Oncology Clinicians and the Minnesota Medical Cannabis Program: A Survey on Medical Cannabis Practice Patterns, Barriers to Enrollment, and Educational Needs

The need for cannabis education in dental hygiene programs

PURPOSE/OBJECTIVE

Cannabis and the endocannabinoid system (ESC) are rarely included in training programs for healthcare providers. Knowledge within the medical and dental health professionals is lacking regarding the treatment of patients using medical or recreational cannabis. Patients are unaware of the risks associated with cannabis use, and healthcare providers should be prepared to assess, educate, and treat the patients who use cannabis. With the increased legalization and use of cannabis for medical and recreational purposes across the US, this study demonstrated the lack of cannabis education provided in dental hygiene programs.

METHODS

In 2021, an online survey was conducted with 327 dental hygiene program directors. Respondents were asked to answer 26 questions.

RESULTS

With a 21% response rate and 100% completion rate, 60% of the participants responded that cannabis content was provided in their dental hygiene program, 38% responded with a "no," and one responded with "I do not know." No significant difference was found regardless of whether cannabis was legal in the state for medical or recreational use and whether the cannabis content was included in the dental hygiene curriculum.

CONCLUSIONS

The results indicate that every dental hygiene program should provide cannabis content, and each patient should receive a cannabis assessment at every dental hygiene appointment. Further research is required to identify standardized educational content on cannabis and the ESC, which will enable educators to teach students. The development and implementation of a standardized cannabis use assessment and the creation of standardized recommendations for patients who use cannabis to alleviate adverse oral health effects are important.

Cannabis and Cannabinoids in Adults With Cancer: ASCO Guideline

PURPOSE

To guide clinicians, adults with cancer, caregivers, researchers, and oncology institutions on the medical use of cannabis and cannabinoids, including synthetic cannabinoids and herbal cannabis derivatives; single, purified cannabinoids; combinations of cannabis ingredients; and full-spectrum cannabis.

METHODS

A systematic literature review identified systematic reviews, randomized controlled trials (RCTs), and cohort studies on the efficacy and safety of cannabis and cannabinoids when used by adults with cancer. Outcomes of interest included antineoplastic effects, cancer treatment toxicity, symptoms, and quality of life. PubMed and the Cochrane Library were searched from database inception to January 27, 2023. ASCO convened an Expert Panel to review the evidence and formulate recommendations.

RESULTS

The evidence base consisted of 13 systematic reviews and five additional primary studies (four RCTs and one cohort study). The certainty of evidence for most outcomes was low or very low.

RECOMMENDATIONS

Cannabis and/or cannabinoid access and use by adults with cancer has outpaced the science supporting their clinical use. This guideline provides strategies for open, nonjudgmental communication between clinicians and adults with cancer about the use of cannabis and/or cannabinoids. Clinicians should recommend against using cannabis or cannabinoids as a cancer-directed treatment unless within the context of a clinical trial. Cannabis and/or cannabinoids may improve refractory, chemotherapy-induced nausea and vomiting when added to guideline-concordant antiemetic regimens. Whether cannabis and/or cannabinoids can improve other supportive care outcomes remains uncertain. This guideline also highlights the critical need for more cannabis and/or cannabinoid research.Additional information is available at www.asco.org/supportive-care-guidelines.

Factors Affecting the Decision on Cannabis Use in Gynecologic Cancer Patients After the Legalization of Cannabis

OBJECTIVE

To characterize the patterns of cannabis use among gynecologic cancer patients, in terms of potential factors influencing their decision-making on cannabis use, the reasons for use or non-use, and sources of information on cannabis use.

METHODS

From March to July 2022, gynecologic cancer patients at a clinic were interviewed and classified into 3 groups: current users, ex-users, and never-users. The received data included: demographic data, cannabis use details, reasons for using and not using, adverse events, satisfaction, and intent to use. Univariate and multivariate analysis were used to identify risk factors influencing decision-making.

RESULT

Among 240 participants, 11.67% were classified as current users, 28.33% as ex-users, and 60% as never-users. The significant factors influencing cannabis use decisions were advanced stage and receiving information on cannabis, regardless of the information source. The satisfaction derived from cannabis was due to the enhancement of mood and physical activity, improvement in sleep quality, stimulation of appetite, and mitigation of adverse events associated with cancer treatment. Approximately 60% of users aimed for a cancer cure. The main reasons for quitting were inability to obtain cannabis and absence of persistent cancer symptoms.

CONCLUSION

Among Thai patients with gynecologic cancer, 40% had a history of cannabis use. Advanced cancer stage was an independent factor for decision-making on cannabis use. Sources of information on cannabis are non-healthcare providers. Many patients intended to use cannabis for cancer cure. Also, many were satisfied with use because of a relief of unwanted symptoms, indirectly suggesting improvement in quality of life. The main reason for quitting was unavailability. The main reason for never trying was a concern of interference with treatment. Our results may guide the direction of strategy of cannabis use among patients with gynecologic cancers.

Therapeutic cannabis use by patients with cancer in Canada: A national survey of the experiences, opinions and information needs of Radiation Therapists

PURPOSE

To understand the experiences, opinions and information needs of Canadian Radiation Therapists when caring for cancer patients who are taking cannabis for therapeutic purposes (CTP).

METHODS

The study employed prospective data collection, via a single cross-sectional web-based questionnaire. After REB approval, the questionnaire was distributed electronically to all Radiation Therapists across Canada. The questionnaire was open for a one month accrual, with reminders sent at two and four weeks. The raw data was aggregated using standard descriptive statistics. The response differences between naturally occurring demographic cohorts was determined using inferential statistics.

RESULTS

Two hundred and eighty two Therapists completed the questionnaire (25.6%), of which 19.1% reported being approached by patients to talk about cannabis more than once per month and 4.4% reported initiating a conversation with patients about cannabis. There were no differences between the provinces or catchment areas regarding how common or socially acceptable cannabis use by patients was. Confidence in discussing cannabis was strongly positively correlated with ratings of current knowledge (r² 0.77). Of the respondents, 99.9% believed that their radiation therapy training did not prepare them to support patients using cannabis.

CONCLUSIONS

The data revealed that patients more frequently seek out guidance for CTP than Therapists initiate those discussions. This lack of Therapist willingness to begin cannabis conversations was associated with the low levels of knowledge. Almost all Therapists recognized the limitations of their knowledge and expressed interest in receiving further information about cannabis. The findings of this study strongly advocate for the development of educational tools to meet Therapists clinical needs.

Cannabis in Cancer Survivors Who Report High Impact Chronic Pain: Findings from a 1500+ Patient Survey

BACKGROUND

Chronic pain in cancer survivors negatively impacts quality of life. This study sought to investigate the relationship between high-impact chronic pain (HICP) -- defined as chronic pain that limits life or work activities on most days or every day in the past 3 months -- and cannabis in cancer survivors.

METHODS

An electronic survey was developed in conjunction with the National Cancer Institute Comprehensive Cancer Centers in the United States. This survey was distributed to cancer survivors within a multi-site, single institution setting.

