Systematic Review Evaluates Cannabis, Cannabinoids in Palliative and Supportive Oncology Care

Medical cannabis and cannabinoid use for symptom management in oncology care has been increasingly significantly in the United States; however, evidence for the efficacy and safety of this use is ambiguous. A systematic review presented in the 2020 American Society of Clinical Oncology Virtual Scientific Program evaluated recent evidence for cannabis and cannabinoid as adjuvant therapy in palliative and supportive oncology care.

Led by investigator Sebastian Jugl, BScPharm, RPh, the research team used the most recent available evidence published from 2016 through 2019, which was inclusive of randomized controlled trials (RCTs) and observational studies evaluating multiple cancer-related outcomes through August 2016. The review excluded studies conducted outside of the United States, studies that did not evaluate cannabis or cannabinoid in oncology care, review not conducted in accordance with systemic best practices, and preclinical studies. A total of 24 studies were included in the qualitative synthesis.

Overall, utilization studies reported a range of 18.3-40.0% of patients with cancer as prevalent users of cannabis and/or cannabinoid, according to the poster.

Regarding the effect of cannabis and cannabinoid use on cancer-related adverse effects, the investigators looked at cancer-related pain, nausea and vomiting, and cancer-related anorexia/cachexia.

Of the 15 studies analyzed for cancer-related pain, data from 2 recent RCTs did not show a significant effect. However, in 1 RCT, a per protocol analyses demonstrated numerically favorable primary outcomes. Another study’s post hoc analyses indicated a statistically favorable treatment effect for Sativex, an oromucosal THC/CBD spray, in US patients older than 65 years. Two observational studies reported positive results.

One recent study supported improvement in outcomes for patients treated with cannabinoid for cancer-related nausea and vomiting; however, findings were inconclusive. Additionally, most evidence was largely inconclusive for cancer-related anorexia/cachexia.

The investigators noted that all evaluated systematic reviews were either of critically low quality or moderate quality, suggesting that “heterogeneity of findings reported for cancer-related outcomes has remained challenging to translate into clinical recommendations.”

However, no recent studies reported worse outcomes as compared with placebo or active comparator.

References:

1. Jugl S, Keshwani S, Joseph V, et al. Abstract 12091: A systematic review of evidence for cannabis and cannabinoids as adjuvant therapy in palliative and supportive oncology care. Presented at: 2020 ASCO Virtual Scientific Program; May 29-31; online. Doi: 10.1200/JCO.2020.38.15_suppl.12091