Patterns and factors among oncology fellows recommending medical cannabis to adults with cancer

TL;DR

Oncology trainees often recommend medical cannabis, but many feel unprepared due to lack of training.

Contribution

This study identifies prior training as a key factor in recommending medical cannabis among oncology fellows.

Findings

22% of participants recommended cannabis to more than 5 patients in the past year.

24% of participants had prior training in medical cannabis.

Prior training was significantly associated with higher cannabis recommendations.

Abstract

Medical cannabis consumption is rising, but limited evidence informs the safety and efficacy of cannabis use in cancer patients. A national survey of oncology trainees found that most fellows felt insufficiently informed to make clinical recommendations about cannabis.

In this secondary analysis, we aimed to measure how frequently trainees recommend in favor of cannabis and determine factors influencing this clinical practice.

In this cross-sectional survey study for fellows enrolled in oncology training programs across the United States, an online survey assessing trainee practices regarding medical cannabis was sent to 155 oncology fellowship program directors from January - March 2021; who were asked to distribute it to their fellows. The primary outcome was the frequency with which oncology fellows recommended cannabis in the prior year.

Nationally, 40 programs from 25 states participated, with 189 of 462 trainees across these programs responding (40.9% response rate). 22% (95% CI: 16.3–29.0%) of participants reported recommending medical cannabis to > 5 patients in the past year. 24% (95% CI: 18.4–30.5%) of participants had prior training in medical cannabis. Regarding participant characteristics, only prior training in medical cannabis was significantly associated with recommending cannabis to > 5 patients (RR: 2.4; 95% CI: 1.4–4.2).

With increasing cannabis use among patients with cancer and given that a substantial number of oncology fellows recommend its use, it is crucial that fellowship training incorporate evidence-based curricula regarding medical cannabis use to guide informed decision-making between patients and their fellow providers.

The online version contains supplementary material available at 10.1186/s42238-025-00293-9.