Cannabis and Cannabinoids in Adults with Cancer
Publication Date: March 13, 2024
Last Updated: March 14, 2024
Treatment
Clinical Communication and Education
Recommendation 1.1
Health systems and clinicians, in partnership, should provide adults with cancer unbiased, evidence-based cannabis and/or cannabinoid educational resources to facilitate clinical communication, informed decision-making, and systematized approaches to care. (GPS, , , )
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Recommendation 1.2
Given the high prevalence of cannabis and/or cannabinoid use among adults with cancer, clinicians should routinely and non-judgmentally inquire about cannabis use (or consideration of use), and either guide care or direct adults with cancer to appropriate resources. (GPS, , , )
Note. Clinicians should remain sensitive to cannabis regulations’ disproportionate impacts on marginalized communities and work to omit cannabis-related and other biases (e.g., racial, ethnic, and socioeconomic) from clinical discussions about cannabis and/or cannabinoids. Table 1 offers suggestions for cannabinoid history-taking.
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Recommendation 1.3
When adults with cancer use cannabis and/or cannabinoids outside of evidence-based indications or clinician recommendations, clinicians should explore goals, educate, and seek to minimize harm. (GPS, , , )
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Cancer Treatment
Recommendation 2.1
Clinicians should recommend against use of cannabis and/or cannabinoids to augment cancer-directed treatment unless in the context of a clinical trial. (EB, , VL, Weak)
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Recommendation 2.2
Clinicians should recommend against use of cannabis and/or cannabinoids in place of cancer-directed treatment. (IC, , VL, Strong)
Note. Cannabis and/or cannabinoids used as cancer-directed treatment may cause significant clinical (e.g., fatigue, confusion, feeling “high”) and financial toxicities without good quality evidence of clinical benefit.
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Cancer Treatment-related Toxicity, Symptoms, and Quality of Life (QOL)
Recommendation 3.1
Adults with cancer who receive moderately or highly emetogenic antineoplastic agents with guideline-concordant antiemetic prophylaxis and experience refractory nausea or vomiting may augment their antiemetic regimen with dronabinol, nabilone, or a quality-controlled oral 1:1 delta-9-tetrahydrocannabinol (THC):cannabidiol (CBD) extract.
[for dronabinol and nabilone] (EB, , M, Weak)
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[for 1:1 THC:CBD extract] (EB, , L, Weak)
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Note. Cannabis and/or cannabinoids are one of several pharmacologic options for adults with cancer experiencing refractory nausea and vomiting despite optimal prophylaxis. For such individuals, the 2020 ASCO antiemetics guideline recommends the addition of olanzapine (if not already prophylactically administered); otherwise, the addition of an antiemetic from a different class (e.g., a neurokinin-1 receptor antagonist, dopamine receptor antagonist, benzodiazepine, or synthetic THC).
Recommendation 3.2
Outside of a clinical trial, clinicians should not recommend that adults with cancer use 300 mg or more of daily, oral CBD to manage symptom burden due to lack of proven efficacy and risk for reversible liver enzyme abnormalities. (EB, , L, Weak)
Note: In adult and pediatric populations without cancer, reversible liver enzyme abnormalities primarily occurred in study participants taking 300 mg or more of daily oral CBD.
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Recommendation 3.3
Evidence remains insufficient to recommend for or against cannabis and/or cannabinoids in managing cancer treatment-related toxicities or symptoms (including cancer pain), aside from clinical settings addressed in Recommendations 3.1 and 3.2 or within the context of a clinical trial (Table 2). (, , , )
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ASCO believes that cancer clinical trials are vital to inform medical decisions and improve cancer care, and that all patients should have the opportunity to participate.
Additional information, which may include data supplements, slide sets, and other clinical tools and resources, is available at www.asco.org/supportive-care-guidelines.
Additional information, which may include data supplements, slide sets, and other clinical tools and resources, is available at www.asco.org/supportive-care-guidelines.
Recommendation Grading
Disclaimer
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.
Overview
Title
Cannabis and Cannabinoids in Adults with Cancer
Authoring Organization
American Society of Clinical Oncology
Publication Month/Year
March 13, 2024
Last Updated Month/Year
March 18, 2024
Supplemental Implementation Tools
Document Type
Guideline
Country of Publication
US
Target Patient Population
Adults with cancer
Target Provider Population
Clinicians providing care to adults with cancer
Inclusion Criteria
Male, Female, Adult, Older adult
Health Care Settings
Ambulatory, Home health, Hospice, Hospital, Long term care, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Treatment
Diseases/Conditions (MeSH)
D000932 - Antiemetics, D009325 - Nausea, D014839 - Vomiting
Keywords
cancer, CINV, Chemotherapy-induced nausea and vomiting, cannabis, cannabinoids, CBD, antiemetic regimen, THC
Source Citation
Braun IM, Bohlke K, Abrams DI, et al. Cannabis and Cannabinoids in Adults with Cancer: ASCO Guideline. J Clin Oncol. 2023 March 13. doi:10.1200/JCO.23.02596