RESULTS

The survey response rate was 23.0% (2304/10,000); 72.7% of these patients (1676/2304) did in fact have a confirmed cancer diagnosis. Among these cancer survivors, 16.5% (unweighted 278/1676) had HICP, and 12.4% (208/1676) reported cannabis use since their cancer diagnosis. The prevalence of past 30-day cannabis use was 12.3% (206/1676). Compared to cancer survivors without pain, those with HICP were more likely to believe in the benefits of cannabis (unweighted 92.1% vs. 74.7%; age-adjusted odds ratio [OR] = 3.1; 95% CI: 1.9-5.1) and less likely to believe in its risks (unweighted 48.2% vs. 58.4%; age-adjusted OR = 0.6; 95% CI: 0.4-0.7).

CONCLUSIONS

Cancer survivors with HICP have a higher prevalence of cannabis use compared to those patients without pain. More research is needed to advance pain and symptom management among cancer survivors and to identify clinical scenarios in which benefit is greater than potential harm.

Patient Reported Outcomes Using Medical Cannabis for Managing Pain in Charcot-Marie-Tooth Disease

Objective: Chronic pain is a major problem for patients with Charcot-Marie-Tooth (CMT) disease. This exploratory study examined patient reported efficacy of medical cannabis for pain management in this population. Methods: Participants (N = 56; 71.4% female; Age = 48.9, SD = 14.6; 48.5% CMT1) were recruited though the Hereditary Neuropathy Foundation. The online survey contained 52 multiple choice questions about demographics, medical cannabis use, symptomology, efficacy, and adverse effects. Results: Nearly all (90.9%) of respondents reported experiencing pain, including all (100%) females and 72.7% of males (chi-square P < .05) with 91.7% of respondents indicating cannabis provided at least 50% pain relief. The most frequent response was an 80% reduction in pain. Moreover, 80.0% of respondents reported using less opiates, 69% noted using less sleep medication, and 50.0% reported using less anxiety/antidepressant medications. Negative side effects were noted by 23.5% of respondents. However, almost all (91.7%) of that subgroup did not have plans to stop consuming cannabis. One-third (33.9%) possessed a medical cannabis certificate. Patient perceptions of their physicians' attitudes regarding patient medical cannabis use greatly impacted whether respondents informed their providers of their usage. Conclusion: The vast majority of patients with CMT reported that cannabis was effective to manage pain symptoms. These data support the need for prospective, randomized, controlled trials using standardized dosing protocols to further delineate and optimize the potential use of cannabis to treat pain related to CMT.

Understanding Cannabis-Related Information Needs: An Analysis of Inquiries to the National Cancer Institute's Cancer Information Service

Purpose: Given increased cannabis use for medical and nonmedical purposes alike, there is growing public interest related to the potential risks and benefits of cannabis use, particularly related to cancer. The purpose of this descriptive study was to analyze cannabis inquiries to the National Cancer Institute's Cancer Information Service (CIS). Materials and Methods: From September 2018 to June 2023, 190,070 noncannabis and 425 cannabis inquiries were documented by the CIS. Cannabis inquiries were delineated into two categories: nonmedical cannabis (NMC, n=240) or medical cannabis (MC, n=185). Chi-square tests were performed to determine differences between noncannabis and cannabis inquiries and descriptive analyses were used to identify patterns within cannabis-specific inquiries. Results: Statistically significant differences between noncannabis and cannabis inquiries were observed. In addition, there were variations in MC and NMC inquiries. For example, 73% of MC inquiries originated from cancer survivors and caregivers, whereas almost half of NMC inquiries (48%) were from individuals identifying as tobacco users. MC and NMC inquiries also differed by CIS access channel (e.g., instant chat, telephone), language used (English vs. Spanish), discussions of cancer continuum phases and cancer sites, and referrals provided to individuals for additional information and resources. Conclusion: Cannabis-related information needs of the public-as documented by the CIS-varied by several factors. Health information sources such as the CIS can help address cannabis-related questions and concerns, while noting differences in who is inquiring, how, and why.

Recommandation par les infirmières en oncologie concernant la prise de cannabis au Canada pour soulager les nausées et les vomissements induits par la chimiothérapie : étude des facteurs d’influence

Une étude transversale descriptive a été réalisée pour déterminer les facteurs qui incitent les infirmières canadiennes en oncologie à suggérer la prise de cannabis à leurs patients pour soulager les nausées et vomissements induits par chimiothérapie (NVIC). Au total, 678 membres de l’Association canadienne des infirmières en oncologie (ACIO/CANO) ont reçu, entre le 8 février et le 10 avril 2022, une invitation à répondre au sondage, suivie de trois rappels. Une infirmière enseignante a aussi envoyé l’invitation à 131 autres infirmières en oncologie de l’est de l’Ontario. Le sondage s’appuyait sur le modèle d’utilisation de la recherche d’Ottawa. En tout, 27 personnes ont ouvert le lien du sondage et 25 l’ont rempli. Onze (47,8 %) d’entre elles ont répondu à la question sur l’efficacité du cannabis pour soulager les NVIC. Les trois principaux obstacles à recommander la prise de cannabis étaient la stigmatisation sociale, le manque de connaissances des infirmières et le manque de directives au sein du milieu de travail. Tous les participants ont relevé l’importance de la formation continue et de directives écrites sur le recours au cannabis pour soulager les NVIC. Le sondage a reçu peu de réponses, mais dans l’ensemble, les répondants se disaient mal préparés pour proposer la prise de cannabis en traitement des NVIC.

Factors influencing Canadian oncology nurses discussing cannabis use with patients experiencing chemotherapy-induced nausea

A descriptive, cross-sectional study was conducted to determine factors influencing Canadian oncology nurses discussing cannabis use with patients experiencing chemotherapy-induced nausea (CIN). A survey invitation and three reminders were sent to 678 members of the Canadian Association of Nurses in Oncology (CANO) between February 8 and April 10, 2022. An educator sent an extra invitation to 131 oncology nurses in Eastern Ontario. The survey was based on the Ottawa Model of Research Use. Twenty-seven opened the link to the survey and 25 responded. Of 25 nurses, 11 (47.8%) correctly answered the knowledge question about the effectiveness of cannabis for CIN. The top three barriers to discussing cannabis use were social stigma, nurses' lack of knowledge, and lack of guidance within the workplace. All participants identified needing continuing education and written guidance about use of cannabis for CIN. Although few oncology nurses responded to the survey, most indicated feeling inadequately prepared to discuss cannabis use with patients experiencing CIN.

Addressing cannabis consumption among patients with hyperemesis gravidarum

Severe nausea and vomiting of pregnancy and hyperemesis gravidarum affect up to 3% of all pregnant people, causing substantial maternal and neonatal morbidity, suffering, and financial cost. Evidence supports the association of cannabis consumption with symptoms of severe nausea and vomiting of pregnancy or hyperemesis gravidarum as the general public has come to believe that cannabis is a natural, safe antiemetic. Cannabis consumption in pregnancy is discouraged strongly by the Surgeon General of the United States and the American College of Obstetricians and Gynecologists because of evidence of potential harms. Symptoms of intractable, severe nausea and vomiting of pregnancy or hyperemesis gravidarum associated with cannabis consumption may be unrecognized cannabinoid hyperemesis syndrome, and this syndrome may be more common than previously thought. Cannabis consumption is especially detrimental when causing or exacerbating debilitating symptoms such as the intense, persistent, recurrent, or cyclic vomiting and associated dehydration and other sequelae of cannabinoid hyperemesis syndrome. Open discussion of cannabis consumption during pregnancy is very challenging for patients and maternity care providers in our current environment of variable legal status across states and variable degrees of personal and societal acceptance. Evidence-based medical knowledge, guidance, tools, and skills are needed to differentially diagnose and treat cannabinoid hyperemesis syndrome in pregnancy. Researchers, clinicians, and medical specialty organizations must work together to strengthen the evidence base and develop or refine the necessary guidelines and tools for maternity care provider skill development, and to increase public and patient awareness of cannabinoid hyperemesis syndrome, specifically during pregnancy.

