Indications of Cannabinoids for the Palliation of Cancer-Associated Symptoms: A Systematic Review and Meta-Analysis.

PURPOSE OF THE REVIEW

As cancer survival rates are increasing, alternative treatments to improve quality of life, such as cannabinoids, are gaining attention. Although cannabinoids are widely used to manage cancer-related symptoms, clear guidelines are lacking. This systematic review and meta-analysis assessed the safety and efficacy of cannabinoids in the management of symptoms among cancer patients. The study protocol was registered on PROSPERO (CRD42023479375). A systematic search was conducted using three main databases (PubMed, Embase, and CENTRAL) on 4 November 2023. We included interventional and observational studies that evaluated cannabinoids for symptom management in cancer patients compared to standard care, placebo, or baseline values. Pooled mean differences (MD), proportions and odds ratios (OR), and the 95% confidence intervals (CI) were calculated with a random-effects model.

RECENT FINDINGS

Overall, 98 articles were eligible. Cannabinoids reduced pain (MRAW: -1.22, CI: -1.92; -0.52) and anxiety (MRAW: -1.30, CI: -2.22; -0.39) as compared to baseline values. Appetite (MRAW: -1.88, CI: -6.23; 2.46), chemotherapy-induced nausea and vomiting (OR: 2.18, CI: 0.79; 6.00), as well as insomnia (MD: -1.08, CI: -2.48; 0.33) presented with a tendency toward improvement. Cannabinoids do not influence constipation, depression, fatigue, mobility or overall quality of life. In terms of safety issues, THC-predominant formulations increase the risks of psychiatric (OR: 10.62, CI: 1.35; 83.57), neurological (OR:2.24, CI: 1.15; 4.35), and gastrointestinal (OR:2.69, CI:0.73;9.90) side effects. The risk of bias of articles included varied from some concerns to high. Cannabinoids may be beneficial for the treatment of cancer-related pain and anxiety; however, their use carries a significant risk of adverse effects, particularly psychiatric complications. Careful patient selection is essential when considering cannabinoid-based treatments.