Medicines

Almost one in two US oncologists recommend medicinal cannabis but Aussies more cautious


Most oncologists have discussed medicinal cannabis with their patients and almost half have recommended it, according to a new survey of specialists in the US.

Out of the 237 oncologists who completed the survey, 80% reported discussing medicinal cannabis – almost always raised by a patient – and while less than 30% felt they knew enough about medicinal cannabis to make recommendations, 46% had recommended it in the past year.

The findings, published online in the Journal of Clinical Oncology, also reveal over two thirds of oncologists viewed it as a helpful adjunct to standard pain management strategies, and 65% thought it was equally or more effective than standard treatments for anorexia and cachexia.

These attitudes are starkly at odds with position adopted by Australian medical groups like the Clinical Oncology Society of Australia and the Cancer Council Australia whose joint position statement published in 2016 asserts that controlled delivery of synthetic cannabis may be of benefit for chemotherapy-induced nausea and vomiting, moderate to severe pain and as an appetite stimulant only when conventional treatments have failed.

While the number of oncologists having discussions about medicinal cannabis is likely to be similar in Australia to in the US, the number who prescribe it is likely to be much lower, says Associate Professor Peter Grimison, a staff specialist in medical oncology at the Chris O’Brien Lifehouse in Sydney.

Changes to Australian law means doctors can legally prescribe pharmaceutical medicinal cannabis in a known dose with a known toxicity with confidence about safety and doctors can access seminars and online resources to learn how to prescribe.

But Professor Grimison, who is currently leading a trial on medical cannabis for chemotherapy-induced nausea and vomiting, said he doubts many oncologists are routinely prescribing it.

“I would only recommend or consider a prescription of they had exhausted other options…and I think many of my colleagues would be more sceptical than me,” he told the limbic.

“A doctor may have already made their own judgement that there’s no role for medicinal cannabis and there’s little high quality evidence to support its use, so they may feel based on that, they don’t need to educate themselves.”

And with a dearth of even moderate quality evidence to suggest medicinal cannabis has a curative effect,  “I would be very surprised if any physicians in Australia are recommending medicinal cannabis to treat or cure cancer”.

The moves to legalise access to pharmaceutical cannabis products is likely to make doctors more willing to prescribe it if they felt the patient would benefit from it, he said.

“But there is still this gap where is there really good evidence that it will help?”

Over the next few years, his trial – and along with two others also being funded by NSW Health – will aim to answer that question.

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