"We want what's best for patients." nurse leaders' attitudes about medical cannabis: A qualitative study

Background

The majority of states have legalized medical cannabis. Nurse leaders must be prepared for an increase in patients' use of the drug across all care settings.

Objectives

To explore nurse leaders' attitudes towards, knowledge of, and experiences with medical cannabis.

Design

: Descriptive qualitative study design.

Participants

28 nurse leaders-19 in four focus groups of 3-7 participants and another 9 in interviews.

Methods

Semi-structured, one-on-one interviews and focus groups of nurse leaders about their attitudes towards and experiences with patients' use of medical cannabis. Thematic analysis was used to identify themes and subthemes.

Results

Four major themes were identified: overwhelming support for legalized medical cannabis; importance of overcoming the stereotype of a gateway drug; problematic mismatch between federal and state cannabis policies; and nursing needs to be move involved.

Conclusions

There was strong support for legalized medical cannabis to meet patients' needs; yet, respondents reported little discussion about or education regarding medical cannabis among nurses. Inconsistent federal and state cannabis policies were viewed as especially problematic and in need of alignment.

Description and Disposition of Patients With Cancer Accessing a Novel, Pharmacist-Led Cannabis Consultation Service

PURPOSE

The Cannabis Consultation Service (CCS) is an innovative pharmacist-led resource at the Sunnybrook Odette Cancer Centre. Its mandate is to provide education and guide patients through access and appropriate use of high-quality plant-derived cannabinoids (PDCs). Our objective was to describe the CCS, explain its processes, and characterize patient disposition with respect to use of PDCs.

METHODS

We retrospectively reviewed the charts of patients referred to the CCS from July 13, 2020, to March 05, 2021. We used descriptive statistics to report on the patient population and service metrics.

RESULTS

During the 34-week period, 96 patients accessed the CCS (median age, 61 years). The top reasons for CCS consultation were management of cancer pain, insomnia, and general interest. Medical cannabis was supported as an option in 44/96 patients. Reasons for not supporting PDC use included lack of indication, potential drug interaction/contraindication, or requiring treatment with first-line therapy. Of the 40 patients requiring a medical document, 22 initiated therapy. The most common product used was a 2:50 THC:CBD (Tetrahydrocannabinol:Cannabidiol) cannabis oil. At the date of last contact, few patients remained on therapy because of lack of benefit, patient choice, and/or hesitancy.

CONCLUSION

Despite patients with cancer having interest in seeking PDCs for symptom management, only a few initiated and continued therapy. Pharmacists have an opportunity to advise patients and the oncology team on the risks and benefits of PDCs. These results can be used to support the development of medical cannabis programs by oncology centers and focus future research priorities.

Healthcare practitioner perceptions on barriers impacting cannabis prescribing practices

Background

Canadians seeking medical cannabis (MC) may encounter difficulties in finding a healthcare provider (HCP) who authorizes their access to it. Barriers that HCPs face in authorizing MC are unclear. The objectives of this study were to evaluate HCP opinions, knowledge, comfort, and practice in MC prescribing and counseling on recreational cannabis use, and whether the COVID-19 pandemic affected MC prescribing practices.

Methods

Eligible participants included HCPs (e.g., attending physicians, nurses, pharmacists) in Canada. A questionnaire evaluating their knowledge, comfort, and practice in medical and recreational cannabis was designed based on instruments developed in previous studies. Between April 13th-December 13th 2021, ninety-one healthcare associations were asked to distribute the survey to their members, and an advertisement was placed in the online Canadian Medical Association Journal. Descriptive statistics were used to analyze the results.

Results

Twenty-four organizations agreed to disseminate the survey and 70 individuals completed it. Of respondents, 71% were attending physicians or medical residents, while the remainder were nurses, pharmacists or other HCPs. Almost none (6%) received training in MC in professional school but 60% did receive other training (e.g., workshops, conferences). Over half (57%) received more questions regarding MC since recreational cannabis was legalized, and 82% reported having patients who use MC. However, 56% felt uncomfortable or ambivalent regarding their knowledge of MC, and 27% were unfamiliar with the requirements for obtaining MC in Canada. The most common symptoms for recommending MC were pain and nausea, whereas the most common conditions for recommending it were cancer and intractable pain. The strongest barrier to authorizing MC was uncertainty in safe and effective dosage and routes of administration. The strongest barrier to recommending or authorizing MC was the lack of research evidence demonstrating its safety and efficacy. During the pandemic, many respondents reported that a greater number of their patients used cannabis to relieve anxiety and depression.

Conclusions

Our results suggest that HCPs across Canada who responded to our survey are unfamiliar with topics related to MC. The strongest barriers appear to be lack of clinical research, and uncertainty in safe and effective MC administration. Increasing research, training, and knowledge may help HCPs feel more equipped to make informed treatment/prescribing decisions, which may help to improve access to MC.

Controversial Link between Cannabis and Anticancer Treatments-Where Are We and Where Are We Going? A Systematic Review of the Literature

Simple Summary

In the field of oncology, preclinical research has shown that cannabis and cannabinoids modulate signaling pathways involved in cell proliferation, migration, invasion, angiogenesis, programmed cell death, and metastasis. Based on these findings, as medical cannabis becomes legal in more and more countries, cancer patients and their families are increasingly interested in the potential benefits of herbal medicine as an element of complementary and alternative medicine in their treatment. Although its clinical efficacy has been demonstrated in preclinical studies, clinical trials with cancer patients are lacking. To draw clear conclusions, we await the results of further prospective and randomized studies on this clinically relevant topic.

Abstract

Background and Objectives: Cannabinoids are currently used in cancer patients primarily for their pain-relieving and antiemetic properties. The aim of our review was to synthesize all available data of studies evaluating the therapeutic efficacy of cannabis in combination with oncological treatments in cancer patients and to explore ongoing studies with different goals and medical areas registered in the field of oncology worldwide. Materials and Methods: This study was performed in accordance with the PRISMA guidelines. A search using MEDLINE/PubMed database was performed between 1 January 2006 and 1 March 2022. Search terms included the following: cannabidiol, cannabis, CBD, dronabinol, endocannabinoids, medical marijuana, nabiximols, nabilone, THC, and cancer. All studies that examined the efficacy of cannabis administered during oncological treatments, regardless of cancer localization, subtype, and sample size, were considered eligible. Results: In three studies, cannabis was administered to patients with glioblastoma, and in two other studies, cannabis was used in combination with immunotherapy in various cancer subgroups. The results of the clinical trials in cancer patients are not sufficient to draw conclusions at this time. Interestingly, several other studies addressing the systemic effects of cannabinoids in cancer patients are currently listed in the U.S. National Library of Medicine’s registry on the ClinicalTrials.gov website. However, only one of the registered studies examined the efficacy of cannabinoids as a potential option for systemic cancer treatment. Conclusions: Although cannabis is touted to the public as a cancer cure, clinical trials need to clarify which combinations of chemotherapeutic agents with cannabinoids are useful for cancer patients.

