Friday, 21 September, 2018

United States cancer docs feel unprepared, but recommend marijuana anyway

Marijuana United States cancer docs feel unprepared, but recommend marijuana anyway
Melissa Porter | 12 May, 2018, 05:21

The survey consisted of 30 questions that attempted to shed light onto oncologists' views and practices with medical marijuana, including whether or not they discussed it's use with their patients, recommended it, and how informed they felt in making recommendations concerning medical marijuana.

Having expertise in medicine means "knowing what you know, as well as what you don't know", said Andrew Epstein, MD, of Weill Cornell Medicine in New York City, who was not involved with the study.

In the United States, cancer is one of the conditions that allows patients access to medical marijuana. The guidelines note insufficient evidence to recommend medical marijuana for initial management of chronic pain in cancer survivors, although evidence suggests it is worthy of consideration as an adjuvant analgesic and for managing pain conditions that are hard to treat. Evidence also remains insufficient to recommend medical marijuana for the prevention of nausea and vomiting in patients with cancer who receive chemotherapy or radiation therapy.

The study raises questions about the present evidence base for medical marijuana and mentions a need for more research to examine the benefit-burden ratio for medical marijuana as compared to other treatments for cancer and cancer-related adverse effects, included Epstein, who is a clinical expert for the American Society of Medical Oncology.

But the report found no evidence one way or the other regarding medical marijuana's ability to treat the lack of appetite and wasting caused by cancer. On the other hand, "healing cannabis" describes nonpharmaceutical cannabis products utilized with "medicinal intent", no matter compliance with the law. While considerable research has gone into the development of cannabinoid pharmaceuticals, much less has been completed on medical marijuana's utility in cancer and other diseases. Non-pharmaceutical medical marijuana, however, is often whole plant, containing hundreds of active ingredients, and thus can not easily be compared to pharmaceutical cannabinoids. Observational research studies showed that medical marijuana legalization is connected with reductions in opioid-related hospitalizations, however no randomized trials have actually compared the two methods for pain relief.

"Unfortunately, at this time, the evidence base to support medical marijuana's efficacy in oncology is young", Braun said to NPR.

Researchers mailed a survey to 400 practicing oncologists in the USA, randomly selected from a national database of board-certified medical oncologists.

The responses were very positive in favor or medical marijuana, but revealed a strong indication that oncologists are not confident in their knowledge on medical marijuana as a treatment for cancer-related illnesses.

A newly published survey made a decision to find out by asking 237 oncologists from across the country.

Size of practice: Oncologists who saw the most patients each week were more likely to have discussed medical marijuana than those who saw the least patients (89 percent vs. 70 percent). Two thirds of the respondents said medical marijuana is equivalent to or better than standard medications for cachexia. When evaluating its effectiveness for other conditions, however, many oncologists responded, "I do not know", from 29 percent for nausea and vomiting to 45 percent for poor sleep.

Most cancer doctors say they don't know enough about medical marijuana to provide an informed opinion to patients.