Cannabinoids for symptom management in children with cancer: A systematic review and meta-analysis

Background

Despite the widespread use of medical cannabis, little is known regarding the safety, efficacy, and dosing of cannabis products in children with cancer. The objective of this study was to systematically appraise the existing published literature for the use of cannabis products in children with cancer.

Methods

This systematic review, registered with the International Prospective Register of Systematic Reviews (CRD42020187433), searched four databases: MEDLINE, Embase, PsycINFO, and the Cochrane Library. Abstracts and full texts were screened in duplicate. Data on types of cannabis products, doses, formulations, frequencies, routes of administration, indications, and clinical and demographic details as well as reported efficacy outcomes were extracted. Data on cannabinoid-related adverse events were also summarized.

Results

Out of 34,611 identified citations, 19 unique studies with a total of 1927 participants with cancer were included: eight retrospective chart reviews, seven randomized controlled trials, two open-label studies, and two case reports. The included studies reported the use of various cannabis products for the management of symptoms. Cannabinoids were commonly used for the management of chemotherapy-induced nausea and vomiting (11 of 19 [58%]). In controlled studies, somnolence, dizziness, dry mouth, and withdrawal due to adverse events were more commonly associated with the use of cannabinoids. Across all included studies, no serious cannabis-related adverse events were reported.

Conclusions

Although there is evidence to support the use of cannabis for symptom management, in children with cancer, there is a lack of rigorous evidence to inform the dosing, safety, and efficacy of cannabinoids. Because of the increasing interest in using cannabis, there is an urgent need for more research on medical cannabis in children with cancer.     

Parathyroid hormone

Parathyroid hormone (PTH) is the most recently approved agent for osteoposis treatment. It differs from other therapies that act by inhibiting bone resorption, because it stimulates bone formation. The resultant increases in bone mineral density are therefore greater than those associated with therapy with bisphosphonates (BPs), selective estrogen receptor modulators, or calcitonin. Despite being available for at least 2 yr. PTH has not been exten sively studied. Although some existing data support its use for reducing the risk of vertebral fractures in women. data are still limited with regard to nonvertebral fracture prevention in women and fracture prevention in men. Preliminary studies have demonstrated a potential role in the management of patients with glucocorticoid-induced osteoporosis, but more data are needed. PTH is administered daily by subcutaneous injection for a maximum of 24 mo. Common adverse effects include pain with injection, arthralgia, and nausea. PTH caused an increase in osteosarcoma in rats and therefore, its use should be avoided in patients at increased risk of osteosarcoma, such as those with Paget's disease, unexplained baseline elevations of alkaline phosphatase, open epiphyses, or previous skeletal radiation exposure. At this time. PTH should not be combined with other agents, but a 2-yr treatment period may be sequentially followed by a BP. Because of high cost, the need for parenteral administration and potential for adverse effects, PTH use should be reserved for patients with severe osteoporosis who fail BP therapy.