. Fessele has disclosed that she will be discussing unlabeled/unapproved uses of cannabidiol/THC, nabilone, and dronabinole in this activity.

William J. Gradishar, MD, FACP, has no significant relationships to disclose. Dr. Gradishar has disclosed that he will be discussing unlabeled/unapproved uses of cannabinoids in this activity.

Judith A. Luce, MD, has no significant relationships to disclose. Dr. Luce has disclosed that she will be discussing unlabeled/unapproved uses of cannabidiol/THC in this activity.

Vincent Maida, MD, has received grant/research support from STN and Valeant Pharmaceuticals North America; is a consultant for Valeant Pharmaceuticals North America; is on the speakers bureau for Bayer Pharmaceuticals Corporation, Purdue Pharma LP, Solvay Pharmaceuticals, Inc, and Valeant Pharmaceuticals North America; and is on the advisory board of Solvay Pharmaceuticals, Inc, and Valeant Pharmaceuticals North America. Dr. Maida has disclosed that he will be discussing unlabeled/unapproved uses of nabilone, dronabinol, levonatrodol, and cannabidiol/THC in this activity.

Peer Reviewer has no significant relationships to disclose.

Projects In Knowledge's staff members have no significant relationships to disclose.

Conflicts of interest are thoroughly vetted by the Executive Committee of Projects In Knowledge. All conflicts are resolved prior to the beginning of the activity by the Trust In Knowledge peer review process.

The opinions expressed in this activity are those of the faculty and do not necessarily reflect those of Projects In Knowledge.

This CME activity is provided by Projects In Knowledge solely as an educational service. Specific patient care decisions are the responsibility of the clinician caring for the patient.

This independent CME activity is supported by an educational grant from

Valeant Pharmaceuticals
North America.





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