Exploratory Factor Analysis of Medical Students’ Perceptions of Medical Cannabis Scale

Background

There are few published research articles investigating medical students’ perceptions of medical cannabis (MC), including their attitudes toward its efficacy and appropriateness in medicine, concerns for potential adverse effects, and their willingness to prescribe it to patients (in future practice). This research investigated the factor structure of a tool to assess medical students’ perceptions of MC for the purpose of curriculum enhancement.

Methods

Using a voluntary electronic survey, quantitative data were collected between January and March 2022 from 526 medical students enrolled in a large medical school in Florida, United States. A 32-item questionnaire developed by the researchers was used to investigate medical students’ perceptions of MC. The survey was anonymous and took about 10 minutes to complete. Bivariate correlation analyses were conducted prior to performing a principal component analysis with varimax rotation.

Results

Using principal component analysis with varimax rotation, three factors were identified with eigenvalues greater than 1.0 and a cumulative variance of 59.694%. These factors are perceived knowledge of MC, concern for possible adverse effects of MC (e.g., the potential for misuse/dependence), and attitudes toward MC (e.g., cannabis having an acceptable role in medicine, willingness (as a future physician) to help patients access MC, obtaining training about MC in school and residency training, the physician’s role as a prescriber, and efficacy and benefits of MC for certain health conditions).

Conclusions

The development of this kind of brief measure may be valuable for defining the future educational needs of medical students and other health professionals as well as a tool for future research.

Therapeutic Cannabis Use in Kidney Disease: A Survey of Canadian Nephrologists

Rationale & Objective

Cannabis use may be helpful for symptom management in patients with chronic kidney disease (CKD). Knowledge, attitudes, and comfort with use of medical cannabis among kidney care providers may be limiting more widespread evaluation and use. We surveyed Canadian nephrologists regarding current prescribing habits, attitudes, and overall comfort level with cannabis products.

Study Design

We carried out a nationwide, mail-in survey focused on capturing general and practice demographics, current cannabis prescribing status, and knowledge and attitudes regarding therapeutic cannabis use in patients with CKD.

Setting & Population

This survey was distributed to every registered nephrologist in Canada.

Analytical Approach

The results of this survey are reported descriptively.

Results

Responses were received from 208 of 723 (29%) nephrologists. Only 21 (10.1%) respondents currently prescribe cannabis, with chronic pain syndromes being the most frequent reason for cannabis prescription (95.2%). Overall, 116 (55.5%) participants reported that changes in legality of cannabis did not influence their decision to prescribe cannabis. The majority of respondents (n = 123; 59%) indicated that they were uncomfortable with their knowledge of the medical cannabis literature. Most respondents (n=188; 91%) indicated that further studies exploring the efficacy and safety of cannabis would likely influence their prescribing habits.

Limitations

Limitations of this study include possible nonresponse bias and a lack of specific data on practice considerations for specific subpopulations, such as transplant patients.

Conclusions

Only a small minority of Canadian nephrologists currently prescribe cannabis, with relatively little practice change after legalization. There is broad support amongst Canadian nephrologists for encouraging their patients to enroll in efficacy/safety studies of cannabis in the CKD population. Ultimately, given limited therapeutic options available for symptom control in CKD, this survey demonstrates the potential for nationwide practice change if cannabis efficacy and safety can be demonstrated in this population.

Predictors of Medical Students’ Perceptions About Medical Cannabis

Background: There has been a recent uptick in interest regarding the therapeutic properties of cannabis. Evidence exists to support the role of medical cannabis (MC) in chronic illness management for conditions such as posttraumatic stress, pain, and cancer. The majority of physicians in the United States report not knowing how to prescribe or answer questions about MC and receive minimal education about it during training. As MC becomes more socially acceptable with federal legalization in process, new physicians will encounter patients looking for information on the utility and safety of MC. The goal of this research was thus to assess the perceived knowledge, beliefs, and perceptions of medical students towards MC, and to obtain a better understanding of factors that may influence their attitudes.

Methods: A descriptive, cross-sectional study design was used to investigate the medical students’ knowledge, attitudes, and perceptions regarding MC. Quantitative data were collected from 526 medical students (years one to four) via an anonymous, online, 32-item questionnaire to determine if perceived knowledge, concerns about the potential negative effects of cannabis, and certain beliefs would significantly contribute to their attitudes toward MC. Hypothesis testing was conducted using Spearman-rank order correlation and multivariate linear regression analyses.

Results: A statistically significant regression equation was found: (F(4, 428)=114.826, p<.001 with an R²=0.518 [adjusted R² =0.513]) indicating greater perception of knowledge about MC, lower concern for possible negative effects of MC use, greater belief in federal legalization of MC, and greater belief in the federal legalization of recreational cannabis significantly contributed to a higher score on positive attitudes and perceptions toward MC. Moreover, while many participants reported physicians should be able to prescribe MC, they reported that little if any MC education had been provided.

Conclusions: This study identified the knowledge, concerns, and perceptions of medical students regarding MC as well as several factors contributing to their attitudes about it. Favorable attitudes toward MC among patients exist and as its popularity and acceptance among patients continue, more may be asking their physicians about symptomatic and curative treatment with cannabis-based products. Results from this research have the potential to assist medical educators in understanding students’ perceptions about MC to help guide innovative and contemporary curricular advances as a public health imperative.

Raba konoplje v medicinske namene

Uvod: Slovenija je leta 2017 spremenila uredbo o razvrstitvi prepovedanih drog in omogočila uporabo konoplje v medicinske namene. Konoplja ima več kot 140 kanabinoidnih spojin, med katerimi sta najbolj izpostavljeni kanabidiol in tetrahidrokanabinol, saj imata potencial za zdravljenje bolezni. Namen pregleda je raziskati rabo konoplje v medicinske namene.Metode: Izveden je bil integrativni pregled literature v digitalni zbirki podatkov PubMed, spletnem iskalniku Google učenjak in vzajemnemu bibliografskemu sistemu COBISS s pomočjo besednih zvez: »cannabis AND medical use«, »marihuana AND medical use« in »raba konoplje v medicinske namene«. Omejitve iskanja so bile: obdobje objave literature (2008–2019), prost dostop do recenziranih strokovnih in znanstvenih člankov ter literatura v angleškem ali slovenskem jeziku. Za pregled literature je bila uporabljena tematska analiza prebranega gradiva.Rezultati: Za pregled literature je bilo za končno analizo primernih 29 člankov. Identificiranih je bilo 52 kod, združenih v štiri teme: (1) zdravljenje s konopljo, (2) lastnosti konoplje, (3) delovanje kanabidiola, (4) delovanje tetrahidrokanabinola.Diskusija in zaključek: Konoplja se že tisočletja uporablja v medicinske namene. Danes jo v svetu uporabljajo predvsem za zdravljenje naslednjih bolezni: astme, diabetesa, epilepsije, raka, Parkinsonove bolezni, Alzheimerjeve demence, multiple skleroze. V Sloveniji je konoplja odstranjena s seznama najbolj nevarnih drog, a do njene rabe v medicinske namene je zahteven proces.

