International forskning

MASCC guideline: cannabis for cancer-related pain and risk of harms and adverse events

Josephine To 1, Mellar Davis 2, Andrea Sbrana 3, Bryony Alderman 4, David Hui 5, Sandip Mukhopadhyay 6, Carole Bouleuc 7, Amy A Case 8 9, Koji Amano 10, Gregory B Crawford 11, Giulia de Feo 12, Kimberson Tanco 5, Jessica Garsed 13

  • 1Division of Aged Care, Rehabilitation and Palliative Care, Northern Adelaide Local Health Network, Adelaide, Australia.
  • 2Palliative Care Department, Geisinger Medical System, Danville, USA.
  • 3University of Pisa, Pisa, Italy.
  • 4Frimley Park Hospital, Frimley, UK.
  • 5Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
  • 6Indian Council of Medical Research, New Delhi, India.
  • 7Department of Supportive and Palliative Care, P.S.L. University, Institut Curie, Paris, France.
  • 8Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
  • 9Division of Geriatrics and Palliative Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, USA.
  • 10Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan.
  • 11Northern Adelaide Local Health Network, South Australia, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.
  • 12Instituto Nazionale dei Tumori, Milan, Italy.
  • 13Geisinger Medical Center, Danville, USA.


Background: Approximately 18% of patients with cancer use cannabis at one time as palliation or treatment for their cancer. We performed a systematic review of randomized cannabis cancer trials to establish a guideline for its use in pain and to summarize the risk of harm and adverse events when used for any indication in cancer patients.

Methods: A systematic review of randomized trials with or without meta-analysis was carried out from MEDLINE, CCTR, Embase, and PsychINFO. The search involved randomized trials of cannabis in cancer patients. The search ended on November 12, 2021. The Jadad grading system was used for grading quality. Inclusion criteria for articles were randomized trials or systematic reviews of randomized trials of cannabinoids versus either placebo or active comparator explicitly in adult patients with cancer.

Results: Thirty-four systematic reviews and randomized trials met the eligibility criteria for cancer pain. Seven were randomized trials involving patients with cancer pain. Two trials had positive primary endpoints, which could not be reproduced in similarly designed trials. High-quality systematic reviews with meta-analyses found little evidence that cannabinoids are an effective adjuvant or analgesic to cancer pain. Seven systematic reviews and randomized trials related to harms and adverse events were included. There was inconsistent evidence about the types and levels of harm patients may experience when using cannabinoids.

Conclusion: The MASCC panel recommends against the use of cannabinoids as an adjuvant analgesic for cancer pain and suggests that the potential risk of harm and adverse events be carefully considered for all cancer patients, particularly with treatment with a checkpoint inhibitor.