A landmark South Australian trial led by the University of Adelaide and the Central Adelaide Local Health Network is investigating if medicinal cannabis can help alleviate the debilitating side effects of cancer treatment.
People with cancer who are about to start or have recently commenced chemotherapy are being recruited for the CANnabinoids in CANcer (CANCAN) trial, which is being carried out at three hospital sites across South Australia, including the Royal Adelaide Hospital, Lyell McEwin Hospital and the Queen Elizabeth Hospital.
Trial participants will be randomly assigned a pharmaceutical-grade medicinal cannabis wafer or a placebo to determine if the drug can protect the gut from chemotherapy, relieve cancer treatment symptoms and improve the quality of life for patients.
"Despite growing interest in medicinal cannabis for cancer symptom management, there remains a lack of high quality evidence to support its use. This trial will address that knowledge gap and provide much-needed data to help clinicians make informed decisions," said Associate Professor Hannah Wardill, a cancer care researcher from the University of Adelaide and Leader of the Supportive Oncology Group at SAHMRI.
"Many people with cancer are so desperate for relief from side effects such as pain, nausea and sleep disturbances, that they're resorting to sourcing cannabis illegally because healthcare professionals don't know how it should be used."
There is some evidence to suggest that CBD and THC- chemicals found in cannabis plants and used in this trial- may be able to protect the gut against damage. CBD appears to have anti-inflammatory properties while THC, the psychoactive ingredient in cannabis, may help to ease symptoms such as nausea, pain and fatigue.
"People with advanced cancer experience a range of side effects, many of which we struggle to control. Anything we can do to help people better tolerate their treatment and stay well would be hugely advantageous," said Professor Timothy Price, the Head of Clinical Oncology Research at The Queen Elizabeth Hospital.
Up to 40 per cent of people with cancer report using cannabis to relieve treatment symptoms - often obtaining it illegally, without medical guidance. Unfortunately, less than 30 per cent of oncology healthcare professionals feel informed enough to advise their patients about medicinal cannabis.
There are strict controls around the use of this pharmaceutical-grade medication in the trial. Participants will receive customised doses of the therapy, with the maximum dose available significantly lower than recreational dosing with psychoactive intent.
"We are hopeful that personalised CBD and THC dosages will reduce the severity of the side effects that come with cancer treatment and improve the wellbeing of patients, so they can continue their treatment plans," said Associate Professor Wardill.
Karen Hawke is a cancer survivor who is supportive of the trial. She was prescribed medicinal cannabis shortly after diagnosis for a rare and aggressive form of anal canal cancer.
"The side effects of my treatment were so much tougher than I ever imagined - I was shocked at just how much it impacted my day-to-day life, and I continue to deal with long-term side effects. Going to the toilet was excruciating during chemoradiation, and painful for months afterward. I was hospitalised for two weeks after treatment ended for complex pain management, it was like nothing I've ever experienced before," she said.
"One of the things I was grateful for early in treatment, was being prescribed medical cannabis which contained THC and CBD. This helped me greatly in the first few weeks, and later in conjunction with palliative care pain medication in hospital. It relaxed me and helped me sleep, it alleviated some of my discomfort, and it assisted me with the anxiety many of us go through during treatment.
"Medical cannabis is not easily accessible, and there is still a lot of important work to be done to tailor the correct dosage and ratio of CBD/THC for each patient. I would highly recommend for people undergoing chemotherapy and/or radiation to join this trial, where they can utilise medical cannabis in a controlled environment."
The trial has been funded by a $1.5 million investment by the Medical Research Future Fund.
Recruitment is ongoing and people with cancer who are scheduled to undergo chemotherapy treatment over multiple cycles at either the Royal Adelaide Hospital, Queen Elizabeth Hospital or Lyell McEwin Hospital may be eligible to participate. People who have started treatment and have developed symptoms may also be eligible. Participants will be required to abstain from driving and recreational cannabis use during the trial.