A systematic review of medical students' and professionals' attitudes and knowledge regarding medical cannabis

Background

Recently, the renewed global interest in cannabis’ therapeutic properties has resulted in shifting attitudes and legislative policies worldwide. The aim of this systematic review is to explore the existing literature on medical professionals’ and students’ attitudes and knowledge regarding medicinal cannabis (MC) to assess any relevant and significant trends.

Methods

This systematic review was conducted in accordance with PRISMA guidelines. Using PubMed and Google Scholar, a literature search was performed to identify studies pertaining to healthcare professionals’ and medical students’ knowledge and attitudes regarding MC. There were no search limits on the year of publication; however, studies without primary data (e.g., abstracts, systematic reviews, meta-analyses) and non-English language papers were excluded. Studies were coded according to the following research questions: (1) Do respondents believe that cannabis should be legalized (for medicinal and/or recreational purposes)? (2) Are respondents confident in their level of knowledge regarding cannabis’ clinical applications? (3) Are respondents convinced of cannabis’ therapeutic potential? 4) What current gaps in knowledge exist, and how can the medical community become better informed about cannabis’ therapeutic uses? and (5) Are there significant differences between the knowledge and opinions of healthcare students versus healthcare professionals with respect to any of the aforementioned queries? Chi-square tests were used to assess differences between medical students and medical professionals, and Pearson’s bivariate correlations were used to analyze associations between survey responses and year of publication—as a proxy measurement to assess change over time.

Results

Out of the 741 items retrieved, 40 studies published between 1971 and 2019 were included in the final analyses. In an evaluation of 21 qualified studies (8016 respondents), 49.9% of all respondents favored legalization (SD = 25.7, range: 16–97%). A correlational analysis between the percentage of survey respondents who support MC legalization and year of publication suggests that both medical students’ and professionals’ support for MC legalization has increased from 1991 to 2019 (r(19) = .44, p = .045). Moreover, medical professionals favor the legalization of MC at a significantly higher rate than students (52% vs. 42%, respectively; χ² (1, N = 9019) = 50.72 p < .001). Also, respondents consistently report a strong desire for more education about MC and a substantial concern regarding MC’s potential to cause dependence and addiction. Pearson’s correlations between year of publication and survey responses for both of these queried variables suggest minimal changes within the last decade (2011–2019 for addiction and dependence, 2012-2019 for additional education; r(13) = − .10, p = .713 and r(12) = − .12, p = .678, respectively).

Conclusion

The finding that both medical students’ and professionals’ acceptance of MC has significantly increased in recent decades—in conjunction with their consistent, strong desire for more educational material—suggests that the medical community should prioritize the development of MC educational programs. MC is far more likely to succeed as a safe and viable therapy if the medical professionals who administer it are well-trained and confident regarding its clinical effects. Limitations include a lack of covariate-based analyses and the exclusion of studies published after the literature search was performed (June 2019). Future research should analyze studies published post-2019 to draw temporal comparisons and should investigate the effect of numerous covariates (e.g., gender, religiosity, prior cannabis use) as newer studies gather data on these factors [PROSPERO Registration: CRD42020204382].

A randomized trial of medical cannabis in patients with stage IV cancers to assess feasibility, dose requirements, impact on pain and opioid use, safety, and overall patient satisfaction

PURPOSE

The prevalence of medical cannabis (MC) use in patients with cancer is growing, but questions about safety, efficacy, and dosing remain. Conducting randomized, controlled trials (RCTs) using state-sponsored MC programs is novel and could provide data needed to guide patients and providers.

METHODS

A pilot RCT of patients with stage IV cancer requiring opioids was conducted. Thirty patients were randomized 1:1 to early cannabis (EC, n = 15) versus delayed start cannabis (DC, n = 15). The EC group obtained 3 months (3 M) of MC through a state program at no charge, while the DC group received standard oncology care without MC for the first 3 M. Patients met with licensed pharmacists at one of two MC dispensaries to determine a suggested MC dosing, formulation, and route. Patients completed surveys on pain levels, opioid/MC use, side effects, and overall satisfaction with the study.

RESULTS

Interest in the study was high as 36% of patients who met eligibility criteria ultimately enrolled. The estimated mean daily THC and CBD allotments at 3 M were 34 mg and 17 mg, respectively. A higher proportion of EC patients achieved a reduction in opioid use and improved pain control. No serious safety issues were reported, and patients reported high satisfaction.

CONCLUSION

Conducting RCTs using a state cannabis program is feasible. The addition of MC to standard oncology care was well-tolerated and may lead to improved pain control and lower opioid requirements. Conducting larger RCTs with MC in state-sponsored programs may guide oncology providers on how to safely and effectively incorporate MC for interested patients.

A Mapping Literature Review of Medical Cannabis Clinical Outcomes and Quality of Evidence in Approved Conditions in the USA from 2016 to 2019

In 2017, a National Academies of Sciences, Engineering, and Medicine (NASEM) report comprehensively evaluated the body of evidence regarding cannabis health effects through the year 2016. The objectives of this study are to identify and map the most recently (2016-2019) published literature across approved conditions for medical cannabis and to evaluate the quality of identified recent systematic reviews, published following the NASEM report. Following the literature search from 5 databases and consultation with experts, 11 conditions were identified for evidence compilation and evaluation: amyotrophic lateral sclerosis, autism, cancer, chronic noncancer pain, Crohn's disease, epilepsy, glaucoma, human immunodeficiency virus/AIDS, multiple sclerosis (MS), Parkinson's disease, and posttraumatic stress disorder. A total of 198 studies were included after screening for condition-specific relevance and after imposing the following exclusion criteria: preclinical focus, non-English language, abstracts only, editorials/commentary, case studies/series, and non-U.S. study setting. Data extracted from studies included: study design type, outcome definition, intervention definition, sample size, study setting, and reported effect size. Few completed randomized controlled trials (RCTs) were identified. Studies classified as systematic reviews were graded using the Assessing the Methodological Quality of Systematic Reviews-2 tool to evaluate the quality of evidence. Few high-quality systematic reviews were available for most conditions, with the exceptions of MS (9 of 9 graded moderate/high quality; evidence for 2/9 indicating cannabis improved outcomes; evidence for 7/9 indicating cannabis inconclusive), epilepsy (3 of 4 graded moderate/high quality; 3 indicating cannabis improved outcomes; 1 indicating cannabis inconclusive), and chronic noncancer pain (12 of 13 graded moderate/high quality; evidence for 7/13 indicating cannabis improved outcomes; evidence from 6/7 indicating cannabis inconclusive). Among RCTs, we identified few studies of substantial rigor and quality to contribute to the evidence base. However, there are some conditions for which significant evidence suggests that select dosage forms and routes of administration likely have favorable risk-benefit ratios (i.e., epilepsy and chronic noncancer pain). The body of evidence for medical cannabis requires more rigorous evaluation before consideration as a treatment option for many conditions, and evidence necessary to inform policy and treatment guidelines is currently insufficient for many conditions.

