背景:胃肠道症状在癌症患者中很常见,是否与治疗或疾病本身的直接影响有关。患者可以选择在其正规医疗处方之外获得大麻素以减轻此类症状。然而,在癌症患者使用此类药物治疗胃肠道症状方面,缺乏临床指南。
方法:对使用大麻素控制癌症患者症状的证据进行了系统评价。搜索策略是为Medline开发的,Embase,心理信息,和Cochrane中央控制试验登记册,包括1975年至2021年11月12日的所有出版物。包括研究,如果他们是大麻素的随机对照试验与安慰剂或活性比较成人癌症患者相比,无论类型,舞台,或治疗状态。所有作者都同意纳入的文章,并由两位作者提取和总结数据。根据Jadad量表对每项研究进行评分。这篇综述专门用于制定使用大麻治疗胃肠道症状的指南,包括化疗引起的恶心和呕吐(CINV),慢性恶心,厌食症-恶病质综合征,和味觉干扰。
结果:确定了36项符合胃肠道症状审查纳入标准的随机对照试验:31项与CINV有关,一是放疗引起的恶心和呕吐,其余四种为厌食恶病质和改变的化学感觉障碍。随机对照试验的人群是异质的,许多研究质量很差,缺乏关于随机化方法的清晰度,盲法,和分配隐藏。ForCINV,与安慰剂相比,11项随机对照试验显示大麻有所改善,但是在21项试验中,将大麻与其他止吐药物用于CINV进行了比较,只有11人喜欢大麻。
结论:与安慰剂相比,四氢大麻酚(THC)和nabilone在预防CINV方面更有效,但并不比其他止吐药更有效。对于折射CINV,一项关于THC:CBD的研究表明,在不使用奥氮平的情况下,作为指南一致的止吐治疗的附加治疗,可减少恶心.MASCC指南委员会发现没有足够的证据推荐用于CINV管理的大麻素,晚期癌症引起的恶心,癌症相关的厌食症恶病质,和味觉干扰。需要高质量的研究来指导实践。
BACKGROUND: Gastrointestinal symptoms are common in patients with cancer, whether related to treatment or a direct effect of the disease itself. Patients may choose to access cannabinoids outside of their formal medical prescriptions to palliate such symptoms. However, clinical
guidelines are lacking in relation to the use of such medicines for gastrointestinal symptoms in patients with cancer.
METHODS: A systematic review of the evidence for the use of cannabinoids for symptom control in patients with cancer was undertaken. Search strategies were developed for Medline, Embase, PsychINFO, and the Cochrane Central Register of Controlled Trials, including all publications from 1975 up to 12 November 2021. Studies were included if they were randomized controlled trials of cannabinoids compared with placebo or active comparator in adult patients with cancer, regardless of type, stage, or treatment status. Articles for inclusion were agreed by all authors, and data extracted and summarized by two authors. Each study was scored according to the Jadad scale. This review was specifically for the purpose of developing
guidelines for the use of cannabis for gastrointestinal symptoms, including chemotherapy-induced nausea and vomiting (CINV), chronic nausea, anorexia-cachexia syndrome, and taste disturbance.
RESULTS: Thirty-six randomized controlled trials were identified that met the inclusion criteria for this review of gastrointestinal symptoms: 31 relating to CINV, one to radiotherapy-induced nausea and vomiting, and the remaining four to anorexia-cachexia and altered chemosensory disturbance. The populations for the randomized controlled trials were heterogeneous, and many studies were of poor quality, lacking clarity regarding method of randomization, blinding, and allocation concealment. For CINV, eleven RCTs showed improvement with cannabis compared to placebo, but out of 21 trials where cannabis was compared to other antiemetics for CINV, only 11 favoured cannabis.
CONCLUSIONS: Tetrahydrocannabinol (THC) and nabilone were more effective in preventing CINV when compared to placebo but are not more effective than other antiemetics. For refractory CINV, one study of THC:CBD demonstrated reduced nausea as an add-on treatment to
guideline-consistent antiemetic therapy without olanzapine. The MASCC
Guideline Committee found insufficient evidence to recommend cannabinoids for the management of CINV, nausea from advanced cancer, cancer-associated anorexia-
cachexia, and taste disturbance. High-quality studies are needed to inform practice.