United States oncologists’ clinical preferences regarding modes of medicinal cannabis use

Dear Editor, Almost every state in the United States with a comprehensive medicinal cannabis (MC) law identifies cancer as a qualifying condition for MC use [1, 2]. A growing body of scientific literature indicates that cancer patients use MC for both symptom management (e.g., pain, low appetite, fatigue,mood disturbance) and cancer-directed therapy [3, 4]. While survey research suggests that cannabis is most typically consumed via combustion, cannabis ismost often consumed orally among cancer patients [5]. Data from a nationally-representative sample of medical oncologists indicate that 80% of them discuss MC with patients and nearly half recommend cannabis clinically [6]. However, little is known about oncologists’ views on different modes of MC use. This study, a secondary analysis of the above-mentioned national survey [6], explored oncologists’ preferences regarding different modes (combustion, smoking, vaporization, and ingested) of MC use. We examined providerlevel and practice-level predictors of these preferences. We hypothesized that oncologists would favor oral MC use given similar trends among medical providers caring for patients with other serious illnesses [7] and potential stigma in the medical community regarding combustion. Between November 2016 and January 2017, a nationallyrepresentative sample of board-certified, medical oncologists was surveyed about their views on MC. The corresponding full methodological details are described elsewhere [6]. Briefly, the survey was mailed to a nationally-representative sample [6], MC was defined as non-pharmaceutical cannabis, and the item of interest was presented in a multiple-select response format: “What mode(s) of medical marijuana use do you prefer for your oncology patients?” (possible responses: “smoking,” “vaporizing,” “ingesting orally,” “no preference,” “I don’t know,” or “do not support medical marijuana”). To simplify interpretation, survey participants who “[did] not support medical marijuana use of any sort”