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14 cannabis patient care | vol. 3 no. 3 cannapatientcare.com nurse focus The Great Debate: Kids, Cancer, and Cannabis B Y K A T H E R I N E G O L D E N , R N A CANCER DIAGNOSIS creates shockwaves of fear, con- cern, and worry for any person, as well as for their friends, family, and colleagues. When that diagnosis ap- plies to a child, those emotions are amplified. No one wants to see a childhood interrupted by constant doctor and healthcare appointments, aggressive treatments, and debilitat- ing side effects. Parents and guardians of children impacted by cancer are in a constant search for resources that can lessen the impact of the diagnosis, ease their child's discomfort, or help hasten a recovery from treatment. It is no surprise that many caregivers wonder if cannabis can help, and with the increasing number of states legalizing medicinal cannabis more parents are asking healthcare professionals for advice. The growing acceptance and legalization of cannabis has pro- vided access to medical cannabis for children like never before. As a result, more people are inquiring about its potential as a treatment option. In a 2017 survey of cancer care providers con- ducted by the Yale School of Medicine, 30% of respondents said that patients or their families had asked for medical marijuana at least once in the past month (1). In addition, that same survey found that 92% of clinicians surveyed were willing to help pedi- atric patients access medical cannabis. Still, the topic of canna- bis medicine for pediatric cancer patients remains controversial. Although stigma surrounding the use of cannabis is dimin- ishing, large portions of the US population still consider it to be potentially dangerous, especially for young people. The "gate- way drug" reputation that has persisted for decades continues to create concern. But there are also more realistic and practical concerns surrounding the use of a psychoactive substance by children. Brain maturity continues well past the teenage years, and there is some evidence that full brain development is not complete until well into a person's 20s. There is concern that any cannabis-based treatment received by children will impact their brain development, according to a 2022 study (2). However, when reduction of pain and suffering for children is a factor, there are those who suggest that limited exposure to potential hazards is worth the risk. A 2021 report found that many parents of children with severe conditions pursued medical cannabis despite these potential obstacles (3). Although there is limited data to support the use of canna- bis as a first-line treatment in cancer-related symptoms, many adult patients are consuming it to relieve the anxiety, pain, nausea, loss of appetite, and insomnia that often come with a cancer diagnosis and subsequent chemotherapy or radia- tion treatment. In 2017, the National Academy of Sciences, En- gineering, and Medicine released its report on The Health Ef- fects of Cannabis and Cannabinoids (4). After reviewing more than 10,000 peer-reviewed journals the report concluded: • There is conclusive evidence that cannabis or cannabi- noids are effective at treating chronic pain in adults and chemotherapy induced nausea and vomiting. • There is moderate evidence that cannabis or cannabi- noids are effective at improving short term sleep distur- bances and limited evidence at improving appetite and decreasing weight loss. Overall, there have been multiple studies suggesting that tet- rahydrocannabinol (THC), the psychoactive or intoxicating com- ponent of cannabis, can be effective in the treatment of nau- sea, pain, appetite loss, insomnia, anxiety and inflammation—all of which can be side effects of chemotherapy. And while this re- search shows that cannabis can help relieve symptoms related to a cancer diagnosis, all the research conducted has been with adult subjects. There is virtually no conclusive literature regard- ing the use of cannabis in pediatric cancer care (5). This lack of research creates the biggest stumbling block to physicians and clinicians when it comes to recommend- ing cannabis for their pediatric cancer patients. Since pediat- ric cancers can vary wildly from adult cancers, it is possible that any therapy, including cannabis, may behave differently in children compared to adults. The limited clinical research combined with a widespread lack of knowledge about can- nabis among healthcare professionals keeps clinicians hes- itant to recommend cannabis to pediatric cancer patients. However, there exist many cases of cannabis use (primar- ily, cannabidiol [CBD]) in children to treat pediatric epilep- sy and chemotherapy-induced nausea and vomiting (CINV) that show both the safety and efficacy of cannabis in pediatric Parents are asking about medical cannabis while seeking relief for their cancer-stricken children, but lack of research and ongoing stigma make things complicated.