As more cancer patients turn to cannabis for symptom relief, oncologists stress the need for clinical guidance and rigorous research. Here’s where things stand in 2025.
Patients Leading the Way in Cannabis Use for Cancer
In recent years, the use of cannabis among cancer patients has surged, particularly for managing pain, nausea, appetite loss, and anxiety. This trend was front and center at the 2025 Community Oncology Alliance (COA) Conference, where leading oncologists voiced both support and concern over the rapid adoption of medical cannabis without consistent medical oversight.
Dr. Donald Abrams, an integrative oncologist at UCSF and former chief of hematology-oncology at Zuckerberg San Francisco General Hospital, cited a 2018 survey showing that 80% of oncologists had discussed cannabis with their patients, though nearly four out of five conversations were patient-initiated. Many physicians agreed cannabis had benefits for symptoms like anorexia and chronic pain. Still, only a minority recommended it officially — largely due to a lack of robust clinical data and formal education.
ASCO Guidelines: Caution First, Especially Outside Clinical Trials
Responding to the growing use of cannabis in cancer care, the American Society of Clinical Oncology (ASCO) released a comprehensive guideline on cannabis and cannabinoids in adult cancer patients. One of the key takeaways: cannabis should not be used as a cancer treatment unless administered within the framework of a clinical trial. The evidence simply isn’t strong enough yet.
However, when it comes to symptom management, especially nausea and vomiting from chemotherapy, ASCO acknowledges cannabis may be helpful. The data supporting cannabis in this context — when used alongside standard anti-nausea medications — is currently the strongest.
Real-World Choices: Why Patients Often Go Off-Script
Despite official recommendations, many patients still take their treatment into their own hands — especially when side effects from conventional medications become intolerable. Dr. Abrams explained that some of his patients prefer inhaled cannabis to standard antiemetics like ondansetron, which, while effective, can cause severe constipation.
“Some people who are suffering — who feel like part of them is dying — want to avoid that constipated, blocked-up feeling,” said Dr. Abrams. “They tell me they’d rather manage with cannabis alone, even though I’ve prescribed the usual anti-nausea drugs.”
This underscores a key challenge for clinicians: while guidelines provide a framework, individual patient preferences and quality-of-life concerns often drive care decisions in the real world.
Starting Low and Staying Safe: Dosing Matters
Both Dr. Abrams and Dr. Richard T. Lee, director at the City of Hope Center for Integrative Oncology, emphasized the importance of starting with low doses of THC and CBD, especially for patients new to cannabis.
They recommend beginning with 2.5 to 5 mg of THC per day, and not exceeding 20–30 mg of THC or 300 mg of CBD daily. Higher doses may cause side effects ranging from cognitive confusion to liver stress — particularly in patients with liver metastases or other organ impairments.
“CBD at doses over 300 mg can affect liver function, and THC at higher levels can cause confusion or dizziness,” Dr. Lee cautioned. “In vulnerable patients, we must be extra careful.”
Research on the Rise: Integrative Oncology Gaining Ground
Dr. Lee also highlighted the growing focus on integrative oncology at institutions like City of Hope, which launched its dedicated center in 2023. Their research explores how cannabis affects chemotherapy-induced neuropathy, quality of life, and overall patient well-being.
He noted that cannabis is just one piece of a larger movement in cancer care that also includes acupuncture, massage therapy, meditation, and nutritional support. “We’re building a more holistic model of care. Patients want options, and the science is finally starting to catch up,” said Dr. Lee.
The Bottom Line: An Evolving Conversation
While cannabis is unlikely to replace standard cancer treatments anytime soon, it is increasingly seen as a valuable tool for symptom management — when used responsibly and under medical supervision. The challenge now is bridging the gap between growing patient interest and cautious clinical practice.
With major institutions calling for more rigorous research and better education for healthcare providers, the coming years are likely to bring clearer guidance and safer use of medical cannabis in cancer care.
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