Expert cancer group found insufficient evidence to recommend cannabinoids for nausea, appetite, or taste problems in cancer patients | Research

The takeaway

A systematic review of 36 RCTs found THC and nabilone were better than placebo for chemotherapy-induced nausea and vomiting but not superior to other antiemetics, leading MASCC to find insufficient evidence to recommend cannabinoids for GI symptoms in cancer.

Oncologists, palliative care providers, cancer patients, and clinical guideline developers.

Insufficient evidence to recommend cannabinoids for cancer-related GI symptoms

What the researchers found

Of 36 RCTs, 11 showed cannabis improved CINV vs. placebo, but of 21 trials comparing cannabis to other antiemetics, only 11 favored cannabis. One THC:CBD study reduced nausea as add-on therapy without olanzapine. MASCC found insufficient evidence to recommend cannabinoids for CINV, advanced cancer nausea, cachexia, or taste disturbance.

Why it matters

Despite widespread patient interest in cannabis for cancer symptoms, this expert review found the evidence base does not support routine use, highlighting the gap between patient expectations and scientific evidence.

The numbers in context

RCTs identified: 36 (31 CINV, 1 radiation-induced nausea, 4 cachexia/taste). Cannabis vs. placebo for CINV: 11/31 positive. Cannabis vs. other antiemetics: 11/21 positive. Many studies poor quality.

How the study worked

Systematic review searching Medline, Embase, PsychINFO, and Cochrane through November 2021. Included RCTs of cannabinoids vs. placebo or active comparator in adult cancer patients. Studies scored on the Jadad scale. Expert panel developed consensus guidance.

What this study cannot tell us

Many included studies were old and used older antiemetic comparators. Heterogeneous populations and cannabinoid formulations. Many studies had poor methodological quality (randomization, blinding, allocation).

How to read the evidence

Comprehensive systematic review with expert consensus, limited by the quality of available primary studies.

When this study was published

Published in 2022 with searches through November 2021.

The bigger picture

The MASCC guideline represents an important reality check for cancer patients and oncologists navigating the gap between preclinical promise and clinical evidence for cannabinoids in cancer care.

Questions still open

Would modern cannabinoid formulations perform better alongside current antiemetic regimens? Is there a subset of cancer patients who benefit more from cannabinoids?

Common questions

Should cancer patients use cannabis for nausea?

MASCC found insufficient evidence to recommend it. While cannabinoids are better than placebo for chemotherapy nausea, they are not clearly superior to existing antiemetic medications.

Does cannabis help with cancer-related appetite loss?

The evidence is insufficient. Of the few trials examining cachexia and appetite, the results did not support a recommendation for cannabinoid use.

Read the original research

Multinational Association of Supportive Care in Cancer (MASCC) expert opinion/consensus guidance on the use of cannabinoids for gastrointestinal symptoms in patients with cancer.

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 31(1), 39

View on PubMed ↗Publisher’s paper ↗

Citation

Alderman, Bryony; Hui, David; Mukhopadhyay, Sandip; Bouleuc, Carole; Case, Amy A; Amano, Koji; Crawford, Gregory B; de Feo, Giulia; Sbrana, Andrea; Tanco, Kimberson; To, Josephine; Garsed, Jessica; Davis, Mellar. (2022). Multinational Association of Supportive Care in Cancer (MASCC) expert opinion/consensus guidance on the use of cannabinoids for gastrointestinal symptoms in patients with cancer.. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 31(1), 39. https://doi.org/10.1007/s00520-022-07480-x