The tide has turned in recent years regarding cannabis in the health industry. More people are turning to medicinal cannabis for cancer, despite legal implications. There’s a growing interest in using cannabis in oncology treatments.
The role of cannabis is mainly as a complementary treatment to traditional methods. The Therapeutic Goods Administration (TGA) in Australia doesn’t approve it for treating cancer-related symptoms. It’s only available through strict regulatory channels.
Medicinal patients have hope for alternative treatment if you, as a healthcare provider, follow the right paths. Our guide digs deeper into the application of cannabis in oncology.
Understanding medicinal cannabis
Medicinal cannabis refers to using the herb to treat and alleviate the symptoms of a health condition. The healing properties are believed to come from certain cannabinoids.
The two most popular ones are cannabidiol (CBD) and tetrahydrocannabinol (THC). The latter is responsible for the intoxicating effects. CBD on the other hand has no psychoactive properties.1
These are both used in treating a wide variety of symptoms.
Several cannabis mechanisms make the plant relevant to oncology. Among these are its analgesic, anti-inflammatory, and antiemetic properties. Some studies even suggest that THC exhibits anti-tumor effects.2
Research regarding the relationship between medical cannabis and oncology is ongoing. Some of the current findings display conflicting results which is why further study is needed.
There are many positive reports regarding medicinal cannabis for cancer and as such, many regions permit it. The legal status differs from one region to the next.
Cancer types and symptoms addressed by medicinal cannabis
Medical cannabis shows potential benefits in certain cancer types. Examples include:
- Breast cancer
- Lung cancer
- Prostate cancer
- Multiple myeloma3
How do the cannabinoids in medicinal cannabis assist? They help alleviate some of the discomforts of the condition. Let’s highlight some of them:
- Nausea and vomiting. These symptoms are a common side effect of chemotherapy. It usually lasts 24–48 hours after a session. In some cases, it can last up to 7 days.4 CBD has antiemetic properties5 which could help with the relief of this discomfort.
- Pain. Pressure from the tumour causes pain in some patients. Medicinal cannabis for cancer may help alleviate it.
Cannabinoids show significant potential in pain management. The analgesic properties are likely the reason many patients report that it's effective for pain management.
- Appetite loss. Cancer releases chemicals that can cause appetite. In almost 50% of cancer cases, individuals experience hunger reduction.7
Other reasons for the change include chemotherapy, targeted cancer drugs, painkillers, and immunotherapy. Some of these also cause taste changes which make food and drink less appealing.
Medical cannabis reportedly promotes eating.8 THC can make you perceive your food as better tasting. It may also trick your brain into thinking that you're hungry.9
- Insomnia. Individuals who have cancer commonly experience sleep disorders. These may be caused by tumours, stress, or other health problems.
Being hospitalised or taking certain treatments may also result in insomnia. Studies suggest that medicinal cannabis may be a promising option for treating this symptom.
A study published on April 26, 2003 observed 25 participants. It involved a two-week ad libitum use of CBD. The results showed an improvement in sleep quality and a reduction in pain intensity. There were also reported positive changes in cognitive function.
Further anecdotal data includes a study published on May 2, 2023. It explored the effectiveness of medicinal cannabis for cancer-related pain.
It involved 358 patients with cancer. The conclusion from the study states that medicinal cannabis is an effective complementary treatment for pain relief.
Scientific evidence and research
There have been various studies regarding cannabis in the health sphere. Many of the findings draw positive results, while others demonstrate conflicting conclusions.
The two studies mentioned before are examples that suggest cannabis efficacy in oncology studies. Let’s look at the one published on April 26, 2003.
The goal of this research was to explore the use of legally available cannabis and how it would affect various aspects of a cancer patient's quality of life. Factors include pain, cognitive function, and sleep quality.
The research analysed data from 25 participants. It had a baseline appointment and a two-week ad libitum cannabis use period.
The use of CBD helped relieve pain and improve sleep quality. The patient’s general quality of life didn’t see any change. The participants didn't report any adverse reactions from the two-week usage period.
This study demonstrates some evidence of the safety and efficacy of medicinal cannabis for cancer.
As promising as these results seem, there are still a few limitations. Medical cannabis doesn’t yet have approval for oncology. There are also no standard doses, and treatment has to be customised for each patient.
Medical practitioners may have challenges with prescribing appropriate quantities for treatment. The result of this may cause inconsistencies. Validating the positive clinical trials requires more robust research.
Luckily, the TGA provides guidance for the use of medicinal cannabis in Australia. You may follow their resources for responsible and ethical healthcare practice.
Another limiting factor is the legal sphere. Medical cannabis is gaining traction globally. Laws are still restrictive in many regions.
