Survey Reveals Lack of Knowledge in Oncology Community on Utility of Medical Marijuana

While 70.6% of oncologists do not feel sufficiently informed to make clinical recommendations regarding medical marijuana, most do conduct discussions in the clinic and close to half recommend it to their patients, according to findings from a national-level survey recently published in theJournal of Clinical Oncology.

The survey was randomly distributed to 400 medical oncologists who documented active involvement in patient care. It queried attitudes regarding the efficacy and safety of medical marijuana compared to standard treatments; their practices regarding medical marijuana, including frequency of discussions with patients and clinical recommendations; and whether they considered themselves adequately informed regarding the utility of medical marijuana in oncology.

“Ensuring that physicians have a sufficient knowledge on which to base their medical recommendations is essential to providing quality care,” noted study co-author Eric G. Campbell, PhD, Director of Research at the Center for Bioethics and Humanities, University of Colorado School of Medicine, in a statement. “Our study suggests that there is clearly room for improvement when it comes to medical marijuana.”

Among the 237 medical oncologists who responded to the survey, 52.8% practiced outside of a hospital setting and 40.8% met with more than 60 patients per week. The largest proportion of respondents practiced in the South (32.6%) and were equal to or greater than 25 years from their terminal degree. Over half (55.1%) practiced in a state in which medical marijuana was legalized.

The vast majority (79.8%) reported having discussed medical marijuana with their patients and 45.9% provided clinical recommendations to at least 1 patient in the past year for the treatment of cancer-related issues. Those in the South were shown to be the least likely to have participated in discussion, while those practicing in the West were the most likely to have done so (68.9% v 94.7%). Only 34.7% of oncologists practicing in the South have recommended medical marijuana to their patients, compared with 84.2% in the West.

Additionally, authors noted that a high volume of patients (>60 patients per week) was associated with a greater chance of an oncologist reporting a discussion or recommendation of medical marijuana for their patient. Practitioners outside of the hospital setting were also documented to have higher percentages.

Investigators found that oncologists were evenly divided when asked to compare the efficacy of medical marijuana to standard treatments for pain. While 34.3% considered medical marijuana as equal or more effective, 32.0% regarded it to be less effective. An additional 33.8% did not know.

Most oncologists (66.7%), however, felt medical marijuana to be a useful adjunct to other standard therapies “to a great extent.” Only 9.6% reported it to have no use as an adjunct.

"Medical marijuana is legal in over half the states, with cancer as a qualifying condition in the vast majority of laws, yet the scientific evidence base supporting use of medical marijuana in oncology remains thin,” reported lead author IIana Braun, MD, chief of Dana-Farber Cancer Institute’s Division of Adult Psychosocial Oncology, in a statement.

Those who were less than 15 years from their terminal degree were more likely to consider medical marijuana as equal or more effective to standard treatments of pain than those who were equal to or greater than 25 years from their terminal degree (42.0% v 22.7%). This was also true for those practicing in nonhospital settings versus hospital settings (39.5% v 36.7%).

The investigators acknowledged a clinical “problematic discrepancy” between oncologists’ attitudes, practices, and knowledge of medical marijuana. “[These findings] highlight a crucial need for expedited clinical trials exploring marijuana’s potential medicinal effects in oncology and the need for programs about medical marijuana,” the authors wrote.

This study is the first to investigate the attitudes, practices, and knowledge of medical oncologists towards medical marijuana on a national level since the establishment of medical marijuana laws in the United States.

Reference:

Braun IM, Wright A, Peteet J, et al. Medical oncologists’ beliefs, practices, and knowledge regarding marijuana used therapeutically: a nationally representative survey study [epub ahead of print].J Clin Oncol. doi: 10.1200/JCO.2017.76.1221. http://ascopubs.org/doi/abs/10.1200/JCO.2017.76.1221?rel=0" .