Using Cannabis as a Bridge for Symptom Management in Cancer

There is strong interest from patients with cancer in using cannabis for symptom management, but these discussions require some level setting on the data around cannabis and what it can really do for them, explained Marie Parish, PharmD, BCOP, a gastrointestinal oncology pharmacist with Mayo Clinic. Marijuana was legalized for medicinal use in 2014 in Minnesota, but since the state legalized recreational use a year earlier, Parish is asked questions about it daily.¹

During a presentation at an Institute for Value-Based Medicine^® event cohosted by The American Journal of Managed Care^® and Mayo Clinic, Parish explained the mechanisms behind how cannabis works to manage pain, delivery mechanisms, and more.

Transcript

What makes you passionate about the use of cannabis for patients with cancer?

I have a very patient-facing job, [and] both of my parents are cancer survivors. And a common theme that I hear very often with patients who have cancer is how kind of out of control they feel with regards to their care. We tell them what chemotherapy they're getting. We tell them whether or not they're getting radiation. We tell them whether or not they're getting surgery. There seems to be this want to take some sort of control over their own health care, and a way that patients have found a way to do that is by the use of cannabis products.

I have found that it's not always terribly effective to just tell someone, “Yes, you can do this,” [or] “No, you can't do this.” What's much more effective is providing them with the information and tools to empower them to make the best decision for their care and where they're at in treatment. And so, I took my love for cannabis and psychoactive pharmaceuticals, [and] I took my love for oncology patient care, and I decided to marry it into this presentation to kind of help other health care providers field some of these questions that patients might have if they are interested in using cannabis products to help manage some of their symptoms.

How has interest and use of cannabis to treat pain evolved over the last few years? What impact has the opioid epidemic had on it?

I will be very honest with you: cannabis use and pain management is one of the areas as a scientific community that we are really struggling to find great data for. One of the questions I get asked most frequently by patients, is whether or not this is going to help with pain management. And truthfully, the data out there is not great as far as efficacy goes, and we're really struggling to find which patients might benefit the most from it, as well as which delivery system of cannabis might be the most effective for patients.

So, I know that we have a lot of patients who are very concerned about asking their providers to increase their doses of opioids, or maybe add on additional opioid pain management agents, and using cannabis as kind of a bridge to some of those has been an area of interest for them.

I am very, very honest with my patients when they ask about this. With regards to efficacy, we found that there are certain types of neuropathic pain, maybe inflammatory-based pain, where cannabis may have a role, but it is not appropriate for all patients.

Reference

1. Minnesota Issue Guide—Cannabis. Minnesota Legislative Reference Library. Reviewed May 2024. Accessed August 22, 2024. https://www.lrl.mn.gov/guides/guides?issue=cannabis