Cannabis and cannabinoid products may have potential as an adjuvant therapy for some adult patients with cancer; however, their role in the management of cancer-related symptoms remains unclear. These findings were presented in a poster at the 47th Annual Oncology Nursing Society (ONS) Congress.
Patients with cancer experience a range of symptoms related to their disease and the effects of chemotherapy and radiotherapy. Therefore, Amber Nenner, BSN, RN; Felita Salim, BSN, RN, OCN; and Ryan Sandler, MS, RN, of Columbia University School of Nursing in New York, New York, sought to explore the safety, efficacy, and implications of cannabis for symptom management of patients with cancer. Specifically, they sought to discover the effects of cannabis on pain, anorexia, nausea/vomiting, anxiety, and quality of life, explained Nenner during her presentation.
The literature review consisted of a search of Pubmed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Embase databases using search terms such as cancer, marijuana, cannabis, oncology, and others. Inclusion criteria were studies conducted within the last 5 years, conducted outside the United States, and published in English. Exclusion criteria were participants who had preexisting chronic pain, were younger than 18 years, and had noncancer pain.
A total of 8 studies were included in the review. Some of the studies evaluated tetrahydrocannabinol (THC), which produces the psychological effects of cannabis, some evaluated CBD (cannabidiol), which produces the physiological effects, and some evaluated both. Their findings were a mix of support for cannabis use and cautions regarding its effects on patients.
Cannabis alone was not found to provide sufficient pain relief; however, in conjunction with opioid therapy, some patients achieved greater pain relief than with opioid therapy alone.
Chemotherapy-induced nausea and vomiting (CINV), anorexia, and cachexia were improved in patients using cannabis. Use of rescue medications for CINV were reduced in patients who used THC:CBD products. Patients who used these products also experienced weight gain and improved appetite.
Cannabinoid receptors had a wide range of effects on patients who used the products. Its combination of control of symptoms such as depression, anxiety, sleep, and appetite are contributed to improved quality of life.
Adverse effects reported included dizziness, somnolence, disorientation, gastointestinal disturbances, hallucinations, and altered functional status. These symptoms often led to high attrition in studies.
“Although these studies were promising at first, there were many limitations such as high attrition, no uniform dosing strategies, high variability of cannabis products, and a high likelihood of possible confounders with other therapies,” explained Nenner. Nevertheless, medical marijuana is a potential therapy for some patients, as it can alleviate symptom burden in combination with standard therapies.
Another drawback may be the variability in the current state of legalization of these products. “Providers can take an active role in caring for patients with cancer by identifying patients who may benefit from medical marijuana based on current conditions, symptomology, and efficacy of previous therapeutics,” the researchers wrote.
Read more of Oncology Nurse Advisor‘s coverage of the 47th Annual ONS Congress by visiting the conference page.
Nenner A, Salim F, Sandler R. Cannabis and symptom management in cancer: safety, efficacy, and implications for clinical use. Poster presented at: 47th Annual ONS Congress; April 27-May 1, 2022; Anaheim, California.