Medical marijuana in pediatric oncology: A review of the evidence and implications for practice

Abstract

Medical marijuana (MM) has become increasingly legal at the state level and accessible to children with serious illness. Pediatric patients with cancer may be particularly receptive to MM, given purported benefits in managing cancer-related symptoms. In this review, we examine the evidence for MM as a supportive care agent in pediatric oncology. We describe the current legal status of MM, mechanism of action, common formulations, and potential benefits versus risks for pediatric oncology patients. We offer suggestions for how providers might approach MM requests. Throughout, we comment on avenues for future investigation on this growing trend in supportive care.

Provider Perspectives on Use of Medical Marijuana in Children With Cancer

“…Specifically, n-ETC providers were more likely to convey approval of pediatric patients using MM in smoked or oral formulations, as cancer-directed therapy, or for symptom management, despite scarce evidence to corroborate this use. 35,37 To place these findings in context, n-ETC provider attitudes observed in this study echo those of the general public, 27,38 whereas ETC provider attitudes align more closely with physician-based data. 22,31,33 We surmise that ETC providers, whose licensure and clinical reputation could theoretically be jeopardized by MM recommendation in the face of federal prohibition, 20,39 may be less willing to endorse MM use in children than providers who face fewer legal ramifications.…”

“…22,24,26,[30][31][32] This reluctance appears to be driven by the potential for side effects, 33 scant high-quality scientific data, 22,34 unclear dosage guidelines, 17,26 and a lack of regulatory oversight by the FDA, unlike other therapeutic and supportive care drugs. 35 Such concerns are magnified when pediatric clinicians must consider MM use by children and adolescents, particularly because habitual marijuana use is associated with dependence, impaired neurocognitive development, and poor academic achievement in children. 12,15,36,37 Recommending MM 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.…”

“…This frequency of inquiries is comparable to published adult literature. 24,30 Given burgeoning interest in MM, especially in oncology care, 3,35 it is critical that providers who are routinely approached for access to MM possess baseline knowledge on regulations, known benefits, and harm. However, providers in this study were largely unaware of statespecific regulations around MM, and approximately one-quarter did not know that MM is federally illegal.…”

Safety and efficacy of nabilone for acute chemotherapy‐induced vomiting prophylaxis in pediatric patients: A multicenter, retrospective review

“…Therefore, the scope of this study is limited to acute CIV control. Further, we were unable to evaluate potential late effects of long‐term nabilone use such as impaired neurocognitive function . With respect to efficacy, the lack of a control arm hinders our ability to make strong conclusions.…”

“…Further, we were unable to evaluate potential late effects of long-term nabilone use such as impaired neurocognitive function. 8,16 With respect to efficacy, the lack of a control arm hinders our ability to make strong conclusions. In defining the end of the acute phase as 24-h following administration of the last chemotherapy dose or the time of discharge, data regarding CIV control for patients discharged within 24 h of administration of the last chemotherapy dose were incomplete.…”