Gap in oncology training leaves doctors unprepared for cannabis questions

Evidence suggests as many as 40% of adults with cancer turn to marijuana—more properly known as cannabis—to manage symptoms like pain, nausea and anxiety, and many want guidance from their physicians. Yet a new national study led by investigators at Beth Israel Deaconess Medical Center (BIDMC) finds that most oncologists-in-training, or fellows, feel underprepared to unprepared to manage this increasingly common aspect of their patients’ care.

“Patients with cancer are using cannabis, and they’re turning to their doctors for advice,” said lead author Deepa Rangachari, MD, director of Graduate Medical Education & Hematology Oncology Fellowship Program Director at BIDMC. “But without high-quality evidence and without structured training, most trainees don’t feel equipped to counsel them appropriately.”

Published in the Journal of Cannabis Research, the study surveyed 189 oncology fellows across 40 training programs in 25 U.S. states. It found that about one in five recommended medical cannabis to more than five patients in the previous year. About one-quarter of fellows had received prior training in medical cannabis, and those with training were twice as likely to recommend it to patients.

They were also significantly more likely to hold informed opinions about its risks, benefits, preferred modes of use, and which cancer patients might benefit most, underscoring the impact education can have on physicians’ confidence.

“These findings highlight a disconnect,” said co-lead author Rushad Patell, MD, associate program director of the Hematology Oncology Fellowship Program and director of Benign Hematology Clinical and Translational Research at BIDMC. “Trainees are expected to guide patients through decisions about cannabis use, yet few have received any structured education, and high-quality clinical data is sparse.”

The results build on Rangachari and Patell and colleagues’ previously published analysis showing that more than half of oncology trainees had discussed cannabis with patients, but far fewer had recommended it. Their new findings highlight how even basic training helps fellows feel more confident and capable of engaging in evidence-based conversations about cannabis use, despite the limited data demonstrating its safety or efficacy in cancer care. Among survey respondents, prior training doubled the rates at which participants recommended medical cannabis to their patients.

“This is about preparing the next generation of cancer physicians to meet patients where they are,” said Rangachari. “Well-informed, patient-centered care starts with giving our trainees the tools they need to engage in nuanced, evidence-based conversations.”

The study also found that oral ingestion was the most recommended mode of administration, cited by two-thirds of fellows, likely reflecting comfort with its perceived controllability and safety. However, nearly one-third of fellows either had no preference or were unsure, highlighting gaps in awareness of, and evidence for, different routes of administration and limited clinical guidelines for use in cancer care.

The researchers note that current evidence is strongest for cannabis providing relief for chemotherapy-induced nausea and vomiting, with less data supporting its use for other symptoms like chronic pain or appetite loss, and virtually none for issues like diarrhea. They also stress the importance of training on cannabis’s potential side effects, drug interactions, and risks in patients receiving immunotherapy.

“Personalized, patient-centered care starts with understanding and communicating the best available evidence,” said co-lead author Kian Tehranchi, MD, a clinical fellow in hematology oncology at BIDMC. “As medical cannabis becomes more widely used and accepted, it’s critical that fellowship training equips future oncologists with the knowledge they need to have informed, thoughtful conversations and support shared decision-making with their patients.”

Co-authors included Laura Dodge, Jason Freed, and Mara A. Schonberg of BIDMC; Poorva Bindal of University of Massachusetts Memorial Health; Mary Buss of UConn Health, University of Connecticut School of Medicine; and Ilana Braun of Dana-Farber Cancer Institute.

Evidence suggests as many as 40% of adults with cancer turn to marijuana—more properly known as cannabis—to manage symptoms like pain, nausea and anxiety, and many want guidance from their physicians. Yet a new national study led by investigators at Beth Israel Deaconess Medical Center (BIDMC) finds that most oncologists-in-training, or fellows, feel underprepared to unprepared to manage this increasingly common aspect of their patients’ care.

“Patients with cancer are using cannabis, and they’re turning to their doctors for advice,” said lead author Deepa Rangachari, MD, director of Graduate Medical Education & Hematology Oncology Fellowship Program Director at BIDMC. “But without high-quality evidence and without structured training, most trainees don’t feel equipped to counsel them appropriately.”

Published in the Journal of Cannabis Research, the study surveyed 189 oncology fellows across 40 training programs in 25 U.S. states. It found that about one in five recommended medical cannabis to more than five patients in the previous year. About one-quarter of fellows had received prior training in medical cannabis, and those with training were twice as likely to recommend it to patients.

They were also significantly more likely to hold informed opinions about its risks, benefits, preferred modes of use, and which cancer patients might benefit most, underscoring the impact education can have on physicians’ confidence.

“These findings highlight a disconnect,” said co-lead author Rushad Patell, MD, associate program director of the Hematology Oncology Fellowship Program and director of Benign Hematology Clinical and Translational Research at BIDMC. “Trainees are expected to guide patients through decisions about cannabis use, yet few have received any structured education, and high-quality clinical data is sparse.”

The results build on Rangachari and Patell and colleagues’ previously published analysis showing that more than half of oncology trainees had discussed cannabis with patients, but far fewer had recommended it. Their new findings highlight how even basic training helps fellows feel more confident and capable of engaging in evidence-based conversations about cannabis use, despite the limited data demonstrating its safety or efficacy in cancer care. Among survey respondents, prior training doubled the rates at which participants recommended medical cannabis to their patients.

“This is about preparing the next generation of cancer physicians to meet patients where they are,” said Rangachari. “Well-informed, patient-centered care starts with giving our trainees the tools they need to engage in nuanced, evidence-based conversations.”

The study also found that oral ingestion was the most recommended mode of administration, cited by two-thirds of fellows, likely reflecting comfort with its perceived controllability and safety. However, nearly one-third of fellows either had no preference or were unsure, highlighting gaps in awareness of, and evidence for, different routes of administration and limited clinical guidelines for use in cancer care.

The researchers note that current evidence is strongest for cannabis providing relief for chemotherapy-induced nausea and vomiting, with less data supporting its use for other symptoms like chronic pain or appetite loss, and virtually none for issues like diarrhea. They also stress the importance of training on cannabis’s potential side effects, drug interactions, and risks in patients receiving immunotherapy.

“Personalized, patient-centered care starts with understanding and communicating the best available evidence,” said co-lead author Kian Tehranchi, MD, a clinical fellow in hematology oncology at BIDMC. “As medical cannabis becomes more widely used and accepted, it’s critical that fellowship training equips future oncologists with the knowledge they need to have informed, thoughtful conversations and support shared decision-making with their patients.”

Co-authors included Laura Dodge, Jason Freed, and Mara A. Schonberg of BIDMC; Poorva Bindal of University of Massachusetts Memorial Health; Mary Buss of UConn Health, University of Connecticut School of Medicine; and Ilana Braun of Dana-Farber Cancer Institute.