The legislative restrictions make extensive research even more challenging. Fortunately, some states have legalised cannabis. This opens the door for future studies on medical cannabis.
Application and dosage
Medical cannabis administration is a bit tricky. Unlike traditional medications, it needs to be tailored to the patient’s needs.
The main method of administration is with oral cannabis. Inhalation is also a possible option, but it’s not typical of medicinal cannabis.
Medicinal cannabis for cancer is available in tablet form. An example of this is Nabilone. There are also oils, edible-infused products, and sprays such as Nabiximol.
When a patient starts using medicinal cannabis as a complementary treatment, the dosage should be low at first. It’s essential to note that when taken orally, the effects of cannabis take longer to set in.
Over time, the oncology provider can gradually increase the dose to tailor it to the patient. Outside of clinical trials, it’s best to keep the prescribed doses below 300mg of oral CBD.
Consensus recommendations for medicinal cannabis have three protocols.14 We list them below.
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A routine protocol where the patient is given a CBD-dominant dose of medical cannabis. The amount is 5mg. It’s administered twice, daily.
It’s then titrated every 2–3 days until the patient's ideal dose is discovered. Alternatively, it continues until 40 mg is administered per day.
At the point of 40 mg CBD, the oncology provider may choose to incorporate THC into the treatment. They can add 2.5 mg and titrate it in the same amount every 2–7 days. This may continue until the patient receives a maximum dose of 40 mg THC per day.
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A conservative protocol where the patient receives a single dose of CBD-dominant medicinal cannabis. The quantity is 5mg per day.
The clinician then titrates this amount by 10mg every 2–3 days. It continues until the patient’s goals are reached or a maximum of 40 mg is reached.
At the maximum dose of CBD, the oncology provider may then begin adding THC. The initial quantity is 1 mg per day. It’s titrated every 7 days by 1 mg per day. It continues until a maximum of 40 mg THC is reached.
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A rapid protocol where the patient receives a balanced CBD-to-THC ratio from the beginning. It includes 2.5mg of THC and 5mg CBD once or twice per day.
The clinician then titrates this in the same quantities every 2–3 days. It continues until the patient reaches their objectives. Alternatively, titration continues until a maximum THC dose of 40mg is reached.
These protocols of expert consensus-based recommendations were developed using a modified Delphi process.
During the titration process, clinicians can assess and make the appropriate considerations for each patient.
Potential side effects and contraindications
Most medications have some potential side effects and contraindications. The benefits of the treatments outweigh the risks. They’re deemed safe for consumption.
Medical cannabis also has some mild potential side effects and contraindications. Some individuals have a higher risk than others. This is why patient monitoring is essential.
Patients who are pregnant or who have certain psychiatric conditions should abstain from the treatment.
In other cases, patients may experience mild side effects. Common discomforts include:
- Dry mouth
- Dizziness
- An altered mental state
Ask your patients to discuss any abnormalities with you. You can then make an assessment. Adjust the dose of medicinal cannabis for cancer according to the individual’s case.
Integrating medicinal cannabis into oncology care
Medicinal cannabis is a new aspect that hasn't been thoroughly researched yet. Most oncology treatments go through preclinical studies, as well as traditional phase analysis. When it comes to cannabis, the data and evidence are still lacking.
How can providers incorporate it as a complementary treatment for cancer? Current data suggests that a blended approach is best.15
Combining traditional oncology medication with medicinal cannabis can be beneficial. This means taking an integrated and multi-disciplinary approach. It would involve oncologists, pharmacists, and primary caregivers.
The main role of medical cannabis in this scenario is:
- Pain management
- Reducing nausea
- Boosting appetite
Future perspectives
Medical cannabis is an emerging trend in oncology. Ongoing research and upcoming clinical trials look promising.
The global stigma surrounding medicinal cannabis for cancer is fading. Robust research in the field is sure to occur. As many people adapt their mindsets to it, hopes for policy changes grow.
There is a shift towards broader acceptance of medical cannabis. Further studies are likely to show that medical cannabis is effective and safe. It may be a more popular complementary treatment.
Provide your patients with superior oncology through PlantEd’s courses
When it comes to medicinal cannabis there are plenty of reported benefits. There are also a large number of considerations for using it in oncology.
While data is barely sufficient, oncology providers can employ evidence-based practice. It’s a sphere of treatment that calls on providers to adopt a mindset of continuous learning.
Healthcare providers should stay updated on new developments. New research may yield exciting results. Now that you know more about medicinal cannabis for cancer, explore more of PlantEd’s courses. Become the health care provider your patients need.
