Karen Hande, PhD, DNP, ANP-BC, CNE, FAANP, ANEF, discusses increased patient interest in cannabinoids and how oncology nurses can steer pain management conversations to keep patients informed.
Cannabinoids have grown in popularity as a method of symptom and pain management for patients with cancer, making candid communication of care options between nurses and patients critical, according to Karen Hande, PhD, DNP, ANP-BC, CNE, FAANP, ANEF.
“Nurses have a role in guiding their patients and sharing with them the available evidence: which is very limited,” Hande, who recently presented on cannabinoids as part of the 2022 ONS Bridge, said in an interview. “We need to share [information] with them, and monitor, and document their use of cannabis and cannabinoids, similar to any other drug therapies that we would follow and educate our patients or caregivers about.”
In an interview with Oncology Nursing News®, Hande, who practices at Vanderbilt-Ingram Cancer Center and specializes in oncology pain management, discussed the importance of nurses staying up to date on developments surrounding cannabinoids and relevant laws as well.
What is the appeal of cannabinoids for patients with cancer? How have consumer attitudes shifted and how has it become popular?
Hande: It’s [become] a pretty popular option for people because they see it on billboards and they hear other people talking; other patients who may be sitting next to them and saying, “Hey, this is what I’m doing to try to feel better or to improve some sort of symptom.”
When you think about the general public [seeing] a store or a facility selling CBD [cannabidiol], it [may appear] that if they’re selling it, it must be safe, or it must be something that is supported or monitored and why not try it.
You cannot blame any [individual] who has cancer [for] trying to mitigate some sort of symptom. [To many,] it looks like it could be harmless. People are curious and [are] trying to manage unwanted symptoms, so they try it; family members also offer this as a mitigating strategy for their loved ones and try to support them with the best intentions.
How effective is it in managing pain and what information can help guide nurses when talking to patients about if cannabinoids are a good idea?
The utility of cannabis, cannabinoids, or cannabis-based medicines for the treatment of cancer is not demonstrated in any sort of data.
With an acceptable safety profile, cannabis may be useful in managing symptoms related to cancer or its treatment, but further clinical trials have to be conducted to evaluate whether the preclinical antitumor effects translate into benefit for cancer patients. We do not know right now.
Oncology nurses must familiarize themselves with the available database to be able to better advise their patients on the potential uses of this complimentary botanical therapy.
Are there any potential risks associated with cannabinoid use? As a nurse, what risks should you look out for especially because patients are not always forthcoming? What might you proactively talk to them about?
CBD is not regulated by the FDA.
When [individuals] see it being sold, they [tend to] believe that this has been monitored or regulated, but it is not; [whether] it is pure CBD or not is not known.
There have been some trials that have been looking at the profile of CBD and the CBD that is being sold. [One] study has shown that there are several contaminants in the CBD that's being sold. So [patients] are just not sure what they are consuming.
We have to share that with patients—that we cannot say one way or the other that this is a benefit to them or a certain type of dose or a certain brand because we don’t know. [Manufacturers] can claim what they would like on the label—even though that’s really against the law to claim something that may not be true or evidence based.
As an oncology nurse, how would you recommend responding if a patient expresses interest in trying CBD products?
I would first affirm that, of course, [the patient is] interested.
This is all over the media, people see this on street corners—it looks very appealing. They may have had friends or family or a patient sitting next to them affirm some sort of benefit from a type of treatment of CBD.
I would [have them] affirm that and say, “Yes, I understand completely”. [Patients] are curious and want to understand and find something else that can help them. Don’t make them feel bad about it; I want them to understand this is a common experience for many patients.
[However,] I would say we do not have the evidence to support that this is of benefit. Also, we don’t have the evidence to support that [CBD products] do not have long-term adverse effects. I would say to them: this is what we know, and this is your decision to take this substance or not, but I cannot confirm it.
Would you encourage documenting patient use of cannabinoids—even in states where stigma is strong? How does undocumented patient use affect our understanding of cannabinoids?
I encourage nurses to ask patients to [both] start the dialogue and decrease the stigma.
Again, affirm that we recognize [individuals] are trying this. [We want to ask] are you trying it?; is this something that you're interested in? There is some negativity about taking CBD or cannabidiol [but] it’s not illegal; it's legal to take [CBD].
We want to have that documented because the challenge is if you do a urine drug screen, sometimes THC [tetrahydrocannabinol] can be positive in urine [samples].
This has consequences if you’re giving them opioid treatment and have to do urine drug screens. In some states, an illegal substance such as THC may have negative consequences. I have had a lot of patients who take CBD but do not use THC and their urine drug screen or drug screens are positive. They end up being very concerned because they did not realize that they [would test] positive for THC. I explain to them that the CBD products that they were consuming may have had detectable levels of THC in it—which, therefore, turns their urine positive for marijuana or THC.
It's important to have that data in their chart, so they recognize that there is a possibility of what can happen, but I try not to discourage them or give them stigma about it because then patients aren’t going to tell you anything.