Palliative Care

Palliative care is focused on providing relief from the symptoms and stress associated with serious illnesses, aiming to improve the quality of life for patients living with life-limiting or chronic conditions.

Unlike curative treatments, palliative care prioritises symptom management, comfort, and emotional support for both patients and their families. It is commonly used for patients with advanced cancer, heart failure, chronic obstructive pulmonary disease (COPD), neurological disorders, and other conditions that severely impact quality of life.

Common Conditions Related to Palliative Care

Palliative care is applied across a wide range of serious illnesses, with the following conditions being the most common:

Advanced Cancer: Patients with terminal or late-stage cancer frequently experience severe pain, fatigue, nausea, and emotional distress.
Chronic Obstructive Pulmonary Disease (COPD): Patients suffer from breathing difficulties, persistent coughing, and fatigue.
Congestive Heart Failure (CHF): Heart failure can cause breathlessness, swelling, and fatigue, making daily activities challenging.
End-Stage Renal Disease (ESRD): Patients undergoing dialysis may experience pain, nausea, itching, and profound fatigue.
Amyotrophic Lateral Sclerosis (ALS): This neurodegenerative disease leads to muscle weakness, speech difficulties, and eventual loss of movement.
Alzheimer’s Disease and Dementia: Later stages are often characterised by confusion, agitation, mobility challenges, and behavioural issues.
Stroke and Neurological Disorders: Conditions like multiple sclerosis and Parkinson’s disease can cause severe pain, mobility issues, and psychological challenges.

Palliative care addresses the physical, psychological, and emotional needs associated with these conditions, focusing on alleviating symptoms rather than treating the disease itself.

Conventional Treatments in Palliative Care

Palliative care employs a range of medications and therapies to alleviate symptoms and enhance the quality of life. These include:

Pain Relief: Opioids such as Morphine, Oxycodone, and Fentanyl are used for moderate to severe pain. Non-opioid analgesics like NSAIDs (ibuprofen, naproxen) are used for mild pain.
Antiemetics: Drugs such as Ondansetron (Zofran) and Metoclopramide (Reglan) are used to manage nausea and vomiting, particularly in patients undergoing chemotherapy or radiotherapy.
Antidepressants and Anxiolytics: SSRIs and benzodiazepines like Lorazepam (Ativan) are prescribed to manage anxiety and depression, common in terminal illnesses.
Muscle Relaxants: Medications like Baclofen or Tizanidine are used for managing muscle spasms in conditions like ALS or multiple sclerosis.
Corticosteroids: Dexamethasone is often used to reduce inflammation, manage pain, and improve appetite.
Oxygen Therapy: For conditions like COPD or heart failure, oxygen therapy eases breathing difficulties.
Appetite Stimulants: Drugs like Megestrol Acetate and Dronabinol are used to address anorexia and weight loss in patients with terminal conditions.

While these treatments can effectively manage specific symptoms, they are often associated with side effects such as sedation, constipation, cognitive impairment, or dependency (particularly with opioids). Some patients may also find conventional treatments inadequate, leading to increased interest in complementary therapies such as medical cannabis.

How Cannabis Can Help

Medical cannabis has gained popularity as a complementary therapy in palliative care due to its ability to manage multiple symptoms with fewer side effects compared to some traditional medications. Cannabinoids such as tetrahydrocannabinol (THC) and cannabidiol (CBD) interact with the body’s endocannabinoid system (ECS), which regulates pain, appetite, mood, and immune responses.

Cannabinoids and Symptom Management in Palliative Care: Clinical Evidence

Pain Management

A 2019 systematic review in The Journal of Pain found that cannabis, particularly THC, was effective in reducing chronic pain, including cancer-related and neuropathic pain. Cannabis also helped patients reduce opioid use, lowering the risks of dependency and overdose.
A 2020 study in Frontiers in Oncology demonstrated that cannabis significantly reduced the need for opioid analgesics in cancer patients, with fewer side effects like constipation and sedation.
A 2018 clinical trial in The Lancet Oncology showed that Nabiximols (Sativex), a THC-CBD oral spray, provided effective pain relief for cancer patients with opioid-resistant pain.

