To Josephine, Davis Mellar, Sbrana Andrea, Alderman Bryony, Hui David, Mukhopadhyay Sandip, Bouleuc Carole, Case Amy A, Amano Koji, Crawford Gregory B, de Feo Giulia, Tanco Kimberson, Garsed Jessica
Division of Aged Care, Rehabilitation and Palliative Care, Northern Adelaide Local Health Network, Adelaide, Australia.
Palliative Care Department, Geisinger Medical System, Danville, USA.
Support Care Cancer. 2023 Mar 6;31(4):202. doi: 10.1007/s00520-023-07662-1.
Approximately 18% of patients with cancer use cannabis at one time as palliation or treatment for their cancer. We performed a systematic review of randomized cannabis cancer trials to establish a guideline for its use in pain and to summarize the risk of harm and adverse events when used for any indication in cancer patients.
A systematic review of randomized trials with or without meta-analysis was carried out from MEDLINE, CCTR, Embase, and PsychINFO. The search involved randomized trials of cannabis in cancer patients. The search ended on November 12, 2021. The Jadad grading system was used for grading quality. Inclusion criteria for articles were randomized trials or systematic reviews of randomized trials of cannabinoids versus either placebo or active comparator explicitly in adult patients with cancer.
Thirty-four systematic reviews and randomized trials met the eligibility criteria for cancer pain. Seven were randomized trials involving patients with cancer pain. Two trials had positive primary endpoints, which could not be reproduced in similarly designed trials. High-quality systematic reviews with meta-analyses found little evidence that cannabinoids are an effective adjuvant or analgesic to cancer pain. Seven systematic reviews and randomized trials related to harms and adverse events were included. There was inconsistent evidence about the types and levels of harm patients may experience when using cannabinoids.
The MASCC panel recommends against the use of cannabinoids as an adjuvant analgesic for cancer pain and suggests that the potential risk of harm and adverse events be carefully considered for all cancer patients, particularly with treatment with a checkpoint inhibitor.
约18%的癌症患者曾使用大麻来缓解或治疗其癌症。我们对大麻用于癌症的随机试验进行了系统综述，以制定其在疼痛治疗中的使用指南，并总结其用于癌症患者任何适应症时的危害风险和不良事件。
从MEDLINE、CCTR、Embase和PsychINFO数据库中对随机试验进行系统综述，有或没有进行荟萃分析。检索涉及大麻在癌症患者中的随机试验。检索于2021年11月12日结束。采用Jadad评分系统对质量进行评分。纳入标准为在成年癌症患者中，大麻素与安慰剂或活性对照进行对比的随机试验或随机试验的系统综述。
34项系统综述和随机试验符合癌症疼痛的纳入标准。7项为涉及癌症疼痛患者的随机试验。两项试验的主要终点呈阳性，但在类似设计的试验中无法重现。高质量的系统综述和荟萃分析发现，几乎没有证据表明大麻素对癌症疼痛是有效的辅助药物或镇痛药。纳入了7项与危害和不良事件相关的系统综述和随机试验。关于患者使用大麻素时可能经历的危害类型和程度，证据并不一致。
MASCC小组不建议将大麻素用作癌症疼痛的辅助镇痛药，并建议所有癌症患者，尤其是接受检查点抑制剂治疗的患者，应仔细考虑潜在的危害风险和不良事件。
