Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland, Australia.
Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, 27 Rainforest Walk, Clayton, Victoria, Australia.
Maturitas. 2024 Jun;184:107941. doi: 10.1016/j.maturitas.2024.107941. Epub 2024 Feb 15.
Medicinal cannabis might have a role in supporting the mental health of people with cancer. This systematic review and meta-analysis examined the efficacy and safety of medicinal cannabis, compared with any control, as an intervention for depression, anxiety, and stress symptoms in people living with cancer. A secondary aim was to examine the effect of low versus high Δ-tetrahydrocannabinol (THC) dose on these outcomes.
Five databases were systematically searched, and complemented with a snowball search from inception to May 2023, for any type of interventional study that included humans of any age with any cancer type. Primary outcomes were incidence and severity of depression, anxiety, and stress symptoms. Secondary outcomes were mood, cognition, quality of life, appetite, nutrition status, gastrointestinal symptoms, and adverse events. Data were pooled using Review Manager. Evidence was appraised using Cochrane risk of bias tools. Confidence in the estimated effect of pooled outcomes was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE).
Fifteen studies (n = 11 randomized trials, n = 4 non-randomized trials) of 18 interventions (N = 1898 total participants; 100 % ≥18 years of age) were included. Ten studies examined THC (70 % synthetic), two synthetic cannabidiol with or without THC, and six whole-plant extracts. No clinically significant effects of medicinal cannabis were found on primary outcomes. The likelihood of anxiety events increased with higher-dose synthetic THC compared with a lower dose (OR: 2.0; 95 % CI: 1.4, 2.9; p < 0.001; Confidence: very low). Medicinal cannabis (THC, cannabidiol, and whole-plant extract) increased the likelihood of improved appetite (OR: 12.3; 95 % CI: 3.5, 45.5; p < 0.001; n = 3 interventions; Confidence: moderate) and reduced severity of appetite loss (SMD: -0.4; 95 % CI: -0.8, -0.1; p = 0.009; Confidence: very low). There was very low confidence that higher doses of synthetic THC increased the likelihood of any adverse event (OR: 0.5; 95 % CI: 0.3, 0.7; p < 0.001). Medicinal cannabis had no effect on emotional functioning, mood changes, confusion, disorientation, quality of life, and gastrointestinal symptoms. Confidence in findings was limited by some studies having high or unclear risk of bias and imprecise pooled estimates.
There was insufficient evidence to determine the efficacy and safety of medicinal cannabis as a therapeutic intervention for depression, anxiety, or stress in people with active cancer. Further research should explore whether medicinal cannabis might improve and maintain appetite and if high-dose synthetic THC might increase the incidence of side-effects, including anxiety. To inform clinical practice, well-powered and rigorously designed trials are warranted that evaluate the effects of medicinal cannabis prescribed to target anxiety, depression, and stress.
药用大麻可能在支持癌症患者的心理健康方面发挥作用。本系统评价和荟萃分析检查了药用大麻的疗效和安全性，与任何对照相比，作为治疗癌症患者抑郁、焦虑和压力症状的干预措施。次要目的是检查低与高 Δ-四氢大麻酚 (THC) 剂量对这些结果的影响。
从五个数据库系统地搜索，并从开始到 2023 年 5 月进行了雪球搜索，以查找任何类型的干预性研究，包括任何年龄和任何癌症类型的人类。主要结果是抑郁、焦虑和压力症状的发生率和严重程度。次要结果是情绪、认知、生活质量、食欲、营养状况、胃肠道症状和不良事件。使用 Review Manager 汇总数据。使用 Cochrane 偏倚风险工具评估证据。使用 Grading of Recommendations, Assessment, Development and Evaluation (GRADE) 评估对汇总结果的估计效果的信心。
纳入了 15 项研究（n=11 项随机试验，n=4 项非随机试验）共 18 项干预措施（N=1898 名总参与者；100%≥18 岁）。10 项研究检查了 THC（70%合成）、两种合成大麻素与或不与 THC 联合使用，以及 6 种全植物提取物。药用大麻对主要结局没有发现有临床意义的影响。与低剂量合成 THC 相比，高剂量合成 THC 增加了焦虑事件的可能性（OR：2.0；95%CI：1.4，2.9；p<0.001；置信度：极低）。药用大麻（THC、大麻二酚和全植物提取物）增加了食欲改善的可能性（OR：12.3；95%CI：3.5，45.5；p<0.001；n=3 种干预措施；置信度：中度）和减少食欲丧失的严重程度（SMD：-0.4；95%CI：-0.8，-0.1；p=0.009；置信度：极低）。非常低的置信度表明，较高剂量的合成 THC 增加了任何不良事件的可能性（OR：0.5；95%CI：0.3，0.7；p<0.001）。药用大麻对情绪功能、情绪变化、认知障碍、定向障碍、生活质量和胃肠道症状没有影响。研究结果的置信度受到一些研究存在高或不明确偏倚风险和汇总估计不精确的限制。
目前尚无足够证据确定药用大麻作为治疗癌症患者抑郁、焦虑或压力的治疗干预措施的疗效和安全性。进一步的研究应该探索药用大麻是否可以改善和维持食欲，以及高剂量合成 THC 是否会增加焦虑等副作用的发生率。为了为临床实践提供信息，需要进行有足够效力和严格设计的试验，以评估针对焦虑、抑郁和压力而开具的药用大麻的效果。