Effectiveness of complementary therapies for the management of symptom clusters in palliative care in pediatric oncology: a systematic review

OBJECTIVE

To evaluate the effectiveness of complementary therapies in the management of symptom clusters in children and adolescents with cancer undergoing palliative care.

METHOD

Systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, resorting to the databases MEDLINE, Web of Science, Central Cochrane, and PsycINFO. The identification, selection, inclusion, extraction, and methodological assessment were conducted by two independent reviewers.

RESULTS

Five quasi-experiments met the eligibility criteria. The heterogeneous characteristics of the studies made meta-analysis impossible. Two studies used therapeutic massage, one used Reiki, one used boswellic acid, and one used Cannabis sativa; three of them (therapeutic massage and Reiki) presented statistically significant results for the management of the cluster pain-anxiety-worry-dyspnea. Most studies presented a moderate risk of bias as per ROBINS-I tool.

CONCLUSION

Therapeutic massage and Reiki may be effective for the symptom clusters management, especially the pain-anxiety-worry-dyspnea cluster in children and adolescents undergoing palliative care.

Parent and patient perceptions of medical marijuana in the childhood cancer context

BACKGROUND

Medical marijuana (MM) is legal in 34 US jurisdictions. Yet, little is known about patient and parent perceptions of MM in pediatric cancer care. We examined attitudes, beliefs, and experiences regarding MM among parents of children with cancer and adolescent and young adult (AYA) patients, to help frame future research initiatives.

PROCEDURE

In this qualitative study, we conducted semi-structured, one-on-one interviews with parents and AYAs at a comprehensive cancer center. Interviews were audio-recorded, transcribed, and coded using both descriptive and inductive coding approaches. We used content and framework analysis to identify key themes.

RESULTS

Fifteen parents and 15 AYAs enrolled. Participants were generally receptive to MM use, concurrently weighing benefits and risks. Participants most often endorsed MM use for relief of nausea, anorexia, and pain. Simultaneously, participants identified concerns about MM, including potential physiologic and psychological effects on children and lack of research. However, concerns were frequently minimized, relative to chemotherapy or supportive care medications with perceived greater side effect profiles. Many participants expressed uncertainty regarding legal access, citing complex processes to obtain MM. Few participants had discussed MM with their oncologist, instead seeking guidance from the internet, family, or peers. Importantly, we elicited several misconceptions regarding MM, including its utility as cancer-directed therapy.

CONCLUSION

Patients and families are receptive to using MM, motivated by potential for symptom relief and cancer-directed effects. Yet, lack of empiric evidence is a barrier, underscoring the need for robust clinical trial data to support MM recommendations and use.

Attitudes toward medical cannabis among family physicians practising in Ontario, Canada: a qualitative research study

BACKGROUND

Medical cannabis has been legally available in Canada since 2001, but its benefits and harms remain uncertain. We explored attitudes toward medical cannabis among family physicians practising in Ontario.

METHODS

Between January and October 2019, we conducted a qualitative study of Ontario family physicians using semistructured telephone interviews. We applied thematic analysis to interview transcripts and identified representative quotes.

RESULTS

Eleven physicians agreed to be interviewed, and 3 themes regarding medical cannabis emerged: reluctance to authorize use, concern over harms and lack of practical knowledge. Participants raised concerns about the limited evidence for, and their lack of education regarding, the therapeutic use of cannabis, particularly the harms associated with neurocognitive development, exacerbation of mental illness and drug interactions in older adults. Some participants thought medical cannabis was overly accessible and questioned their role following legalization of recreational cannabis.

INTERPRETATION

Despite the increasing availability of medical cannabis, family physicians expressed reluctance to authorize its use because of lack of knowledge and concerns regarding harms. Family physicians may benefit from guidance and education that address concerns they have surrounding medical cannabis.

Nephrologist Views Regarding Cannabinoid Use in Advanced Chronic Kidney Disease and Dialysis: A Survey

CONTEXT

The efficacy and safety of cannabinoids to treat symptoms in individuals with kidney disease is uncertain.

OBJECTIVES

We sought to elicit Canadian nephrologists' views regarding the use and study of cannabinoids in patients with kidney disease in an Internet-based survey of Canadian of Society of Nephrology members treating adult patients with kidney disease including dialysis.

METHODS

The degree to which respondents supported the use or study of cannabinoids for symptoms common in kidney disease was assessed using a modified Likert scale ranging from 1 to 7 (anchored at 1-definitely would not and 7-being definitely would). Participants were asked their degree of support for cannabinoid use in clinical practice and for randomized controlled trials examining cannabinoids for anxiety, depression, restless legs syndrome, itchiness, fatigue, chronic pain, decreased appetite, nausea/vomiting, sleep disorder, and others. Multilevel multivariable linear regression was used to identify independent predictors of the degree of support.

RESULTS

There were 151 (43.4%) responses from 348 eligible participants. One hundred twenty-four (82%) previously cared for patients using prescribed cannabinoids by other providers, and 29 (19%) had previously prescribed cannabinoids themselves. One hundred thirty-seven (91%) had previously cared for patients using nonprescription cannabinoids, which were used most commonly recreationally (88.3%), for chronic pain (73.7%) or for anxiety (52.6%). Respondents supported the use of cannabinoids (mean score >5) for each symptom in the setting of refractory symptoms. Similarly, respondents supported enrolling patients for trials for all symptoms (mean scores >5).

CONCLUSION

Nephrologists broadly support the use and study of cannabinoids for symptoms in patients with kidney disease.

The Role of Cannabinoids as Anticancer Agents in Pediatric Oncology

Simple Summary

The endocannabinoid system (ECS) is a complex signaling pathway system involved in the regulation of multiple functions in both normal tissues and cancer. Δ9-tetrahydrocannabinol and cannabidiol are plant-derived cannabinoids that possess some efficacy against adult cancer, in part via modulation of the ECS, and may be less toxic agents compared to other treatments used in oncology. To date, there are minimal studies that have investigated these drugs in the pediatric cancer setting. Indeed, there are currently no preclinical or clinical studies examining the effects of cannabinoids in pediatric brain cancer, although there is some evidence that they can alleviate symptoms associated with childhood cancer therapy, such as vomiting and nausea. Given there is accumulating evidence that cannabis use during adolescence is associated with poor mental and cognitive health, there is a present and urgent need to investigate the safety and efficacy of cannabinoids in pediatric oncology to provide guidance to families and physicians.

Abstract

Cannabinoids are a group of chemicals that bind to receptors in the human body and, in turn, modulate the endocannabinoid system (ECS). They can be endogenously produced, synthetic, or derived from the plant Cannabis sativa L. Research over the past several decades has shown that the ECS is a cellular communication network essential to maintain multiple biological functions and the homeostasis of the body. Indeed, cannabinoids have been shown to influence a wide variety of biological effects, including memory, pain, reproduction, bone remodeling or immunity, to name a few. Unsurprisingly, given these broad physiological effects, alterations of the ECS have been found in different diseases, including cancer. In recent years, the medical use of cannabis has been approved in different countries for a variety of human conditions. However, the use of these compounds, specifically as anticancer agents, remains controversial. Studies have shown that cannabinoids do have anticancer activity in different tumor types such as breast cancer, melanoma, lymphoma and adult brain cancer. Specifically, phytocannabinoids Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) has been shown to induce apoptosis and inhibit proliferation of adult cancer cells, as well as modulate angiogenesis and metastasis. Despite increasing evidence that cannabinoids elicit antitumor effects in adult cancers, there is minimal data available on their effects in children or in pediatric cancers despite public and clinical demand for information. Here we describe a comprehensive and critical review of what is known about the effects of cannabinoids on pediatric cancers, highlight current gaps in knowledge and identify the critical issues that need addressing before considering these promising but controversial drugs for use in pediatric oncology.

