When to Pause Before Recommending Cannabis to Patients With Cancer

Providers may want to pause before recommending cannabis to patients with cancer based on certain conditions or circumstances, such as the therapy they are on, and certain delivery mechanisms for cannabis may want to also be avoided, said Marie Parish, PharmD, BCOP, a gastrointestinal oncology pharmacist with Mayo Clinic.

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

Are there any contraindications of cannabis in patients with cancer? What should providers consider when trying to understand if a patient would benefit?

There is some data that's lacking with regards to absolute contraindications to cannabis use in the oncology space. However, we do have some information about certain conditions or certain circumstances that may give us pause when we're trying to recommend cannabis products to patients. For example, there was recently some data that was published, retrospective data, that said that folks who are on immunotherapy-based regimens may have lower response rates if they are chronic cannabis users. So, that would be a circumstance that maybe would give me pause if a patient was wanting to incorporate cannabis into their treatment plan.

We do know that cannabis is a sponge in the soil. It will soak up anything that it is grown in, including certain types of fungus in the soil. And so, for our immunocompromised patients who take inhaled products, they are at an increased risk for fungal infections. And so I try to steer my patients who are on cytotoxic chemotherapy away from taking inhaled products, because I don't want to put them at risk for serious infections. We know that patients who have preexisting mental health conditions, who are heavy and repeat cannabis users, and then all of a sudden stop using cannabis, can have rebound or psychiatric symptoms, including mania and depression. So I do try to be very careful about recommending cannabis products to patients with a pretty heavy psych history. I wouldn't say that there's absolute contraindications to cannabis at this time, but I am very thoughtful about the kinds of recommendations that I give to patients, and I do look at kind of their health history as a whole before guiding them in one direction or another.