Guest Editor’s Note: Cannabis products are rising in popularity and increasingly used for medical purposes. For appropriate counseling and guidance in an oncology setting, clinicians must understand current cannabis use patterns among patients with cancer. In this article, Nirupa Raghunathan, MD, summarizes a retrospective study of patient experiences with medical cannabis at an academic cancer center’s medical cannabis clinic.
Nirupa Raghunathan, MD
Overview
Although cannabis use remains illegal at the federal level, as of October 2023, 38 states in the United States have passed laws allowing access to medical cannabis, with 23 states and the District of Columbia also allowing adult use of recreational cannabis. In medical cannabis programs, cancer is a qualifying condition in nearly all states. There is some evidence that cannabinoids may be effective in the management of symptoms commonly associated with cancer, including sleep, pain, anxiety, appetite, nausea, and vomiting.1-5
My colleagues and I set out to describe patient experiences with medical cannabis, including cannabidiol (CBD), at a dedicated clinic at a National Cancer Institute–designated cancer center, with a focus on use contexts and patients’ reported benefits and harms. We implemented a standardized intake form and abstracted the data for all initial visits from October 2019 to October 2020. We reported descriptive statistics, chi-square analysis, and multivariate logistic regression.
Study Findings
Among 163 unique new patients, the mean patient age was 48, and roughly half were men (n = 84). Patients were predominately White and Non-Hispanic. Among cancer diagnoses, the largest group had sarcoma (22%, n = 36), followed by gastrointestinal malignancies (16%, n = 26); 56% (n = 91) were actively receiving cancer treatment, and 58% (n = 95) had stage IV or advanced disease at the time of intake form completion. The most common treatment received was chemotherapy (87%).
In this study,6 approximately 50% of patients reported sleep, appetite, pain, and anxiety as the reasons for current interest in medical cannabis. About 30% of these patients considered medical cannabis for nausea and cancer treatment. A total of 40% and 46% reported past use of CBD and tetrahydrocannabinol (THC), respectively, for medical purposes. Among past users of CBD, commonly reported benefits were less pain (21%) or anxiety (17%) and improvement in sleep (15%); 92% reported no side effects. Among those with past use of THC, reported benefits included improvements in appetite (40%), sleep (32%), nausea (28%), and pain (17%); side effects included feeling “high.
Guest Editor
Jun J. Mao, MD, MSCE
Dr. Mao is the Laurance S. Rockefeller Chair in Integrative Medicine and Chief of Integrative Medicine Service at Memorial Sloan Kettering Cancer Center, New York.
Of note, 48 patients (29.5%) were interested in using CBD for cancer treatment. There was no apparent significant association between interest in using CBD for cancer treatment and gender, race, and cancer stage. However, patient age (19.1% for those < age 40 vs 39.7% for those between the ages of 40 and 60 vs 29.7% for those ≥ age 60; P = .040) and active treatment (37.4% in active treatment vs 19.4% not in active treatment; P = .013) were significantly associated with expressing interest in using CBD for cancer treatment. This finding, however, should be interpreted in the context of the mean age of patients in our study, which was 48, compared with the higher national median age of 66 at cancer diagnosis.6
Concluding Thoughts
Evidence that cannabinoids may improve symptoms associated with cancer and its treatments is scant. Some data suggest that THC-containing cannabis may improve chemotherapy-induced nausea and vomiting, although studies are generally of poor quality. Studies of THC, as an adjunct to opioids, for pain have shown some effectiveness, with similar methodologic limitations. To our knowledge, there is no evidence supporting the use of THC for cancer-related anxiety. Data in support of the use of CBD for symptom management are even more scant, but the product’s lack of psychoactive effects makes it an attractive potential therapy.
Amid the growing interest in cannabinoids in the medical community and the general population, as well as shifting attitudes toward cannabis, clinicians must understand current cannabis use patterns among patients with cancer to inform appropriate counseling and guidance.
DISCLOSURE: Dr. Raghunathan reported no conflicts of interest.
REFERENCES
1. Mersiades AJ, Tognela A, Haber PS, et al: Oral cannabinoid-rich THC/CBD cannabis extract for secondary prevention of chemotherapy-induced nausea and vomiting. BMJ Open 8:e020745, 2018.
2. Grimison P, Mersiades A, Kirby A, et al: Oral THC:CBD cannabis extract for refractory chemotherapy-induced nausea and vomiting. Ann Oncol 31:1553-1560, 2020.
3. Strasser F, Luftner D, Possinger K, et al: Comparison of orally administered cannabis extract and delta-9-tetrahydrocannabinol in treating patients with cancer-related anorexia-cachexia syndrome. J Clin Oncol 24:3394-3400, 2006.
4. Shannon S, Lewis N, Lee H, et al: Cannabidiol in anxiety and sleep: A large case series. Perm J 23:18-41, 2019.
5. Bergamaschi MM, Queiroz RH, Chagas MH, et al: Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naive social phobia patients. Neuropsychopharmacology 36:1219-1226, 2011.
6. Raghunathan NJ, Brens J, Vemuri S, et al: In the weeds: A retrospective study of patient interest in and experience with cannabis at a cancer center. Support Care Cancer 30:7491-7497, 2022.
Dr. Raghunathan is Director of Pediatric Integrative Oncology at the Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York.