Cancer patients' experiences with medicinal cannabis-related care

BACKGROUND

Little is known about medical cannabis (MC)-related care for patients with cancer using MC.

METHODS

Semistructured telephone interviews were conducted in a convenience sample of individuals (n = 24) with physician-confirmed oncologic diagnoses and state/district authorization to use MC (Arizona, California, Florida, Illinois, Massachusetts, Oregon, New York, and Washington, DC) from April 2017 to March 2019. Standard qualitative techniques were used to assess the degree of MC-related health care oversight, MC practices, and key information sources.

RESULTS

Among 24 participants (median age, 57 years; range, 30-71 years; 16 women [67%]), MC certifications were typically issued by a professional new to a patient's care after a brief, perfunctory consultation. Patients disclosed MCuse to their established medical teams but received little medical advice about whether and how to use MC. Patients with cancer used MC products as multipurpose symptom management and as cancer-directed therapy, sometimes in lieu of standard-of-care treatments. Personal experimentation, including methodical self-monitoring, was an important source of MC know-how. Absent formal advice from medical professionals, patients relied on nonmedical sources for MC information.

CONCLUSIONS

Patients with cancer used MC with minimal medical oversight. Most received MC certifications through brief meetings with unfamiliar professionals. Participants desired but were often unable to access high-quality clinical information about MC from their established medical teams. Because many patients are committed to using MC, a product sustained by a growing industry, medical providers should familiarize themselves with the existing data for MM and its limitations to address a poorly met clinical need.

Perceptions of quality and safety in cannabis acquisition amongst young gay and bisexual men living with HIV/AIDS who use cannabis: Impact of legalisation and dispensaries

BACKGROUND

Upwards of 35% of young gay and bisexual men living with HIV report daily use of cannabis in the U.S. The effects of legalisation of recreational and medical cannabis on the acquisition of cannabis products amongst a group with such high prevalence of use is largely unknown.

METHODS

We investigated potential effects of recent legalisation and changes in distribution venues/networks in U.S. jurisdictions (Denver and Chicago) with different legal statuses regarding medical and recreational cannabis. We conducted semi-structured interviews with 30 young gay and bisexual men living with HIV recruited from adolescent HIV clinics and service sites in the two cities.

RESULTS

Findings indicate four domains in which the acquisition of cannabis from medical or recreational dispensaries was differentiated by participants from acquisition from illicit drug distribution networks: quality of information, perceived quality of products, safety of acquisition, and safety of products. Some participants expressed reservations in becoming involved with requirements for accessing legal distribution of medical and recreational cannabis.

CONCLUSIONS

Our findings indicate that young men living with HIV in Denver perceive benefits from legalisation of cannabis in terms of quality of information and products and safety of acquisition for a range of medical, therapeutic, and recreational uses. Participants in Chicago report mixed levels of knowledge of potential benefits through the medical cannabis dispensaries in their area, and continue to be exposed to safety risks associated with street-based acquisition. Concerns regarding institutional involvement in medical cannabis registries and dispensaries may inhibit the uptake of legal means of acquisition in sub-populations of young men living with HIV.

Experiences, patient interactions and knowledge regarding the use of cannabis as a medicine in a cohort of New Zealand doctors in an oncology setting

PURPOSE OF STUDY

To explore the experiences, patient interactions and knowledge regarding the use of cannabis as a medicine in New Zealand doctors in an oncology setting.

STUDY DESIGN

An observational cross-sectional survey undertaken between November 2019 and January 2020 across four secondary-care hospital oncology departments within New Zealand (Auckland, Wellington, Christchurch and Dunedin). Participants were a convenience sample of doctors; consultants, registrars, medical officers of special status and house surgeons working in oncology departments. Of 53 individuals approached, 45 participated (85% Response Rate). The primary outcome was reporteddoctor-patient interactions. Secondary outcomes included knowledge of cannabis-based products, their efficacy, prescribing regulations and educational access.

RESULTS

Of 44 doctors, 37 (84%, 95% CI: 70 to 93) reported patient requests to prescribe cannabis-based products and 43 (98%, 95% CI: 88 to 100) reported patients using illicit cannabis for medical symptoms. Primary request reasons were pain, nausea/vomiting and cancer treatment. 33/45 (73%, 95% CI: 58 to 85) cited knowledge of at least one cannabis-based product and 27/45 (60%, 95% CI: 44 to 74) indicated at least one condition that had evidence of efficacy. 36/44 (82%, 95% CI: 67 to 92) expressed future prescribing concerns but all were willing to use a cannabis-based product developed with traditional medical provenance.

CONCLUSION

In the oncology setting, patients are asking doctors about symptomatic and curative treatment with cannabis-based products. Doctors are not biased against the use of products showing medical provenance; however, NZ-specific clinical and regulatory guidelines are essential to support patient discussions and appropriate prescribing.

Exploring the Use of State Medical Cannabis Legislation as a Proxy for Medical Cannabis Use Among Patients Receiving Chemotherapy

OPINION STATEMENT

The use of medical cannabis is expanding in the USA. Due to conflicting, low-quality evidence, many oncologists may not feel confident to recommend it to patients. Given the potential for legal and financial risks when conducting clinical trials with medical cannabis, the use of observational data should be explored. Observational data that directly capture medical cannabis use in relation to prescription medications and track the prevalence and patterns of cannabis use is sparse. To gain insights into the role medical cannabis plays in the pharmaceutical landscape, proxies such as cannabis legislation need to be explored. In the context of recommendation-nonadherent antiemetic prescribing among patients experiencing chemotherapy-induced nausea and vomiting, medical cannabis may be a suitable alternative to an antiemetic in states that allow medical cannabis. Findings suggest that legislation may impact the use of certain antiemetics in states with cannabis legislation in place. The presence or absence of legislation regarding medical cannabis use may serve as an early, observable surrogate marker of medical cannabis use in the community. In light of the paucity of clinical trials and observational datasets that capture cannabis use, there remains a tremendous need for the development of methodologies or standardized datasets that appropriately and reliably capture the use of medical cannabis to facilitate research into its clinical application and effect on prescription medication use. Standardizing the reporting and destigmatizing use could eliminate the dependence upon proxy measures as a substitute for more extensive data and go a long way in improving data capture, thus allowing us to generate knowledge and hypotheses from observational data until research conditions improve and allow for expanded clinical trials involving medical cannabis.

Medical Cannabis in Cancer Patients: A Survey of a Community Hematology Oncology Population

OBJECTIVES

Cancer patients are using medical cannabis (MC) to address symptoms; however, little data exist to guide clinicians when counseling patients. We seek to define the patterns of MC use among cancer patients, as well as efficacy and safety of MC.

