Cannabis in cancer therapy

Dr. Pittl, you use cannabis in integrative oncology and palliative care. Do you have to contend with prejudices?
Yes, unfortunately this still happens, cannabinoids still arouse defensive reflexes in many places. Until a few years ago, I had to apply to the FOPH every time I wanted to prescribe a cannabis preparation with a higher THC content. In the last 10 years, however, the situation has improved significantly. More and more doctors, but also patients, are aware of the potential of this plant and are asking about it, and prejudices are also becoming less prevalent in conventional medicine. Cannabinoids are already much more established in the treatment of other conditions, such as spastic and neuropathic pain symptoms associated with multiple sclerosis (MS). There have also been breakthroughs, for example in the treatment of early childhood epilepsy with preparations made from CBD, which has also encouraged a new openness in the use of cannabinoids.

How do you use the plant with cancer patients?
There are a variety of indications, whereby the effectiveness always depends on what proportion of the plant is prescribed. The most established use is in chemotherapy, as a remedy for nausea, which has been used since the 1980s. In palliative medicine, there are also a variety of treatment options, for example for loss of appetite, to supplement complex pain therapy, to treat sleep disorders or to support a depressive mood, to name but a few. Cannabinoids support the balance of the autonomic nervous system, which can have a positive effect on many areas of life, especially the psyche and sleep. It happens that in palliative care we can sufficiently and very effectively save on some medications by supplementing cannabinoids.

Are cannabinoids also used after anti-tumor therapy has been completed?
Yes, in this area we mainly work with preparations that contain more cannabidiol (CBD). It helps many patients to regain their psycho-emotional balance after completing treatment. From the point of view of our autonomic nervous system, completing chemotherapy is, metaphorically speaking, like successfully escaping from a sabre-toothed tiger. We must first recognize this trauma and these emotions in order to be able to process them and integrate them step by step. In addition to holistic, integrative medical support, cannabinoids can also help to improve sleep and mood, reduce fascial tension and thus restore inner balance.

In a recent publication, they reported an anti-tumor effect of certain cannabinoids.
Yes, there are recent studies in basic research and also in research with smaller numbers of patients that indicate that this effect exists with a higher proportion of tetrahydrocannabinol (THC). These effects are described differently depending on the type of cancer. Unfortunately, like so many things to do with cannabis, too little research has been done into these relationships.

Why is that?
There may be a lack of sufficient political will or even effective research funding for the fields of palliative medicine or integrative medicine. In medicine, it is often said that treatment must be taken «from bench to bedside», i.e. from theory in the research laboratory to practice at the patient's bedside. Here it is the other way around: we have a lot of practical experience from everyday life with our patients, which needs to be collected in a more structured way and should also be incorporated into research questions and fields of research with an open mind so that even more scientific evidence can be built up. In turn, this currently means that we often have to go to great lengths to obtain cost approvals for the use of cannabis in cancer medicine.

Does health insurance cover these forms of therapy?
I can't answer that in general, it has to be assessed individually in each case. It tends to be a little easier with established measures, such as those used to treat pain or nausea. What I can guarantee in any case is that we do our utmost to ensure that every patient receives the best possible treatment.