Department of Palliative Care, Frimley Park Hospital, Frimley, UK.
Phyllis Tuckwell Hospice Care, Farnham, UK.
Support Care Cancer. 2022 Dec 16;31(1):39. doi: 10.1007/s00520-022-07480-x.
Gastrointestinal symptoms are common in patients with cancer, whether related to treatment or a direct effect of the disease itself. Patients may choose to access cannabinoids outside of their formal medical prescriptions to palliate such symptoms. However, clinical guidelines are lacking in relation to the use of such medicines for gastrointestinal symptoms in patients with cancer.
A systematic review of the evidence for the use of cannabinoids for symptom control in patients with cancer was undertaken. Search strategies were developed for Medline, Embase, PsychINFO, and the Cochrane Central Register of Controlled Trials, including all publications from 1975 up to 12 November 2021. Studies were included if they were randomized controlled trials of cannabinoids compared with placebo or active comparator in adult patients with cancer, regardless of type, stage, or treatment status. Articles for inclusion were agreed by all authors, and data extracted and summarized by two authors. Each study was scored according to the Jadad scale. This review was specifically for the purpose of developing guidelines for the use of cannabis for gastrointestinal symptoms, including chemotherapy-induced nausea and vomiting (CINV), chronic nausea, anorexia-cachexia syndrome, and taste disturbance.
Thirty-six randomized controlled trials were identified that met the inclusion criteria for this review of gastrointestinal symptoms: 31 relating to CINV, one to radiotherapy-induced nausea and vomiting, and the remaining four to anorexia-cachexia and altered chemosensory disturbance. The populations for the randomized controlled trials were heterogeneous, and many studies were of poor quality, lacking clarity regarding method of randomization, blinding, and allocation concealment. For CINV, eleven RCTs showed improvement with cannabis compared to placebo, but out of 21 trials where cannabis was compared to other antiemetics for CINV, only 11 favoured cannabis.
Tetrahydrocannabinol (THC) and nabilone were more effective in preventing CINV when compared to placebo but are not more effective than other antiemetics. For refractory CINV, one study of THC:CBD demonstrated reduced nausea as an add-on treatment to guideline-consistent antiemetic therapy without olanzapine. The MASCC Guideline Committee found insufficient evidence to recommend cannabinoids for the management of CINV, nausea from advanced cancer, cancer-associated anorexia-cachexia, and taste disturbance. High-quality studies are needed to inform practice.
胃肠道症状在癌症患者中很常见，无论是与治疗相关还是疾病本身的直接影响。患者可能会选择在正式的医疗处方之外使用大麻素来缓解这些症状。然而，目前缺乏针对癌症患者胃肠道症状使用此类药物的临床指南。
我们对大麻素用于癌症患者症状控制的证据进行了系统评价。为 Medline、Embase、PsychINFO 和 Cochrane 对照试验中心注册库制定了搜索策略，包括从 1975 年到 2021 年 11 月 12 日的所有出版物。如果是随机对照试验，比较了大麻素与安慰剂或活性对照剂在成年癌症患者中的应用，无论癌症类型、阶段或治疗状态如何，均纳入研究。所有作者均同意纳入的文章，并由两名作者提取和总结数据。根据 Jadad 量表对每项研究进行评分。本综述专门用于制定大麻用于胃肠道症状（包括化疗引起的恶心和呕吐 [CINV]、慢性恶心、厌食-恶病质综合征和味觉障碍）的使用指南。
确定了 36 项符合本胃肠道症状综述纳入标准的随机对照试验：31 项与 CINV 相关，1 项与放疗引起的恶心和呕吐相关，其余 4 项与厌食-恶病质和化学感觉障碍相关。随机对照试验的人群存在异质性，许多研究质量较差，在随机分组、盲法和分配隐藏方法方面缺乏清晰度。对于 CINV，11 项 RCT 显示大麻素与安慰剂相比有所改善，但在 21 项比较大麻素与 CINV 其他止吐药的试验中，只有 11 项试验支持大麻素。
四氢大麻酚（THC）和纳布隆在预防 CINV 方面比安慰剂更有效，但并不比其他止吐药更有效。对于难治性 CINV，一项 THC:CBD 的研究表明，作为指南一致的止吐治疗的附加治疗，添加 THC:CBD 可减少恶心，而无需添加奥氮平。MASCC 指南委员会发现没有足够的证据推荐大麻素用于 CINV、晚期癌症引起的恶心、癌症相关厌食-恶病质和味觉障碍的管理。需要高质量的研究来为实践提供信息。
