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MASCC guideline: cannabis for cancer-related pain and risk of harms and adverse events

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A Correction to this article was published on 06 May 2023

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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Authors

Contributions

Josephine To and Mellar Davis: review of studies derived from the systematic review and writing the manuscript.

Jessica Garsed: the clinical informationist performance of the systematic review.

Andrea Sbrana, Bryony Alderman, David Hui, Sandip Mukhopadhyay, Carole Bouleuc, Amy A. Case, Koji Amano, Gregory P. Crawford, Giulia de Feo, and Kimberson Tanco: reviewed and edited the manuscript and provided consensus as to the recommendations.

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Correspondence to Mellar Davis.

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The original version of this article was revised. The correct name should be Gregory B. Crawford.

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To, J., Davis, M., Sbrana, A. et al. MASCC guideline: cannabis for cancer-related pain and risk of harms and adverse events. Support Care Cancer 31, 202 (2023). https://doi.org/10.1007/s00520-023-07662-1

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