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Doctors Support Medical Marijuana For Children With Cancer

Doctors Support Medical Marijuana For Children With Cancer
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An overwhelming majority of health care professionals who care for children with cancer would be willing to help those children get medical marijuana—though less enthusiastically if they happen to be among the providers who are actually eligible to provide it, found a new study.

In a survey of pediatric oncology providers published in Pediatrics, 85% of providers who were certified to provide access to medical marijuana would be willing to help children with cancer access it, compared to 95% of their colleagues who lacked the ability to provide it.

Those with the professional ability to provide patients with medical marijuana were also less supportive of children smoking it or using oral formulations, though they strongly supported clinical trials to investigate its use in children. They also became increasingly willing to support children’s use of it as the child’s disease became more advanced or the child came closer to dying.

“Several studies over the past decade have ascertained that physicians are apprehensive about adult use of medical marijauna,” wrote Prasanna Ananth, MD, MPH, a pediatric oncologist/hematologist at Yale School of Medicine in New Haven, Connecticut, and fellow researchers. “This reluctance appears to be driven by the potential for side effects, scant high-quality scientific data, unclear dosage guidelines and a lack of regulatory oversight by the FDA, unlike other therapeutic and supportive care drugs.”

These concern grow larger when it comes to children and teens using medical marijuana, “particularly because habitual marijuana use is associated with dependence, impaired neurocognitive development, and poor academic achievement in children,” the authors wrote. “Recommending medical marijuana may thus be fundamentally problematic for physicians who are accustomed to evidence-based practice, as they cannot be assured by empirical data that benefits outweigh possible harm.”

The researchers sent a survey to 654 doctors, nurse practitioners, physician assistants, psychologists, social workers and registered nurses who care primarily for children with cancer at three pediatric cancer centers: Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Ann & Robert H. Lurie Children’s Hospital of Chicago and Seattle Children’s Hospital Cancer and Blood Disorders Center.

The 44% response rate resulted in 288 responders who answered questions about their knowledge, practices and attitudes toward using medical marijuana to treat children with cancer. The providers who responded ranged from 22 to 70 years old, with half of them under age 35. Nearly all of them were white (except 8%),a and 85% were women.

A third of respondents were “eligible to certify” for medical marijuana, which means they have gone through the formal certification process to be able to provide patients with access to medical marijuana. Most of those eligible to certify were physicians except the 13 respondents who were nurse practitioners or physician assistants.

Three in 10 providers had been asked for medical marijuana at least once in the previous month. Most of the families who asked for medical marijuana (79%) wanted it to manage nausea and vomiting, and about half of those requesting it (52%) wanted marijuana to help with loss of appetite. Approximately a quarter of patients requested it to treat pain (26%) or to treat depression or anxiety (24%).

Only 8% of providers said they sometimes or frequently recommended medical marijuana to patients, but 92% would be willing to help children with cancer get medical marijuana and would approve of using it to treat children’s symptoms. Most would support using oral formulations of marijuana (89%), with only a little over half (57%) approving of children smoking it to manage cancer. Conducting clinical trials with medical marijuana for children with cancer also received wide support, from 93% of those surveyed.

But when it came only to the providers certified to provide access, only 74% approved of oral formulations and 39% approved of smoking it among pediatric patients with cancer. These practitioners had the most support (94%) for clinical trials to study its use in kids.

Most of the providers (86%) responding knew medical marijuana was legal in their state. However, four out of 10 of providers (41%) did not know federal law prohibits use of medical marijuana, including a quarter of those eligible to certify and half of those who could not provide access. Further, only 5% of the providers knew regulations specific to their state pertaining to medical marijuana.“

Given burgeoning interest in medical marijuana, especially in oncology care, it is critical that providers who are routinely approached for access to medical marijuana possess baseline knowledge on regulations, known benefits and harm,” the authors wrote.

Yet most respondents (80%) did not have any concerns about prosecution if they helped patients get medical marijuana. More than half also did not have concerns about substance abuse among children using medical marijuana. Rather, the biggest obstacle to providing medical marijuana to pediatric cancer patients, cited by nearly half of those who responded, was not having a standard for medical marijuana formulations, dosages or strength.“

Randomized clinical trials using such MM formulations for supportive care in children with cancer are needed to better understand the therapeutic potential,” the authors concluded.

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