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research focus 9 cannapatientcare.com october 2022 | cannabis patient care Surveys on Cannabis for Pediatric Oncology Several surveys have been conducted of doctors and of parents with children who have cancer to gauge their attitudes toward medical cannabis, that is, to assess the extent to which doctors and parents would use or actually do use cannabis to treat cases of pediatric cancer. Parents and Caretakers A small survey (64 respondents) of parents and caretakers of children with cancer on their attitudes toward medical cannabis reported the following (7). The most common form of can- cer in patients using cannabis was leukemia. Roughly 20% of respondents reported using cannabis, many of whom reported using it for both treating the cancer itself, as well as managing symptoms of both the cancer and its treatments. All parents and caretakers using cannabis reported improved symptoms, particularly pain. The majority (almost 2/3) obtained their can- nabis from friends or dispensaries, rather than from a prescrip- tion or agency. Healthcare Providers Several surveys of healthcare providers have been conducted on their attitudes toward medical cannabis for pediatric cancer, with the following findings. First, pediatricians are seeing grow- ing demand for medical cannabis for kids (not limited to can- cer) (8,9). Second, regarding the use of cannabis to treat cases of children with cancer, healthcare providers are concerned about: the potential for cognitive impairment, the lack of guid- ance or formulation or dosing, the potential for illicit or toxic use, and the Schedule I status with all its associated baggage. That said, providers are willing to consider cannabis for cases of pediatric oncology (3,8,10). One survey found more favor- able attitudes from doctors who were "not eligible to certify" (N-ETC) (that is, prescribe) cannabis for their patients relative to attitudes from doctors who were eligible (ETC). Research- ers interpreted the results to mean that N-ETC doctors had attitudes more similar to those of the general public, whereas ETC doctors who risked their license and reputation by recom- mending medical cannabis were less amenable to its use for their patients (10). Finally, doctors "overwhelmingly identified a role for cannabis in helping treat the symptoms associated with pediatric oncology, but almost none viewed cannabis as an anti-cancer agent" (8). The American Academy of Pediatrics While the American Academy of Pediatrics generally oppos- es pediatric cannabis, it does support medical cannabis for use in "children with life-limiting or seriously debilitating conditions," which arguably includes pediatric cancer and CINV (11). Risks Cognitive Impairment The biggest risk in using cannabis as a therapeutic to treat cases of pediatric oncology is the potential for cannabis to induce cognitive impairment in children whose brains are still undergoing development. All the studies referenced in this article were quick to cite this concern. This issue begs some fur ther context. First, the vast ma- jority of providers who have used medical cannabis to treat children with cancer repor t "a high level of general satisfac- tion with the use of cannabis" (1,3–6). Second, many children with cancer eventually die from their disease. In the case of the Israeli study previously mentioned, two-thirds of the pa- tients who were treated with medical cannabis died from their disease (4). And third, the children with cancer who sur- vive tend to suffer, some severely, from long-term health problems from their disease. In par ticular, as of 2020, there are more than 500,000 sur vivors of childhood cancer cur- rently living in the US (1). More than half (60%) of these sur- vivors suffer from late effects, some of which (about 25%) are severe (1,2). One source lists numerous cognitive and physio- logical impairments (1), while another source lists psychoso- cial and mental health disorders (2). When considered in context, then, the benefits associat- ed with using cannabis to treat pediatric oncology (less nau- sea and improved appetite, better sleep, increased quality of life) appear to far outweigh the potential costs (long term cog- nitive impairment), especially given the high incidence either of death or of severe, long-term health problems in survivors of pediatric cancer. Of course, each case is different, and the deci- sion should be left to patients and their doctors, but the option should be there. Interactions with Chemotherapeutics Researchers warn that certain enzymes that play large roles in metabolizing cannabinoids (THC and CBD) are also involved in metabolizing several chemotherapeutics. So then taking cannabis while undergoing chemotherapy could alter the bioavailability of chemotherapeutics. "As such, cannabinoid use during conventional cancer therapy should be very carefully considered" (3). Conclusion Cannabis provides a conundrum for treating pediatric oncology: while preclinical research provides clear mechanisms of action for cannabis's potential to treat pediatric oncology, clinical stud- ies are difficult to conduct, due to the associated ethics. At the same time, both preliminary clinical studies, as well as reported use of cannabis administered by parents and caregivers, have established the benefits of cannabis for children with cancer. All