Knowledge and attitudes of Italian medical oncologists and palliative care physicians toward medical use of cannabis in cancer care: a national survey.
Cancer
Cannabis
Medical marijuana
Oncology
Palliative care
Journal
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
ISSN: 1433-7339
Titre abrégé: Support Care Cancer
Pays: Germany
ID NLM: 9302957
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
received:
24
02
2021
accepted:
21
06
2021
pubmed:
28
6
2021
medline:
29
10
2021
entrez:
27
6
2021
Statut:
ppublish
Résumé
Despite advances in supportive care, cancer-related symptoms tend to be persistent regardless of cancer type, stage of disease, or treatment received. There is an increasing prescription for complementary and alternative medicines, such as medical cannabis (MC). Knowledge and attitudes of Italian medical oncologists and palliative care physicians toward medical cannabis in cancer care remain unknown. We conducted a cross-sectional study to investigate the knowledge and attitude toward MC prescription among cancer care professionals in Italy. All invited participants received an email with the electronic questionnaire accessible through a direct link. Among the 2616 members who received the invitation, 475 replied to the questionnaire and were considered for the survey analysis. The most prescribed formulations among those available in Italy were cannabis FM2. The most frequent clinical indications for the use of MC were pain, gastrointestinal, and mood disorders. Only 9 responders reported MC-related side effects like anxiety insomnia and muscle spasms. The question regarding the normative references for MC prescription and use in Italy had conflicting results: only 14% indicated the exact legislative reference. Our study highlights a significant discrepancy between personal attitudes, prescription levels, and actual knowledge on MC. This represent a critical issue that should be systemically faced, building educational programs and national guidelines that sublimate personal physicians' beliefs and predispositions, resulting in a robust science-based MC practice. Only through coordinated interventions on science and health policy of MC, there will be success of safety and efficacy, ensuring the best knowledge for the best outcomes.
Identifiants
pubmed: 34176017
doi: 10.1007/s00520-021-06383-7
pii: 10.1007/s00520-021-06383-7
doi:
Substances chimiques
Medical Marijuana
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
7845-7854Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Hill KP (2015) Medical marijuana for treatment of chronic pain and other medical and psychiatric problems: a clinical review. JAMA 313(24):2474–83. https://doi.org/10.1001/jama.2015.6199
doi: 10.1001/jama.2015.6199
pubmed: 26103031
Gould J (2015) The cannabis crop. Nature 525(7570):S2-3. https://doi.org/10.1038/525S2a
doi: 10.1038/525S2a
pubmed: 26398736
Fonseca BM, Teixeira NA, Correia-da-Silva G (2017) Cannabinoids as modulators of cell death: clinical applications and future directions. Rev Physiol Biochem Pharmacol 173:63–88. https://doi.org/10.1007/112_2017_3
doi: 10.1007/112_2017_3
pubmed: 28425013
WHO (2019) Cannabis recommendations. Available at: https://www.who.int/publications/m/item/ecdd-41-cannabis-recommendations. Accessed 12 Feb 2021
Law. February 1998, 94. Conversione in legge, con modificazioni, del decreto-legge 17 febbraio 1998, n. 23, recante disposizioni urgenti in materia di sperimentazioni cliniche in campo oncologico e altre misure in materia sanitaria. (G.U. Serie Generale, n. 86 del 14 April 1998), http://www.camera.it/parlam/leggi/98094l.htm . Accessed 17 Jan 2021
Decree of the Ministry of Health ((GU Serie Generale n.33 del 08–02–2013). Aggiornamento delle tabelle contenenti l’indicazione delle sostanze stupefacenti e psicotrope, di cui al decreto del Presidente della Repubblica 9 ottobre 1990, n. 309 e successive modificazioni e integrazioni. Inserimento nella Tabella II, Sezione B, dei medicinali di origine vegetale a base di Cannabis (sostanze e preparazioni vegetali, inclusi estratti e tinture). (13A00942). Available at: https://www.gazzettaufficiale.it/eli/id/2013/02/08/13A00942/sg. Accessed 12 Feb 2021
Cannabis Price Index (2018). Available at: http://weedindex.io/ . Last access 12 Feb 2021
Ministero della Salute, Ministero della Difesa. Accordo di collaborazione tra il Ministro della salute e il Ministro della Difesa per l’avvio del Progetto Pilota per la produzione nazionale di sostanze e preparazioni di origine vegetale a base di cannabis. http://www.salute.gov.it/imgs/C_17_notizie_1737_listaFile_itemName_0_file.pdf . Accessed 17 Jan 2021
