Study register · detailSystematic Review · Dementia · 2022
Cannabis in Palliative Care: A Systematic Review of Current Evidence.
Doppen et al.·Journal of pain and symptom managementImpact 0.8
MixedGRADEHigh44 citations
Samplek = 52 Studien n = 4.786 Pat.
DurationSearch period 1960 to September…
ControlPlacebo or active control
EndpointSymptom management
Blindingunklar
DesignSystematic Review
”Key finding
Positive treatment effects reported for some cannabis products for pain, nausea, appetite and sleep in cancer patients as well as appetite and agitation in dementia patients, however very low to low evidence quality across all included studies.
Summary
Systematic review on medical cannabis in the palliative setting; k=52 studies (20 RCTs, 32 non-randomised), n=4.786 participants (cancer n=4.491, dementia n=43, AIDS n=235, spasticity n=16, NORSE n=1). For dementia: positive treatment effects (p<0,05) for appetite and agitation. Evidence quality 'very low' or 'low' for all studies. Meta-analysis not feasible due to heterogeneity of cannabis products and outcomes. High-quality evidence needed for clinical recommendations.
P
PopulationPalliative patients with incurable diseases (cancer n=4491, AIDS n=235, dementia n=43, spasticity n=16, NORSE n=1), total sample n=4786
I
InterventionMedical cannabis (various products and forms of administration)
C
ControlPlacebo or active control (in RCTs)
O
OutcomePositive treatment effects (p<0,05) for pain, nausea/vomiting, appetite, sleep, fatigue, chemosensory perception and paraneoplastic night sweats in cancer patients; appetite and agitation in dementia patients; appetite and nausea/vomiting in AIDS patients; overall quality of evidence 'very low' to 'low'
Confidence in the evidence
Very lowLowModerateHigh
High
The highest of four GRADE levels, the effect estimate is very reliable.
Quality profile
Sample size★★★★★
Blinding—
Effect sizeMixed
Citations / year★★★★★
Authors
Doppen M, Kung S, Maijers I, John M, Dunphy H, Townsley H, Eathorne A, Semprini A, Braithwaite I
Context: Palliative care aims to improve the quality of life in patients with incurable illness. Medicinal cannabis (MC) has been used in the palliative care setting to address multiple symptoms in patients.
Objectives: To evaluate the full scope of available literature investigating the effects and potential harms of MC on symptom management and quality of life in palliative care.
Methods: PubMed, Embase, The Cochrane Library and clinicaltrials.gov were searched for eligible articles, published between 1960 and September 9, 2021. Quality of the evidence was assessed in accordance with Grading of Recommendations, Assessment, Development and Evaluations. Risk of bias was assessed using the RoB 2 tool for randomised controlled trials and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) tool for non-randomized trials.
Results: Fifty-two studies (20 randomised; 32 non-randomised) with 4786 participants diagnosed with cancer (n = 4491), dementia (n = 43), AIDS (n = 235), spasticity (n = 16), NORSE syndrome (n = 1) were included. The quality of evidence was 'very low' or 'low' for all studies, and low for only two randomised controlled trials. Positive treatment effects (statistical significance with P < 0.05) were seen for some MC products in pain, nausea and vomiting, appetite, sleep, fatigue, chemosensory perception and paraneoplastic night sweats in patients with cancer, appetite and agitation in patients with dementia and appetite, nausea and vomiting in patients with AIDS. Meta-analysis was unable to be performed due to the wide range of cannabis products used and the heterogeneity of the study outcomes.
Conclusion: While positive treatment effects have been reported for some MC products in the palliative care setting, further high quality evidence is needed to support recommendations for its use in clinical practice.