Cannabis can be an option in palliative care

Carlotta Jarach

Cannabis is an effective and safe option to help patients cope with malignancy related symptoms, such as nausea, vomiting, sleep disorders, pain, anxiety, and depression. In a scenario where a physician often prescribes one medication for each symptom, cannabis becomes a desirable therapeutic option, as a comprehensive treatment. These are the conclusions of a study, published online March 5 on the European Journal of Internal Medicine. The analysis gives a representation of cannabis users for different types of cancers, analysing the benefits over an observational study in Israel lasted 6 months. 2.960 patients took part on the analysis, but only 1.742 had survived through the entire period: 60% of them achieved treatment success, according to Victor Novack, MD, PhD, director of the Cannabis Clinical Research Center and Research Authority, Soroka University Medical Center, Beersheba, Israel.

The Israeli Ministry of Health had approved the use of medical cannabis already in 2007, but no evidence existed regarding characteristics of the patients, their use patterns, possible adverse reactions and in general the overall epidemiology of patients receiving medical cannabis treatment. For this reason, the private Israeli company Tikun-Olam (“repair the world” in Hebrew) that grows and supplies medical marijuana supervised by the Ministry of Health itself, sponsored this investigation: the team reviewed data three times, from questionnaires at baseline, at 1 month and at 6 months, on about 3.000 cancer patients who were prescribed with medical cannabis between 2015 and 2017.

Credits: manuel m. v.

The main symptoms were: sleep problems (78,4%), pain (77,7%, median intensity 8/10), weakness (72,7%), nausea (64,6%) and lack of appetite (48,9%). After six months of follow up, 902 patients (24,9%) died and 682 (18,8%) stopped the treatment. Of the remaining, 1211 (60,6%) responded; 95,9% reported an improvement in their condition, 45 patients (3,7%) reported no change and four patients (0,3%) reported deterioration in their medical condition. Due to the observational nature of the study, “no causality between cannabis therapy and symptom improvement can be established” authors said.

Seventeen different cancers were taken into account, and treatment success rates varied among them. Treatment for 69,2% of renal cancer and Hodgkin lymphoma patients succeeded. Other cancers with high rates of treatment success included brain/central nervous system tumours in adults (67,8%), multiple myeloma (67%), and cervical cancer (66,6%). The lowest success rates were prostate cancer (53,4%) and melanoma (31,2%). Among the side effects, the most common were dizziness (8,0%), dry mouth (7,3%), increased appetite (3,6%), sleepiness (3,3%), and psychoactive effect (2,8%).

Most patients use cannabis to reduce pain. Results of this study demonstrate that pain intensity levels were initially reported as very high (8–10 out of 10, VAS scale) in over 50% of the population, while after 6 months of treatment less than 5% of patients reported such high levels. Another successful result was the significant decrease in opioids use: in fact, after the study, 36% patients had stopped taking opioids, and 9,9% had decreased the dose.

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