Cancer patients of all ages are asking their clinicians for medicinal cannabis – with around one in four patients believing it will help in control or cure the cancer, a Victorian study has found.
Pain, nausea and loss of appetite were the main reasons cited by patients for requesting information of a prescription for medicinal cannabis, a study involving 28 palliative care specialists and trainees at three Victorian centres found.
But their consultation records for 104 cancer patients – of whom 87% had metastatic disease – revealed that 26 patients (25%) intended to use medicinal cannabis for cancer control or cancer cure.
The study, led by Stacey Panozzo of the Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre, Melbourne, investigated the characteristics and medicinal cannabis requests of 1700 patients with breast, colorectal, melanoma and oesophageal cancer patients attending the centres over a six month period in 2018-2019.
Of the 104 consultations that reported a discussion about medicinal cannabis, 60% involved requests for more information and 40% were requests for a prescription. Almost all discussions (93%) were initiated by the patient or carer. The average age of the patients was 51 years, indicating that it was not just young patients who had an interest in using medicinal cannabis.
The most common reasons for intended use of medicinal cannabis were pain (64%), nausea (48%) and appetite (35%), whereas only 5% intended to use it of anxiety/sleep and 3% for mood/relaxation.
About a quarter of the consultations (27%) resulted in a prescription for medicinal cannabis. But 29% of patients said they were already sourcing their own supply of cannabis, mostly cannabis oil/product (60%), with only 17% using cannabis dried leaf/bud product.
The study authors said the wide interest in the use of medicinal cannabis across age groups may be prompted by high levels of media coverage heightening community awareness.
And the low levels of clinician initiation of discussions of medicinal cannabis probably reflected uncertainties within the profession about the role of medicinal cannabis, concern about the limited evidence supporting use, and a lack of confidence about the processes of prescribing, they suggested.
The finding that one in four patients believed cannabis would help control their cancer suggested a need for more informational resources “to aid clinicians in their discussions as these issues are raised by patients with cancer and their carers,” they said.
But cancer experts have said it is difficult to disseminate information on medicinal cannabis when there is little research or evidence available to support its safety, efficacy and optimum dose.
Speaking at a recent Senate inquiry into barriers to accessing medicinal cannabis, Dr David Speakman, Expert Adviser to Clinical Oncology Society of Australia (COSA) said the situation had arisen because the government had ‘jumped the gun’ and regulated the availability of a therapeutic product before it had undergone clinical trials by its sponsors.
“Traditionally, non-commercial entities will provide information and training when there’s evidence about what to use a product for, how to use it and how to bring it out into general usage in the community. I think that’s the gap here,” he said.
“For most institutions that might take up the role of trying to educate GPs or specialists who are going to prescribe medicinal cannabis, their evidence base to go out and say, ‘We’re going to run a seminar on this and explain how to use it,’ doesn’t sit there to the criteria that we use, usually, to do such education.”