Medical Cannabis as a treatment option

Palliative Care

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Overview

What is Palliative Care?

Palliative care is a type of medical care that focuses on comfort and emotional support rather than cure. Doctors may consider palliative care for people who have illnesses that cannot be cured and may be at the end of life.

Different healthcare professionals usually work together in a palliative care team to improve the quality of life of patients and their families. The goal of treatment is to relieve suffering by managing pain and physical symptoms as well as dealing with emotional distress.

Who Is Palliative Care for?

Some illnesses cannot be cured with medical treatment, only slowed down, for example:

  • Advanced cancer
  • Progressive organ failure, e.g. heart failure, chronic obstructive pulmonary disease, chronic kidney disease
  • Progressive neurological conditions, e.g. dementia
  • End stages of genetic disorders
  • Severe traumatic injuries from which a person is not expected to recover

Sometimes giving a person standard medical care to extend their life can significantly increase their suffering. Some people in this situation and their families may decide not to continue with standard medical care, instead choosing a palliative approach.

Doctors may also use a palliative approach earlier in the course of an illness along with treatments to prolong life, such as chemotherapy.

Established Treatments

What Does Palliative Care Involve?

Palliative care is highly individualised. It may take place in hospital, at home, in a nursing home or a hospice, depending on a person’s wishes and the nature of their illness.

Healthcare professionals from different backgrounds often work together in a palliative care team. The team may include specialised doctors and nurses, social workers, physical and occupational therapists, counsellors and pharmacists.

Medicines In Palliative Care

In palliative care, doctors use medicines to relieve pain and other distressing symptoms rather than to extend life. People at the end of life can have various symptoms, such as:

  • Worsening pain
  • Weakness
  • Fatigue
  • Shortness of breath (dyspnea)
  • Nausea
  • Delirium - confusion, restlessness, agitation
  • Anxiety
  • Noisy respiratory secretions
  • Decreased food intake
  • Decreasing levels of consciousness

Medicines that are commonly used to control these symptoms include:

  • Opioids for pain and dyspnea, e.g. morphine
  • Antiemetics for nausea, e.g. metoclopramide
  • Antipsychotics for delirium, e.g. haloperidol
  • Sedatives for anxiety and agitation, e.g. lorazepam, midazolam
  • Lorazepam, diazepam or phenobarbital for seizures
  • Glucocorticoids for pain, appetite, nausea, and fatigue, e.g. dexamethasone
  • Benzodiazepines, barbiturates or propofol for palliative sedation
Emotional, Social and Spiritual Matters

In addition to medication, palliative care teams often use a mixture of approaches to allow a person to live as actively as possible in the time they have left.

Social workers can help with practical matters such as accommodation and legal affairs. Counsellors and pastoral care staff help patients and their families deal with emotional, social and spiritual issues such as inner conflict, the search for meaning and unresolved religious concerns.

Your doctor can provide more information about palliative care.

Treatment with Medical Cannabis

Medical Cannabis and Palliative Care

The cannabis plant contains many compounds which affect the human body in different ways. Cannabinoids THC (Δ9-tetrahydrocannabinol) and CBD (cannabidiol) are the most abundant active compounds. THC is responsible for most of the mind-altering effects of cannabis.

Some clinical trials suggest that cannabinoids may be effective for a number of symptoms relevant to palliative care, such as pain which does not respond adequately to opioids, nausea and vomiting from cancer chemotherapy and loss of appetite and weight loss in people with AIDS. However, results overall are inconsistent and most currently published studies on cannabis in palliative care do not meet the gold standard of a double-blind, placebo controlled design. Findings are limited by small sample size, non-randomised participants, lack of adjustment for important factors which can alter results and lack of a control group.

Adverse effects in this patient group and interactions with other medicines are not well understood. Further large scale studies are needed before any conclusions can be drawn on the use of cannabis-based medicines in palliative care.

  • Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel-Group Study of the Efficacy, Safety, and Tolerability of THC:CBD Extract and THC Extract in Patients with Intractable Cancer-Related Pain
    This study compared a THC:CBD extract with a THC extract and a placebo for pain relief in people with advanced cancer. This trial was double-blind which means neither the patients nor the staff knew which treatment was given.

    177 people with pain from cancer that could not be adequately controlled with opioids were divided into three groups and given the THC:CBD extract, the THC extract or a placebo for two weeks. Patients recorded the severity of their pain on a numeric scale during this period.

    Results found that the THC:CBD performed better than the placebo while the THC group had no significant change. Twice as many patients in the THC:CBD group had a reduction of more than 30% from their original pain score in comparison with the placebo.

    Both treatments were well tolerated. 60% of patients had side effects including somnolence, dizziness and nausea, most of which were of mild or moderate severity. One patient fainted, most likely as a side effect of THC.
  • Nabiximols for opioid-treated cancer patients with poorly-controlled chronic pain: a randomized, placebo-controlled, graded-dose trial
    This double-blind study looked into the effect of nabiximols on advanced cancer pain that is not adequately controlled with opioids. Nabiximols is an extract of cannabis that contains THC and CBD.

    263 people with advanced cancer were divided into four groups and given a placebo, low-dose nabiximols, medium-dose nabiximols or high-dose nabiximols for five weeks. Participants recorded their pain and sleep disruption with questionnaires during this period.

    Results found that more people reported pain relief in the nabiximols groups than the placebo group, particularly in the low-dose and medium-dose groups. Side effects were dose-related; only the high-dose group compared unfavourably to the placebo.
  • Delta-9-tetrahydrocannabinol may palliate altered chemosensory perception in cancer patients: results of a randomized, double-blind, placebo-controlled pilot trial
    This double-blind study compared THC with a placebo to improve sense of taste
    and smell in people with advanced cancer.

    21 people with advanced cancer, poor appetite and changes in sense of taste and smell were divided into two groups and given either THC or a placebo for 18 days. Participants recorded taste and smell perception, appetite, food intake and quality of life before and after the treatment period.

    Results found that the THC group reported a larger improvement in taste and smell, premeal appetite, protein intake, sleep quality and relaxation compared to the placebo group. THC was well tolerated.
  • Cannabis and cancer chemotherapy: a comparison of oral delta-9-THC and prochlorperazine
    This double-blind study compared THC with traditional antiemetic prochlorperazine for chemotherapy-induced nausea and vomiting.

    214 patients on chemotherapy were divided into two groups and given four doses of either THC or prochlorperazine. Results found that both treatments equally effective in reducing chemotherapy-induced nausea and vomiting for a wide range of chemotherapy regimens and tumor types

    The THC group had more drug-related side effects, including reduced ability to concentrate, less social interaction and less activity, however these did not reduce preference for the drug.
  • Dronabinol as a treatment for anorexia associated with weight loss in patients with AIDS
    This study compared dronabinol - a man-made, purified form of THC - with a placebo for loss of appetite and weight loss in people with AIDS.

    139 people with anorexia from AIDS and at least 2.3kg of weight loss were divided into two groups and given either dronabinol or a placebo for six weeks. Patients recorded change in appetite, mood, nausea and weight during this period.

    Results found that people on dronabinol had a significant improvement in appetite, mood and nausea compared to the placebo group. Weight was stable in the dronabinol group, while the placebo group had a mean loss of 0.4 kg. Side effects from dronabinol were mostly mild to moderate and included euphoria, dizziness and thinking abnormalities.

References available at end of page.

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Research Articles

Related Advocacy Groups

There are several organizations in Australia which provide information and support to people receiving palliative care and their families. Below are links to their websites:

Palliative Care Australia

Cancer Council Australia

Australian Government Department of Health