Prospective analysis of safety and efficacy of medical cannabis in large unselected population of patients with cancer

Schleider, Lihi Bar-Lev; Mechoulam, Raphael; Lederman, Violeta E.; Hilou, Mario; Lencovsky, Ori; Betzalel, Oded; Shbiro, Liat; Novack, Victor

doi:10.1016/j.ejim.2018.01.023

Cited by 161 publications

(120 citation statements)

References 26 publications

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“…We analyzed safety and efficacy of cannabis formulations in a large unselected group of 7000 patients out of approximately 32 000 receiving treatment in Israel. Our first reports suggest that cannabis treatment is safe, reduces pain and improves quality of life in a population of 2736 patients older than 65 and 2970 cancer patients receiving palliative therapy . Moreover, treatment with cannabis seems associated with a decrease in opioids consumption.…”

Section: Prospective Registrymentioning

confidence: 99%

Medical cannabis: aligning use to evidence‐based medicine approach

Schleider

Abuhasira

Novack

2018

Brit J Clinical Pharma

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During the past decade we have been witnessing a rise in medical cannabis use, yet the evidence for the safety and efficacy of the various cannabinoid compounds is scarce. The State of Israel has always been at the forefront of clinical and translational research in support of Evidence Based Medicine. With respect to cannabis Israel has created a medical and regulatory environment that enables clinical studies with cannabis which may lead to improved Evidence Based use of these compounds. This opinion paper discusses selected studies into the safety and effects of cannabis derived products.

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Section: Prospective Registrymentioning

confidence: 99%

Medical cannabis: aligning use to evidence‐based medicine approach

Schleider

Abuhasira

Novack

2018

Brit J Clinical Pharma

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“…Cancer and its treatments currently are designated as qualifying conditions in the majority of the 33 states that now have legalized medical cannabis . Consequently, cannabis use in patients with cancer is common: nearly one‐quarter of individuals with cancer report current cannabis use and >90% of cancer survivors view cannabis as potentially beneficial for symptom management and support its legalization . Recent studies have suggested that physicians may be more likely to recommend cannabis to patients with cancer compared with patients with other serious illnesses, and that oncologists are becoming increasingly accepting of patients using cannabis, despite their continued concerns regarding its safety and efficacy .…”

Section: Cannabis: Indications Use Versus Evidence Basementioning

confidence: 99%

Medical cannabis use among individuals with cancer: An unresolved and timely issue

Nugent

Meghani

Rogal

et al. 2020

Cancer

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The role of cannabis in cancer care is a complex and challenging issue. Cancer and its treatments currently are designated as qualifying conditions in the majority of the 33 states that now have legalized medical cannabis. 1 Consequently, cannabis use in patients with cancer is common: nearly one-quarter of individuals with cancer report current cannabis use 2,3 and >90% of cancer survivors view cannabis as potentially beneficial for symptom management and support its legalization. 4 Recent studies have suggested that physicians may be more likely to recommend cannabis to patients with cancer compared with patients with other serious illnesses, 5 and that oncologists are becoming increasingly accepting of patients using cannabis, despite their continued concerns regarding its safety and efficacy. 6,7 For example, approximately 46% of oncologists reported recommending medical cannabis clinically and approximately 80% discussed it with their patients, despite the fact that approximately 70% acknowledged that they were insufficiently educated regarding medical cannabis. 8 Thus, there appears to be a disconnect between medical cannabis's legal status and high acceptance by patients, recommendations from clinicians, and a poor evidence base concerning its safety and efficacy.A more complete and nuanced understanding of the relevant issues is imperative in this current climate of growing cannabis availability and acceptance. In this commentary, we have discussed key clinical issues related to the efficacy and safety of cannabis in patients with cancer and noted important lingering questions for clinical practice and research in this area. Cannabis: Indications, Use Versus Evidence BaseApproximately 75% of individuals with cancer use cannabis for symptom management, most commonly pain, nausea, and sleep disruption 9,10 ; however, to the best of our knowledge, the evidence base supporting this has been limited. It is important to note at the outset that the majority of the cannabis research conducted in oncology patients lacks the rigor that would be required of most other oncology treatments in practice. Even the limited number of randomized controlled trials that exist for comparing the efficacy of cannabis with that of placebo or other drugs in oncologic patients are homogeneously low or very low in quality. 11 A recent systematic review characterized the available evidence regarding cannabis for cancer symptom management as low quality and found no benefit for its common indications of pain, sleep, or a reduction of opioid dose. 12 In addition, to our knowledge, evidence for the antiemetic properties of plantbased preparations is seriously lacking. In effect, the best evidence exists for oral, pharmaceutically prepared, synthetic tetrahydrocannabinols (THCs) such as nabilone and dronabinol, which have been found to be superior to placebo and equivalent to other antiemetic medications. [13][14][15] For example, one observational prospective study found at least a 30% reduction in symptoms such as vomiting and fatigue ...

