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Use of cannabinoids in patients with advanced cancer : a systematic review
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Introdução/Contextualização: Os cuidados paliativos (CPAL) sustentam uma abordagem que suporta e visa a melhoria da qualidade de vida (QDV) dos doentes, cuidadores e famílias que enfrentam problemas de saúde com risco de vida. Objetivos: Com este trabalho pretendeu-se verificar a evidência: 1) da prescrição de canabinoides nos doentes com cancro, nomeadamente no controlo sintomático e na melhoria da QDV; 2) do uso de canabinoides em doentes medicados com opioides; 3) da segurança na prescrição de canabinoides. Material e Metodologia: Fez-se uma revisão sistemática (RS) da literatura. Foram pesquisados artigos na PubMed, Web of Science e Cochrane, sobre o uso de canabinoides na população adulta com cancro avançado, publicados entre janeiro de 2011 e dezembro de 2022. Resultados: A partir do protocolo de pesquisa estabelecido obtiveram-se dez estudos elegíveis para análise qualitativa. A maioria com risco de viés moderado. O uso de canabinoides no alívio da dor oncológica é benéfico, mas os resultados nem sempre têm significância estatística. Há melhoria das perturbações do sono, mas o aumento da ingestão alimentar e diminuição da anorexia nem sempre apresentaram significado estatístico. Constatou-se evidência de melhoria clínica da QDV geral dos doentes com o uso de canabinoides. É útil a prescrição de canabinoides em doentes já medicados com opioides, apesar de não ser evidente um efeito “poupador” do consumo de opioides. A utilização clínica de canabinoides é segura. Conclusão: Os canabinoides, de modo geral, reduzem a sobrecarga sintomática e melhoram a QDV dos doentes com cancro avançado, possuindo bom perfil de segurança, podendo ser usados concomitantemente com opioides. É necessário incrementar a investigação sobre a prescrição de canabinoides em indivíduos com doença avançada, com comorbilidades e polimedicação diversas, nos diferentes contextos de saúde.
Introduction: Palliative care (PL) aims to support and improve the quality of life (QOL) of the patients, caregivers and families that face end of life health problems. Objectives: With this work it was intended to verify the evidence of 1) the prescription of cannabis to patients with cancer for symptom control and in the improvement of quality of life, 2) the use of cannabis in patients prescribed with opioids, 3) the safety of cannabis prescription. Methods: It was made a systematic review (SR) of literature. Articles were searched on PubMed, Web of Science and Cochrane, for the use of cannabinoids in the adult population with advanced cancer, published between january of 2011 and december of 2022. Results: From the research parameters established were retrieved ten eligible studies for qualitative analysis. Most of the articles had moderate bias. The use of cannabinoids in the relief of oncologic pain is beneficial, but the results sometimes do not have statistical significance. There is improvement in sleep disturbances, but the increase in food intake and a reduction of anorexia does not have statistical significance. There is evidence of clinical improvement in the general QOL of patients with the use of cannabinoids. It is usefulness the prescription of cannabinoids in patients already taking opioids, despite the fact it does not decrease opioid consumption. The clinical use of cannabinoids is safe. Conclusion: The cannabinoids generally reduce the symptoms and increase the QOL of patients with advanced cancer, they have a good safety profile, and they can be used alongside opioids. It is necessary to increase the research on cannabinoid prescription in patients with advanced disease, with comorbidities and polymedication in different health seekings.
Introduction: Palliative care (PL) aims to support and improve the quality of life (QOL) of the patients, caregivers and families that face end of life health problems. Objectives: With this work it was intended to verify the evidence of 1) the prescription of cannabis to patients with cancer for symptom control and in the improvement of quality of life, 2) the use of cannabis in patients prescribed with opioids, 3) the safety of cannabis prescription. Methods: It was made a systematic review (SR) of literature. Articles were searched on PubMed, Web of Science and Cochrane, for the use of cannabinoids in the adult population with advanced cancer, published between january of 2011 and december of 2022. Results: From the research parameters established were retrieved ten eligible studies for qualitative analysis. Most of the articles had moderate bias. The use of cannabinoids in the relief of oncologic pain is beneficial, but the results sometimes do not have statistical significance. There is improvement in sleep disturbances, but the increase in food intake and a reduction of anorexia does not have statistical significance. There is evidence of clinical improvement in the general QOL of patients with the use of cannabinoids. It is usefulness the prescription of cannabinoids in patients already taking opioids, despite the fact it does not decrease opioid consumption. The clinical use of cannabinoids is safe. Conclusion: The cannabinoids generally reduce the symptoms and increase the QOL of patients with advanced cancer, they have a good safety profile, and they can be used alongside opioids. It is necessary to increase the research on cannabinoid prescription in patients with advanced disease, with comorbidities and polymedication in different health seekings.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Avaliação de sintomas Canabinoides Qualidade de vida Neoplasias Cuidados paliativos