Adverse events and cannabinoid use in cancer management: systematic review.
Sosorburam et al.·BMJ supportive & palliative careImpact 1.4
MixedGRADEModerate0 citations
Samplek = 14 Studien n = 12 Pat.
Duration48 hours to 12 months
ControlPlacebo or standard therapy
EndpointAdverse events
Blindingunklar
DesignSystematic Review
”Key finding
Cannabinoid therapies are associated with a broad spectrum of side effects, particularly gastrointestinal, neurological and psychiatric disorders, while possibly offering symptomatic relief.
Summary
Systematic review of k=14 RCTs on side effects of cannabinoid therapies in adult cancer patients (n=12–399 per study, intervention duration 48h–12 months). Most common side effects: gastrointestinal (nausea, dry mouth), neurological (dizziness, somnolence) and psychiatric (anxiety, hallucinations). 1–>12 different side effects reported per study. 10 studies with 'some concerns', 2 with 'high risk' in the bias assessment.
P
PopulationAdult cancer patients (adults with carcinoma, n varies by study: 12–399)
ControlPlacebo or standard therapy (depending on included RCT)
O
OutcomeAdverse events (AEs) reported in all 14 RCTs; most common AEs: gastrointestinal (nausea, dry mouth), neurological (dizziness, somnolence), psychiatric (anxiety, hallucinations); 10 studies with 'some concerns', 2 with high risk of bias
Confidence in the evidence
Very lowLowModerateHigh
Moderate
The third of four GRADE levels, the effect estimate is probably reliable.
Background: Cannabinoid-based therapies are increasingly used in cancer care to manage symptoms such as pain, chemotherapy-induced nausea and distress in palliative settings. Despite their clinical adoption, the safety profiles of these therapies remain incomplete. This systematic review synthesises randomised controlled trials (RCTs) reporting adverse events (AEs) associated with cannabinoid-based therapies in adult patients with cancer.
Methods: We searched PubMed, CINAHL and Web of Science for studies published between January 2015 and March 2025. Eligible studies included RCTs involving adult patients with cancer receiving cannabinoid-based treatments that reported AEs. Data were extracted on study characteristics, intervention type and AEs, which were categorised by systemic disorder. Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines were followed throughout.
Results: 14 RCTs were included. Studies varied in sample size (12 to 399), intervention duration (48 hours to 12 months), and cannabinoid formulations. All studies reported AEs, with the most frequent involving gastrointestinal (eg, nausea, dry mouth), neurological (eg, dizziness, somnolence) and psychiatric (eg, anxiety, hallucinations) disorders. The number of distinct AEs reported per study ranged from 1 to more than 12. Risk of bias assessments revealed that 10 studies had 'some concerns' and 2 were classified as 'high risk' due to incomplete outcome reporting or selective bias.
Conclusions: Cannabinoid therapies are associated with a broad range of AEs in adult patients with cancer, particularly affecting the gastrointestinal and nervous systems. While these therapies may offer symptomatic relief, clinicians must weigh benefits against potential harms. Further studies with larger samples, longer follow-ups and standardised AE reporting are recommended.