Exploring the Role of Medicinal Cannabis in Palliative Care

Palliative care is a crucial aspect of healthcare, aiming to enhance the quality of life for patients facing incurable illnesses. Within this context, the use of medicinal cannabis (MC) has emerged as a potential avenue for addressing various symptoms and improving overall well-being. This article delves into a systematic review conducted by Marjan Doppen and colleagues, which examines the current evidence surrounding MC’s effects and potential harms in palliative care settings.

Background: With the growing interest in alternative therapies, medicinal cannabis has garnered attention for its potential therapeutic benefits. Patients undergoing palliative care often experience a range of distressing symptoms, including pain, nausea, loss of appetite, and sleep disturbances. Traditional treatment approaches may not always provide adequate relief, leading to exploring alternative options such as MC.

Methodology: The systematic review conducted by Doppen et al. involved a comprehensive search of databases including PubMed, Embase, The Cochrane Library, and clinicaltrials.gov. Eligible articles, spanning from 1960 to September 2021, were scrutinized to evaluate the effects of MC on symptom management and quality of life in palliative care patients. The quality of evidence was assessed using established criteria, and the risk of bias was meticulously examined.

Key Findings: The review included a total of 52 studies, comprising both randomized controlled trials and non-randomized trials, with a combined participant pool of 4786 individuals diagnosed with various conditions, including cancer, dementia, AIDS, spasticity, and NORSE syndrome. Despite the diversity of study populations and methodologies, several positive treatment effects of MC were identified. These effects encompassed improvements in pain, nausea and vomiting, appetite, sleep, fatigue, chemosensory perception, and paraneoplastic night sweats among cancer patients, as well as enhancements in appetite and agitation among dementia patients, and alleviation of symptoms such as nausea and vomiting in AIDS patients.

Conclusion: While the findings of the review suggest promising benefits of MC in palliative care, the overall quality of evidence was deemed to be of low or very low quality. Only two randomized controlled trials exhibited a low risk of bias, highlighting the need for further high-quality research in this domain. The heterogeneity of cannabis products used and the variability in study outcomes underscore the complexity of assessing MC’s efficacy in palliative care settings. Consequently, while MC shows potential as a therapeutic intervention, robust evidence is necessary to guide its clinical use effectively.

Implications for Clinical Practice:

Despite the current limitations in evidence, healthcare providers should remain open to considering Medical Cannabis (MC) as part of a multimodal approach to symptom management in palliative care. The endocannabinoid system, which plays a crucial role in regulating various physiological processes, including pain perception, appetite, mood, and sleep, underscores the potential therapeutic benefits of MC. Close monitoring of patients, individualized treatment plans, and informed decision-making are essential components of integrating MC into clinical practice. Collaborative efforts between healthcare professionals, researchers, and policymakers are warranted to facilitate further research and establish evidence-based guidelines for using MC in palliative care, ensuring patients receive comprehensive and compassionate care tailored to their unique needs.

References: Doppen, M., Kung, S., Maijers, I., John, M., Dunphy, H., Townsley, H., Eathorne, A., Semprini, A., & Braithwaite, I. (2022). Cannabis in Palliative Care: A Systematic Review /  of Current Evidence. Journal of Pain and Symptom Management. doi:10.1016/j.jpainsymman.2022.06.002.

Contact: Keith W Fiveson, 917-952-9662 at www.workmindfulness.com / www.mettatouch.org