References
- Healthdirect Australia. 22 June 2023. “Medicinal Cannabis.” https://www.healthdirect.gov.au/medicinal-cannabis
- Velasco, G., Sánchez. C., Guzmán, M. 23 March 2016. “Anticancer Mechanisms of Cannabinoids.” Current Oncology, vol. 23, no. S23–S32, p. 23. https://doi.org/10.3747/co.23.3080
- Benisek, Alexandra. 30 June 2022. “Medical Marijuana and Multiple Myeloma.” WebMD. www.webmd.com/cancer/multiple-myeloma/multiple-myeloma-medical-marijuana
- NCI. 2015. “Nausea and Vomiting and Cancer Treatment – Side Effects - NCI.” National Cancer Institute. www.cancer.gov/about-cancer/treatment/side-effects/nausea-vomiting
- Parker, Linda A., Rock, Erin M., Limebeer, Cheryl L. 22 Dec. 2010. “Regulation of Nausea and Vomiting by Cannabinoids.” British Journal of Pharmacology, vol. 163, no. 7, pp. 1411–1422. https://doi.org/10.1111/j.1476-5381.2010.01176.x
- Mack, Alison, and Janet Joy. 2000. “MARIJUANA and PAIN- Marijuana as Medicine?” National Library of Medicine, National Academies Press (US). www.ncbi.nlm.nih.gov/books/NBK224384/
- Cancer Research UK. 2023. “Taste Changes and Loss of Appetite | Coping with Cancer | Cancer Research UK.” Cancer Research UK. www.cancerresearchuk.org/about-cancer/coping/physically/diet-problems/types/taste-changes-and-loss-of-appetite
- Kirkham, Tim C. 11 July 2009. “Cannabinoids and Appetite: Food Craving and Food Pleasure.” International Review of Psychiatry, vol. 21, no. 2, pp. 163–171. https://doi.org/10.1080/09540260902782810
- Black, Lester. 19 January 2023. “The Munchies: Why Does Marijuana Sometimes Make You Hungry?” GoodRx Health. www.goodrx.com/health-topic/cannabis/why-does-weed-make-you-hungry
- NCI. 31 October 2019. “Sleep Disorders (PDQ®)–Health Professional Version.” National Cancer Institute, Cancer.gov. www.cancer.gov/about-cancer/treatment/side-effects/sleep-disorders-hp-pdq
- Vaillancourt, Régis; Gallagher, Shannon; Cameron, Jameason D., Dhalla, Rahim. 15 April 2022. “Cannabis Use in Patients with Insomnia and Sleep Disorders: Retrospective Chart Review.” Canadian Pharmacists Journal, vol. 155, no. 3, pp. 175–180. www.ncbi.nlm.nih.gov/pmc/articles/PMC9067069/ https://doi.org/10.1177/17151635221089617
- Vinette, Billy; Côté, José; El-Akhras, Ali; Mrad, Hazar; Chicoine, Gabrielle; Bilodeau, Karine. 24 Mar. 2022. “Routes of Administration, Reasons for Use, and Approved Indications of Medical Cannabis in Oncology: A Scoping Review.” BMC Cancer, vol. 22, no. 1. https://doi.org/10.1186/s12885-022-09378-7
- Braun, Ilana M., Bohlke, K., Abrams, D. I., Anderson, H., Balneaves, L. G., Bar-Sela, G., Bowles, D. W., Chai, P. R., Damani, A., Gupta, A., Hallmeyer, S., Subbiah, I. M., Twelves, C., Wallace, M. S., Roeland, E. J. 13 Mar. 2024. “Cannabis and Cannabinoids in Adults with Cancer: ASCO Guideline.” Journal of Clinical Oncology, vol. 42, no. 13. https://doi.org/10.1200/jco.23.02596
- Bhaskar, A., Bell, A., Boivin, M., Briques, W., Brown, M., Clarke, H., Cyr, C., Eisenberg, E. de Oliveira Silva, R. F., Frohlich, E., Georgius, P., Hogg, M., Horsted, T. I., MacCallum, C. A., Müller-Vahl, K. R., O’Connell, C., Sealey, R., Seibolt, M., Sihota, A., Smith, B. K., Sulak, D., Vigano, A., Moulin, D. E. 2 July 2021. “Consensus Recommendations on Dosing and Administration of Medical Cannabis to Treat Chronic Pain: Results of a Modified Delphi Process.” Journal of Cannabis Research, vol. 3, no. 22. www.ncbi.nlm.nih.gov/pmc/articles/PMC8252988/ https://doi.org/10.1186/s42238-021-00073-1
- Abrams, D. I. 16 March 2016. “Integrating Cannabis into Clinical Cancer Care.” Current Oncology (Toronto, Ont.), vol. 23, no. 2, pp. S8–S14. www.ncbi.nlm.nih.gov/pmc/articles/PMC4791148/