Nausea and Vomiting

Chemotherapy-induced nausea and vomiting (CINV) is one of the most well-recognised uses of cannabis in palliative care. A 2016 review in The Cochrane Database of Systematic Reviews found that cannabinoids were more effective than traditional antiemetics in reducing nausea and vomiting.
Dronabinol, a synthetic THC, is FDA-approved for managing nausea in cancer and AIDS patients and has demonstrated effectiveness in clinical studies. A 2018 study in The Journal of Pain and Symptom Management also found that Nabiximols provided significant relief from nausea and improved appetite in palliative care patients.

Appetite Stimulation and Cachexia

Cachexia, or wasting syndrome, is a significant concern for patients with cancer, AIDS, and other terminal conditions. Cannabis, particularly THC, stimulates appetite by activating CB1 receptors in the brain.
A 2011 clinical trial in The Journal of Supportive Oncology showed that Dronabinol improved appetite and weight gain in patients with advanced cancer and HIV/AIDS.
A 2014 study in Appetite found that THC increased food intake and stabilised weight in patients with cancer-related cachexia.

Anxiety and Depression

A 2019 study in The Permanente Journal reported that patients using CBD experienced significant reductions in anxiety and improvements in mood and quality of life.
A 2020 clinical trial in Frontiers in Psychiatry demonstrated that THC-rich strains reduced anxiety and depressive symptoms in cancer patients, particularly those facing treatment-related or existential distress.

Sleep Disorders

Insomnia and disturbed sleep are common in palliative care patients. A 2019 review in Cannabis and Cannabinoid Research found that THC-dominant cannabis improved sleep quality by helping patients fall asleep faster and reducing nighttime awakenings.
A 2021 study in Sleep Medicine reported that both THC and CBD improved sleep patterns in patients with chronic conditions, with fewer side effects compared to conventional sedatives.

Breathlessness in COPD and Heart Failure

A 2014 study in the European Respiratory Journal found that low-dose THC alleviated breathlessness in COPD patients by relaxing airway muscles and reducing the sensation of breathlessness.
Research has also shown that cannabinoids can help manage dyspnoea (shortness of breath) in heart failure patients, reducing anxiety and improving overall comfort.

Mechanisms of Action

Cannabinoids, particularly THC and CBD, interact with the ECS to regulate key physiological processes:

THC: Binds to CB1 receptors in the brain and nervous system, reducing pain, alleviating nausea, stimulating appetite, and improving sleep. Its psychoactive properties can also help relieve anxiety and depression, promoting relaxation.
CBD: Indirectly influences the ECS by preventing the breakdown of endocannabinoids like anandamide, promoting pain relief and reducing inflammation. CBD’s anxiolytic and anti-inflammatory properties make it particularly suitable for patients seeking symptom relief without psychoactive effects.

Advantages Over Conventional Treatments

Medical cannabis offers several advantages compared to traditional medications used in palliative care:

Multifaceted Symptom Relief: Cannabis can address multiple symptoms simultaneously—pain, nausea, appetite loss, anxiety, and sleep disturbances—offering a comprehensive approach to care.
Fewer Side Effects: Compared to opioids and other medications, cannabis generally has a more favourable side effect profile. CBD-dominant formulations, in particular, reduce the risk of dependency and cognitive impairment.
Improved Quality of Life: By managing a wide range of symptoms, cannabis can significantly enhance comfort and emotional well-being in palliative care patients.

Conclusion

Medical cannabis has emerged as a valuable therapeutic option in palliative care, offering effective relief from pain, nausea, appetite loss, anxiety, and sleep disturbances. With its ability to address multiple symptoms and a more favourable side effect profile compared to conventional medications, cannabis provides a natural and comprehensive solution for patients seeking improved quality of life.

By adhering to regulatory guidelines, healthcare providers can ensure that patients in palliative care have access to safe and high-quality cannabis-based therapies tailored to their individual needs.