MATERIALS AND METHODS

Cancer patients attending oncology office visits at Beaumont Hospital, Michigan from July to December 2018 were anonymously surveyed. The survey included data regarding demographics, diagnosis, treatment, symptom burden, and MC use. Patients who reported MC use since their cancer diagnosis completed a section on patterns of use, efficacy, and safety.

RESULTS

The response rate was 188 of 327 (57.5%). MC use was reported by 46 of 188 (24.5%). A median composite baseline symptom score ranging from 8 (best) to 32 (worst) was higher in patients using MC versus nonusers; 17.5 versus 14.4 (P<0.001). Pain was the symptom with the highest frequency of improvement 34/42 (81%), followed by appetite 34/44 (77.3%), and anxiety 32/44 (73%). MC improved the ability to tolerate treatment in 24/44 (54.5%). Cloudy thinking is the symptom that worsened the most 7/42 (16.7%), with decreased energy being experienced by 4/41 (9.8%) of the users.

CONCLUSIONS

MC was utilized by a significant portion of cancer patients in this sample, across age, diagnosis, stage, and treatment. Patients with a higher severity of baseline symptoms were more likely to use MC and report a favorable efficacy profile of MC. Minimal toxicity was reported in this cohort. Prospective studies are needed to define the efficacy and safety of MC.

Medical cannabis in supportive cancer care: lessons from Canada

Medical cannabis, or cannabinoid-based products, continues to grow in popularity globally, driving the evolution of regulatory access frameworks; cancer patients and caregivers often rely on guidance from their physicians regarding cannabinoid-based treatments. But the majority of healthcare practitioners still feel unprepared and insufficiently informed to make reasonable, evidence-based recommendations about medical cannabis. More than 30 countries worldwide have now legalized access to medical cannabis; yet various nations still face arduous regulatory challenges to fulfill the needs of patients, healthcare practitioners, and other medical stakeholders. This has affected the deployment of comprehensive medical cannabis access programs adapted to cultural and social realities. With a 20-year history of legal medical cannabis access and nearly 400,000 registered patients under its federal access program, Canada serves as a model for countries which are developing their regulatory frameworks. The Canadian clinical experience in cannabinoid-based treatments is also a valuable source of lessons for healthcare professionals who wish to better understand the current evidence examining medical cannabis for oncology patients.

Online patient-provider cannabis consultations

Cannabis has been legalized, decriminalized, or medicalized in over half the U.S. states. With restrictions on cannabis research, accepted standards to guide clinical practice are lacking. Analyzing online communications through a digital health platform, we characterized patient questions about cannabis use and provider responses. Coded for content were 4579 questions posted anonymously online between March 2011 through January 2017, and the responses from 1439 U.S. licensed clinicians. Provider responses to medical cannabis use questions were coded for sentiment: "negative", "positive", and "mixed." Responses could be "thanked" by patients and receive "agrees" from providers. The most frequent themes were detection of cannabis use (25.3%), health harms (19.9%), co-use with other substances (9.1%), and medical use (8.2%). The 425 medical cannabis use questions most frequently related to treatment of mental illness (20.3%), pain (20.0%), and cancer care (6.7%). The 762 provider responses regarding medical cannabis use were coded for sentiment as 59.6% negative, 28.6% mixed, and 11.8% positive. Provider sentiment was most positive regarding cannabis use for palliative care and most negative for treating respiratory conditions, poor appetite, and mental illness. The proportion of positive sentiment responses increased from 17.6% to 32.4%. Provider responses coded as negative sentiment received more provider "Agrees" (mean rank = 280) than those coded as positive (mean rank = 215), beta coefficient = 0.33; 95% CI: 0.05, 0.62; p = .02. Cannabis use is a health topic of public interest. Variability in provider responses reflects the need for more research and consensus building to inform evidence-based clinical guidelines for cannabis use in medicine.

Should Oncologists Recommend Cannabis?

OPINION STATEMENT

Cannabis is a useful botanical with a wide range of therapeutic potential. Global prohibition over the past century has impeded the ability to study the plant as medicine. However, delta-9-tetrahydrocannabinol (THC) has been developed as a stand-alone pharmaceutical initially approved for the treatment of chemotherapy-related nausea and vomiting in 1986. The indication was expanded in 1992 to include treatment of anorexia in patients with the AIDS wasting syndrome. Hence, if the dominant cannabinoid is available as a schedule III prescription medication, it would seem logical that the parent botanical would likely have similar therapeutic benefits. The system of cannabinoid receptors and endogenous cannabinoids (endocannabinoids) has likely developed to help us modulate our response to noxious stimuli. Phytocannabinoids also complex with these receptors, and the analgesic effects of cannabis are perhaps the best supported by clinical evidence. Cannabis and its constituents have also been reported to be useful in assisting with sleep, mood, and anxiety. Despite significant in vitro and animal model evidence supporting the anti-cancer activity of individual cannabinoids-particularly THC and cannabidiol (CBD)-clinical evidence is absent. A single intervention that can assist with nausea, appetite, pain, mood, and sleep is certainly a valuable addition to the palliative care armamentarium. Although many healthcare providers advise against the inhalation of a botanical as a twenty-first century drug-delivery system, evidence for serious harmful effects of cannabis inhalation is scant and a variety of other methods of ingestion are currently available from dispensaries in locales where patients have access to medicinal cannabis. Oncologists and palliative care providers should recommend this botanical remedy to their patients to gain first-hand evidence of its therapeutic potential despite the paucity of results from randomized placebo-controlled clinical trials to appreciate that it is both safe and effective and really does not require a package insert.

Impact of Medical Cannabis on Patient-Reported Symptoms for Patients With Cancer Enrolled in Minnesota’s Medical Cannabis Program

PURPOSE:

Minnesota’s medical cannabis program is unique, in that it routinely collects patient-reported scores on symptoms. This article focuses on changes in symptom severity reported by patients with cancer during their first 4 months of program participation.

MATERIALS AND METHODS:

Patients with cancer in Minnesota’s medical cannabis program reported symptoms (anxiety, lack of appetite, depression, disturbed sleep, fatigue, nausea, pain, and vomiting) at their worst over the last 24 hours before each medical cannabis purchase. Baseline scores on each of the eight symptoms were statistically compared with the average symptom scores reported in the first 4 months of program participation. Symptom scores were also calculated as percent change from baseline, with patients achieving and maintaining at least a 30% reduction in symptoms reported in this article. Patients also reported intensity of adverse effects.

RESULTS:

A significant reduction in scores was found across all symptoms when comparing baseline scores with the average score submitted within the first 4 months of program participation (all Ps < .001). The proportion of patients achieving 30% or greater symptom reduction within the first 4 months of program participation varied from 27% (fatigue) to 50% (vomiting), with a smaller proportion both achieving and maintaining those improvements. Adverse effects were reported in a small proportion of patients (10.5%).

CONCLUSION:

Patients with cancer enrolled in Minnesota’s medical cannabis program showed significant reduction across all eight symptoms assessed within 4 months of program participation. Medical cannabis was well tolerated, and some patients attained clinically meaningful and lasting levels of improvement.