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“…There has been increasing recent interest with wide acceptance and authorisation of use of herbal preparations in many European countries and even more widespread authorisation of oral cannabinoid medications in most European countries and the USA and Canada (table 4). The most accepted indications include chronic pain, spasticity in multiple sclerosis, certain rare epilepsy syndromes, and chemotherapy-induced nausea and vomiting [57]. There has also been experimental evidence in the anti-neoplastic effect of cannabinoids [19], as well as in palliative care.…”

Section: Medical Use Of Cannabismentioning

confidence: 99%

Marijuana and the lung: hysteria or cause for concern?

Ribeiro

Ind

2018

Breathe

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Increasing cannabis use and legalisation highlights the paucity of data we have on the safety of cannabis smoking for respiratory health. Unfortunately, concurrent use of tobacco among marijuana smokers makes it difficult to untangle individual effect of marijuana smoking. Chronic cannabis only smoking has been shown in large cohort studies to reduce forced expiratory volume in 1 s/forced vital capacity via increasing forced vital capacity in chronic use contrary to the picture seen in tobacco smoking. The cause of this is unclear and there are various proposed mechanisms including respiratory muscle training secondary to method of inhalation and acute anti-inflammatory effect and bronchodilation of cannabis on the airways. While cannabis smoke has been shown to increase symptoms of chronic bronchitis, it has not been definitively shown to be associated with shortness of breath or irreversible airway changes. The evidence surrounding the development of lung cancer is less clear; however, preliminary evidence does not suggest association. Bullous lung disease associated with marijuana use has long been observed in clinical practice but published evidence is limited to a total of 57 published cases and only one cross-sectional study looking at radiological changes among chronic users which did not report any increase in macroscopic emphysema. More studies are required to elucidate these missing points to further guide risk stratification, clinical diagnosis and management.Key pointsCannabis smoking has increased and is likely to increase further with relaxation of legalisation and medicinal use of cannabinoids.Chronic marijuana smoking often produces symptoms similar to those of chronic tobacco smoking such as cough, sputum production, shortness of breath and wheeze.Cessation of marijuana smoking is associated with a reduction in respiratory symptoms and no increased risk of chronic bronchitis.Spirometry changes seen in chronic marijuana smokers appear to differ from those in chronic tobacco smokers. In chronic marijuana smokers there is an increase in FVC as opposed to a definite decrease in FEV1.Multiple case series have demonstrated peripheral bullae in marijuana smokers, but no observational studies have elucidated the risk.There is currently no clear association between cannabis smoking and lung cancer, although the research is currently limited.Educational aimsTo update readers on legalisation of recreational and medicinal cannabis.To summarise the evidence base surrounding the respiratory effects of inhaled marijuana use.To provide clinicians with an understanding of the main differences between cannabis and tobacco to be able to apply this to patient education.To highlight common respiratory problems among cannabis users and the need for recreational drug history taking.

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Prospective analysis of safety and efficacy of medical cannabis in large unselected population of patients with cancer

Cited by 161 publications

References 26 publications

Medical cannabis: aligning use to evidence‐based medicine approach

Medical cannabis: aligning use to evidence‐based medicine approach

Medical cannabis use among individuals with cancer: An unresolved and timely issue

Marijuana and the lung: hysteria or cause for concern?

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