Two of the most common and undesirable side effects that come with doing chemotherapy is nausea and vomiting. Nausea and vomiting can especially be rough on children, with chemotherapy-induced nausea and vomiting (CINV) affecting roughly around 70% of children with cancer (Dupius et al., 2017). There are three main forms of chemotherapy-induced nausea and vomiting: acute, delayed, and anticipatory. Acute CINV follows almost directly after a chemotherapy session; delayed CINV follows 24-hrs after chemotherapy treatment, present in around 80% of children; and anticipatory CINV is usually experienced before treatment and can be triggered by sensory cues, with around 25% of children experiencing this (Ruggiero et al., 2018).
A way to alleviate CINV is to use anti-emetic medication, however there are some drawbacks to this, as antiemetics seem to be only highly effective for chemotherapy-induced vomiting, but not to the same extent as for chemotherapy-induced nausea. Around 20% of patients with cancer stop chemotherapy treatment due to the severe displeasing effect of nausea, even if being treated with an antiemetic or other pharmaceutical drug (Andrews and Horn, 2006). New treatment for CINV is urgently needed to ensure that people with cancer, especially children, can have an improved quality of life. One potential form of treatment that can be used to effectively treat CINV and has shown promising results is the cannabis-component tetrahydrocannabinol—or better known as THC.
In a study conducted by Abrahamov et al. (1995), eight children undergoing chemotherapy were given delta-8 THC to identify its anti-emetic effects in nausea and vomiting. Delta-8 THC is another form of Delta-9 THC—which is what is more commonly known and used in cannabis products—that has a low affinity for CB1 receptors (where cannabinoids bind in the body) and produces less psychoactive effects (Hollister and Gillespie, 1973; Kruger and Kruger, 2022). Two hours before the children underwent chemotherapy, they were given oil-drops of delta-8 THC on the tongue or on food, and this procedure was repeated every 6 hours for 24 hours. As a result, treatment of delta-8 THC alongside chemotherapy prevented acute vomiting in all of the children, and no delayed nausea or vomiting was observed (Abrahamov et al., 1995). Furthermore, no major side effects were seen, with only two children showing slight irritability and one child experiencing euphoria. Though the study showcased promising results of THC treating CINV, there has been no further follow-up studies or clinical trials as of today.
There is controversy and mixed-feelings regarding the use of cannabinoids on pediatric patients—which is extremely understandable. Marijuana is on the rise for being one of the most abused substances in adolescents through daily use, and there is evidence to suggest that early-marjiuana use in childhood can lead to neuropsychological decline into adulthood (Hadland et al., 2015; Meier et al., 2012). The Food and Drug Administration (FDA) has not approved delta-8 THC products for safe use to be put into the market, and states that 8% of pediatric patients less than 18 years of age have experienced aversive effects such as: hallucinations, vomiting, tremor, anxiety, loss of consciousness, and more (FDA, 2022). While there is no doubt that cannabis usage can lead to the risk of abuse and unwanted side effects in children, there are also benefits to its constituents when utilized properly and used under close medical supervision—especially for those who suffer from cancer.
There is a lack of research regarding delta-8 THC being effective in children undergoing chemotherapy besides Abrahamov et al. ‘s study, which was previously discussed. However, cannabis has been utilized for its anti-emetic properties for a while now, and research has backed up its efficiency in reducing nausea and vomiting. Cannabis has been shown to reduce nausea in people within one hour in 96% of participants in one study (Stith et al., 2022). In the book titled Cannabinoids and the Brain (2017), Dr. Linda Parker goes into depth into the several studies that have showcased THC, CBD, and endocannabinoids being effective in reducing chemotherapy-induced nausea and vomiting in both human and animal studies, as well as a collection of other effects in different body systems and diseases.
