Updates in Oncologic Use of Medicinal Cannabis

Only three states have no legal MC. With evidence that one-in-four cancer patients use cannabis, understanding the intersection between MC and oncologic care is of salience for the consultation-liaison psychiatrist.

Updates in Clinical Trial Evidence for Oncologic Use of MC

In synthesizing the latest clinical trial research, Dr. Braun will highlight that comparisons between tetrahydrocannabinol (THC) & whole plant cannabis are speculative as MC is comprised of hundreds of bioactive ingredients; and that evidence for MC ameliorating chemotherapy-induced nausea/vomiting is strong while for all other indications it is limited. In addition, she will briefly cover the legal landscape for MC and the many avenues by which patients access the botanical.



Oncologic Clinicians’ Views, Practices and Knowledge Regarding MC

Dr. Patell will present findings from a survey administered to a national sample of oncology trainees (n=462 across 25 states; response rate=40%). Despite the fact that 91% discussed MC with patients and 58% recommending MC clinically, only a quarter received MC training and but 12% felt sufficiently informed to make MC recommendations. Patell will compare these results to those of a published survey of a nationally-representative sample of oncologists (n=400; 2017). He will conclude that while most oncologists discuss cannabis with patients, the majority do not feel sufficiently informed about the botanical’s role in cancer care.



Modes of MC Self-administration

Dr. Chai will present a secondary analysis from a qualitative study of cancer patients using MC (n=24, across eight states). A majority of participants reported at least two routes of MC self-administration; These included vaping, vaporizing, smoking; consuming edibles or sublinguals; using topicals or rectal suppositories. Choices were guided by perceived adverse effects and onset of action. Dr. Chai will conclude that psycho-oncologists should consider a wide range of potential routes of MC use by their patients.



The Role of Cannabidiol (CBD) in Cancer Care

Dr. Nayak will present secondary analyses of both the abovementioned national survey of oncologists and the qualitative study of cancer patients using medicinal cannabis. Although 80% of oncologists conducted MC conversations with their patients, 65% reported “no preference” or “don’t know” as to whether they clinically favored THC- or CBD-predominant products. Cancer patients targeted CBD-predominant products as cancer-directed therapy, to address sleep and anxiety, and to counteract the deleterious side-effects of THC. Nayak will also address the scientific evidence-base for CBD in oncology.



How to Advise Cancer Patients in the Clinic

Dr. Abrams will pragmatically discuss how a psycho-oncologist might advise cancer patients in the clinic regarding MC’s risks, benefits and alternatives. In doing so, he will cover common side-effects, including drug-botanical interactions, and how a harm reduction model may be employed in MC patient care.