Is It Helping or Harming? A Clinician’s Guide to Cannabis Use in Oncology

In this episode of Oncology on The Go, created in collaboration with the American Psychosocial Oncology Society, Daniel C. McFarland, DO, and Ilana M. Braun, MD, dove into the complexities of cannabis use within the oncology landscape. They explored the tension between rising public popularity and the need for rigorous scientific scrutiny in symptom management.

Key Discussion Points:

• The 2024 ASCO Guidelines: Braun highlighted the first-of-its-kind clinical guidelines from the American Society of Clinical Oncology, which acknowledge medicinal utility for chemotherapy-induced nausea, vomiting (as an adjunct), and non-cancer pain.
• Routes of Administration: McFarland and Braun compared oral, combusted, and vaporized methods, noting that while oncologists favor oral routes, they are subject to "first-pass metabolism," which can delay relief.
• Safety and Clinical Concerns: There are potential negative impacts on outcomes for patients using immune checkpoint inhibitors.
  • Risks may impact patients with a personal or family history of psychosis when using THC-predominant products.
  • There are possible dangers linked to e-cigarette or vaping use-associated lung injury (EVALI) from informally sourced products.
• Addressing "Cancer-Directed" Claims: The pair addressed the misconception that cannabis treats the cancer itself, noting that ASCO explicitly discourages using it as a replacement for conventional treatments like chemotherapy or surgery.
• The Future of Research: The discussion concluded with the potential impact of reclassifying cannabis to Schedule III, which could reduce red tape and enable high-quality comparative efficacy trials for sleep, anxiety, and depression.

The conversation emphasized a "harm reduction" approach, urging oncologists to provide stigma-free, evidence-based education while respecting patient autonomy.

McFarland is the director of the Psycho-Oncology Program at Wilmot Cancer Center and a medical oncologist who specializes in head, neck, and lung cancer, in addition to being the psycho-oncology editorial advisory board member for the journal ONCOLOGY. Braun is an associate professor of psychiatry at Harvard Medical School and senior physician at Dana-Farber Cancer Institute.

Reference

Braun IM, Bohlke K, Abrams DI, et al. Cannabis and cannabinoids in adults with cancer: ASCO guideline. J Clin Oncol. 2024;42(13):1575-1593. doi:10.1200/JCO.23.02596