ASCO Guidelines on Cannabis and Cannabinoid Use in Adults With Cancer
abstract
This abstract is available on the publisher's site.
Access this abstract nowPURPOSE
To guide clinicians, adults with cancer, caregivers, researchers, and oncology institutions on the medical use of cannabis and cannabinoids, including synthetic cannabinoids and herbal cannabis derivatives; single, purified cannabinoids; combinations of cannabis ingredients; and full-spectrum cannabis.
METHODS
A systematic literature review identified systematic reviews, randomized controlled trials (RCTs), and cohort studies on the efficacy and safety of cannabis and cannabinoids when used by adults with cancer. Outcomes of interest included antineoplastic effects, cancer treatment toxicity, symptoms, and quality of life. PubMed and the Cochrane Library were searched from database inception to January 27, 2023. ASCO convened an Expert Panel to review the evidence and formulate recommendations.
RESULTS
The evidence base consisted of 13 systematic reviews and five additional primary studies (four RCTs and one cohort study). The certainty of evidence for most outcomes was low or very low.
RECOMMENDATIONS
Cannabis and/or cannabinoid access and use by adults with cancer has outpaced the science supporting their clinical use. This guideline provides strategies for open, nonjudgmental communication between clinicians and adults with cancer about the use of cannabis and/or cannabinoids. Clinicians should recommend against using cannabis or cannabinoids as a cancer-directed treatment unless within the context of a clinical trial. Cannabis and/or cannabinoids may improve refractory, chemotherapy-induced nausea and vomiting when added to guideline-concordant antiemetic regimens. Whether cannabis and/or cannabinoids can improve other supportive care outcomes remains uncertain. This guideline also highlights the critical need for more cannabis and/or cannabinoid research.
Additional information is available at www.asco.org/supportive-care-guidelines.
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Additional Info
Disclosure statements are available on the authors' profiles:
Cannabis and Cannabinoids in Adults With Cancer: ASCO Guideline
J. Clin. Oncol 2024 Mar 13;[EPub Ahead of Print], IM Braun, K Bohlke, DI Abrams, H Anderson, LG Balneaves, G Bar-Sela, DW Bowles, PR Chai, A Damani, A Gupta, S Hallmeyer, IM Subbiah, C Twelves, MS Wallace, EJ RoelandFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Braun et al present us with the ASCO guidelines on the use of cannabis and cannabinoids in adults with cancer. I think this is a very useful and practical guideline. One of the major benefits is the fact that it includes a proper systematic literature review, which identified 13 systematic reviews and 5 additional primary studies (4 randomized controlled trials and 1 cohort study).
Often, we are confronted in clinics by patients, family members, and/or other carers who claim that doctors are unaware of the potential benefits of cannabis or cannabinoids. This guideline is a great source of credible information on this topic. The authors have looked at different suggested benefits of cannabis and cannabinoids, including as a treatment for chemotherapy-induced nausea and vomiting, total symptom burden, cancer pain, sleep, poor appetite, quality of life, and anxiety and depression.
In summary, the evidence is most commonly of low certainty, with two exceptions being very low or moderate certainty. In the end, the only recommendation in favor of cannabis or cannabinoid use is that it may improve refractory, chemotherapy-induced nausea and vomiting when added to guideline-concordant antiemetic regimens. There are no data to support the use of cannabis or cannabinoids as an anticancer treatment; however, the authors do state that the data looking at this are minimal. They recommend against using it as an anticancer treatment unless in the context of clinical trials.
Some practical recommendations include — given the high prevalence of cannabis and/or cannabinoid use among adults with cancer — that clinicians should routinely and nonjudgmentally enquire about cannabis use (or consideration of use) and either guide care or direct adults with cancer to appropriate resources. When adults with cancer use cannabis and/or cannabinoids outside evidence-based indications or clinician recommendations, clinicians should explore goals, educate, and seek to minimize harm.
In conclusion, I recommend that every medical specialist who works in oncology read this guideline as it gives a good summary of the data on cannabis and cannabinoid use in oncology, considers the methods of action, and gives practical recommendations that can be used in daily practice.