It is hard to say 100% whether THC is good or bad to use to treat nausea and vomiting in children with cancer, especially with the lack of studies available regarding the issue. On one hand, one study revealed that delta-8 THC can effectively treat nausea and vomiting in children with cancer with no major side effects, and there has been a ton of research that has highlighted cannabis’ antiemetic effects in adults and animal studies. On the other hand, there is a risk of misuse, abuse, and neuropsychological alterations that can occur through childhood cannabis usage, which can be especially scary for parents. There are both positives and negatives that come with THC administration in children, and there is a need for further research to be done to identify its full effects and potential on safely treating children with cancer who go through chemotherapy. This need for further research would make sure that a child with cancer can experience an improved quality of life, which is something that all children deserve.
Abrahamov, A., Abrahamov, A., & Mechoulam, R. (1995). An efficient new cannabinoid antiemetic in pediatric oncology. Life Sciences (1973), 56(23-24), 2097-2102. https://doi.org/10.1016/0024-3205(95)00194-B
Andrews, P. L., & Horn, C. C. (2006). Signals for nausea and emesis: Implications for models of upper gastrointestinal diseases. Autonomic neuroscience : basic & clinical, 125(1-2), 100–115. https://doi.org/10.1016/j.autneu.2006.01.008
Dupuis, L. L., Sung, L., Molassiotis, A., Orsey, A. D., Tissing, W., & van de Wetering, M. (2017). 2016 updated MASCC/ESMO consensus recommendations: Prevention of acute chemotherapy-induced nausea and vomiting in children. Supportive Care in Cancer, 25(1), 323-331. https://doi.org/10.1007/s00520-016-3384-y
FDA. (2022). 5 things to know about delta-8 tetrahydrocannabinol – delta-8 THC. U.S. Food and Drug Administration. Retrieved May 6, 2023, from https://www.fda.gov/consumers/consumer-updates/5-things-know-about-delta-8-tetrahydrocannabinol-delta-8-thc
Hadland, S. E., Knight, J. R., & Harris, S. K. (2015). Medical marijuana: Review of the science and implications for developmental-behavioral pediatric practice. Journal of Developmental and Behavioral Pediatrics, 36(2), 115-123. https://doi.org/10.1097/DBP.0000000000000129
Hollister, L. E., & Gillespie, H. K. (1973). Delta 8- and delta 9 tetrahydrocannabinol. comparison in man by oral and intravenous administration. Clinical Pharmacology and Therapeutics, 14(3), 353-357. https://doi.org/10.1002/cpt1973143353
Kruger, J. S., & Kruger, D. J. (2022). Delta-8-THC: Delta-9-THC’s nicer younger sibling?. Journal of cannabis research, 4(1), 4. https://doi.org/10.1186/s42238-021-00115-8
Meier, M. H., Caspi, A., Ambler, A., Harrington, H., Houts, R., Keefe, R. S. E., McDonald, K., Ward, A., Poulton, R., & Moffitt, T. E. (2012). Persistent cannabis users show neuropsychological decline from childhood to midlife. Proceedings of the National Academy of Sciences – PNAS, 109(40), E2657-E2664. https://doi.org/10.1073/pnas.1206820109
Parker, L. A. (2017). Cannabinoids and the brain. The MIT Press. https://doi.org/10.7551/mitpress/10457.001.0001
Ruggiero, A., Rizzo, D., Catalano, M., Coccia, P., Triarico, S., & Attiná, G. (2018). Acute chemotherapy-induced nausea and vomiting in children with cancer: Still waiting for a common consensus on treatment. The Journal of international medical research, 46(6), 2149–2156. https://doi.org/10.1177/0300060518765324
Stith, S. S., Li, X., Orozco, J., Lopez, V., Brockelman, F., Keeling, K., Hall, B., & Vigil, J. M. (2022). The effectiveness of common cannabis products for treatment of nausea. Journal of Clinical Gastroenterology, 56(4), 331-338. https://doi.org/10.1097/MCG.0000000000001534
One thought on “Can we use THC to treat chemotherapy-induced side effects in children?”
Another great blog post, Sarah!