Circolare del Ministero della Salute n. 12516. Trasmissione del documento recante raccomandazioni ai medici prescrittori di Cannabis FM-2 prodotta dallo Stabilimento Chimico Farmaceutico Militare di Firenze secondo le normative dell’UE in materia di sostanze attive, certificata GMP secondo le Good manufacturing practices dell’UE, http://www.trovanorme.salute.gov.it/norme/renderNormsanPdf?anno=2017&codLeg=58262&parte=1%20&serie=null . Accessed 17 Jan 2021
“Uso medico della cannabis - Cenni generali”. The official website of the Italian Ministry of Health. http://www.salute.gov.it/portale/temi/p2_6.jsp?lingua=italiano&id=4587&area=sostanzeStupefacenti&menu=vuoto . Accessed 17 Jan 2021
SICP (2017). Informazioni sui farmaci. Cannabis. Available at: https://www.sicp.it/wp-content/uploads/2018/12/134_cannabinoidi.pdf (last access 12 Feb 2021) AIOM (2019). Terapia del dolore in oncologia. Available at: https://www.aiom.it/wp-content/uploads/2019/10/2019_LG_AIOM_Terapia_dolore.pdf . Accessed 12 Feb 2021
Braun IM, Wright A, Peteet J, Meyer FL, Yuppa DP, Bolcic-Jankovic D, LeBlanc J, Chang Y, Yu L, Nayak MM, Tulsky JA, Suzuki J, Nabati L, Campbell EG (2018) Medical oncologists’ beliefs, practices, and knowledge regarding marijuana used therapeutically: a nationally representative survey study. J Clin Oncol 36(19):1957–1962. https://doi.org/10.1200/JCO.2017.76.1221
doi: 10.1200/JCO.2017.76.1221
pubmed: 29746226
pmcid: 6553839
Law. March 15, 2010, n. 38. https://www.gazzettaufficiale.it/eli/id/2014/03/12/14A02098/sg , GU General Series n.65. https://www.gazzettaufficiale.it/gunewsletter/dettaglio.jsp?service=1&da . Accessed Feb 15, 2021
Vyas MB, LeBaron VT, Gilson AM (2018) The use of cannabis in response to the opioid crisis: a review of the literature. Nurs Outlook. 66(1):56–65. https://doi.org/10.1016/j.outlook.2017.08.012
doi: 10.1016/j.outlook.2017.08.012
pubmed: 28993073
Ishida JH, Wong PO, Cohen BE, Vali M, Steigerwald S, Keyhani S (2019) Substitution of marijuana for opioids in a national survey of US adults. PLoS ONE 14(10):e0222577. https://doi.org/10.1371/journal.pone.0222577
doi: 10.1371/journal.pone.0222577
pubmed: 31584957
pmcid: 6777788
Humphreys K, Saitz R (2019) Cannabis as a substitute for opioids-reply. JAMA 322(3):273–274. https://doi.org/10.1001/jama.2019.6471
doi: 10.1001/jama.2019.6471
pubmed: 31310294
Sagy I, Peleg-Sagy T, Barski L, Zeller L, Jotkowitz A (2018) Ethical issues in medical cannabis use. Eur J Intern Med 49:20–22. https://doi.org/10.1016/j.ejim.2018.01.016
doi: 10.1016/j.ejim.2018.01.016
pubmed: 29482739
Dei Cas M, Casagni E, Saccardo A, Arnoldi S, Young C, Scotti S, Vieira de Manicor E, Gambaro V, Roda G (2020) The Italian panorama of cannabis light preparation: determination of cannabinoids by LC-UV. Forensic Sci Int 307:110113. https://doi.org/10.1016/j.forsciint.2019.110113
Zamengo L, Frison G, Zwitser G, Salomone A, Freeman TP (2020) Cannabis knowledge and implications for health: considerations regarding the legalization of non-medical cannabis. Med Sci Law 60(4):309–314. https://doi.org/10.1177/0025802420934255
doi: 10.1177/0025802420934255
pubmed: 32600171
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2018). Medical use of cannabis and cannabinoids. Questions and answers for policymaking. Accessible at: https://www.emcdda.europa.eu/system/files/publications/10171/20185584_TD0618186ENN_PDF.pdf . Accessed 12 Feb 2021
Cartabellotta A, Iacono C. Uso terapeutico della cannabis nel dolore cronico: efficacia ed effetti avversi. Evidence 2017;9(9): e1000173. Available at https://www.evidence.it/articoli/pdf/e1000173.pdf . Accessed 21 Feb 2021
Davis MP (2016) Cannabinoids for symptom management and cancer therapy: the evidence. J Natl Compr Canc Netw 14(7):915–922. https://doi.org/10.6004/jnccn.2016.0094
doi: 10.6004/jnccn.2016.0094
pubmed: 27407130
Mirelman D, Waissengrin B, Goldway N, Sharon H, Brill S, Wolf I (2019) Use of medical cannabis: perceptions of Israeli oncologists. Lancet Oncol 20(4):475–477. https://doi.org/10.1016/S1470-2045(19)30077-4
doi: 10.1016/S1470-2045(19)30077-4
pubmed: 30942172
Temple LM, Lampert SL, Ewigman B (2019) Barriers to achieving optimal success with medical cannabis: opportunities for quality improvement. J Altern Complement Med 25(1):5–7. https://doi.org/10.1089/acm.2018.0250
doi: 10.1089/acm.2018.0250
pubmed: 30188174
pmcid: 6352514
Multi-Societal Strategy for cancer care (FAVO, AIOM, AIRO, SICO, SIPO e FNOPI). Documento programmatico per la XV Giornata Nazionale del Malato Oncologico. Available at: https://www.favo.it/images/Documento_Programmatico_Giornata_Nazionale_del_Malato_Oncologico_2020.pdf . Accessed 12 Feb 2021
European Society for Medical Oncology (2020). ESMO Perspectives. It is time to extend the continuity of cancer care beyond hospital walls. Available at: https://perspectives.esmo.org/latest-edition/featured-content/it-is-time-to-extend-the-continuity-of-cancer-care-beyond-hospital-walls . Accessed 12 Feb 2021