Observational study on role of crude cannabis in pain control and quality of life in terminally ill cancer patients: An Indian perspective

Abstract

Background: Terminal cancer pain continues to be a significant morbidity. Most of the patients need intervention by pain specialists - and few still remain "difficult to treat". In India, most of these patients do shift to alternative medicine in desperation, with active ingredients, such as steroids/cannabinoids, and few unclassified anti-tumor substances. After listing and analyzing these the two most frequently observed ones are steroids and cannabinoids wherever patients have satisfactory pain control. Method(s): An interview based study was conducted as a part of QOL Data collection, which included other symptoms (such as fatigue, cachexia, well-being etc.) in the period of 2016-2018. One of key inclusions was - patients with advanced cancer progressed on multiple lines for which there was no standard of care. After data collection, a subset analysis was conducted with reference to pain control and use of alternative medication. For ease of analysis subjects were grouped into 4 categories based on pain control with opioids and concurrent use of cannabinoids. Subjects whose nature of the medication was not known were excluded. All four groups were analyzed for the pain control with help of visual analogy scale (VAS). Result(s): The baseline demographic characters in all four groups were well balanced and depicted in Table -1. Overall there were no statistically significant differences in the duration of symptoms, average dose of opioid analgesia, performance status and the stage of disease. Pain relief was better in the cannabis group, when it was used independently or in combination with opioids. No significant additional side effects pertaining to cannabis were reported by the patients. The overall qualities of life, as well as weight gain and nausea control were better in the cannabis group. Conclusion(s): We could infer that Bhang [cannabis crude form], is an effective analgesic independently having synergy with opioids. It also improved overall QOL, especially in cachexia, without adverse effects. If scientifically proven with pharmaceutical grade, it will be a significant addition to the symptomatic care of terminally ill cancer patients. Though available in US, India still does not have regulatory approval for medical cannabis.