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Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Feb, 2022;30 (2): 1181-1190.

Cannabis use among Danish patients with cancer: a cross-sectional survey of sociodemographic traits, quality of life, and patient experiences.

Sebastian W Nielsen, Christina H Ruhlmann, Lise Eckhoff, Dorthe Brønnum, Jørn Herrstedt, Susanne O Dalton
Author Information
  1. Sebastian W Nielsen: Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Vestermarksvej 9, 4000, Roskilde, Denmark. sewn@regionsjaelland.dk. ORCID
  2. Christina H Ruhlmann: Department of Clinical Research, University of Southern Denmark, 5000, Odense C, Denmark.
  3. Lise Eckhoff: Department of Oncology R, Odense University Hospital, 5000, Odense C, Denmark.
  4. Dorthe Brønnum: Centre for Clinical Research, North Denmark Regional Hospital, 9800, Hjoerring, Denmark.
  5. Jørn Herrstedt: Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Vestermarksvej 9, 4000, Roskilde, Denmark.
  6. Susanne O Dalton: Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 1165, Copenhagen, Denmark.
PMID: 34453567 DOI: 10.1007/s00520-021-06515-z

Abstract

PURPOSE: Patients with cancer are using cannabis for self-treatment. The reasons, experienced effects, and prevalence of use are unknown in the European general oncological population.
METHODS: Adult patients with cancer attending outpatient oncology clinics were invited to participate in a cross-sectional survey. The questionnaire consisted of sociodemographic questions, validated scales on quality of life, neuropathy, anxiety and depression as well as questions regarding use of cannabis.
RESULTS: The overall response rate was 83% (2839 patients) and 13% of patients were using or had used cannabis during their treatment. Rate of use was higher in smokers (19% vs 11%, p adjusted 0.002), in patients in active cancer treatment (14% vs 10%, p adjusted = 0.02), and in patients with depression (19% vs 11%, adjusted p = 0.002). Cannabis use was also correlated with lower quality of life (EORTC C30 SumScore mean diff. =  - 7.61, 95% CI = [- 9.69; - 5.53]). In total, 77% of users experienced at least one positive effect of cannabis, 18% experienced no effect, and 5% experienced other effects. At least one side effect was experienced by 33% of users. Management of pain and nausea were the primary reasons for initiating cannabis use (39% for both). Less nausea and better sleep were the most common effects experienced (26% for both). Oils for oral use were the most common route of administration (88%).
CONCLUSION: Cannabis use among patients with cancer is prevalent and correlated with worse quality of life. Patients report using cannabis for symptom management and many experience relief of their symptoms. However, one third of patients experienced side effects.

Keywords

Alternative medicine Cannabis Complimentary medicine Patient survey Self-treatment

References

  1. Martell K, Fairchild A, LeGerrier B et al (2018) Rates of cannabis use in patients with cancer. Curr Oncol 25:219. https://doi.org/10.3747/co.25.3983 [DOI: 10.3747/co.25.3983]
  2. Pergam SA, Woodfield MC, Lee CM et al (2017) Cannabis use among patients at a comprehensive cancer center in a state with legalized medicinal and recreational use. Cancer 123:4488–4497. https://doi.org/10.1002/cncr.30879 [DOI: 10.1002/cncr.30879]
  3. Braun IM, Blonquist TM, Campbell EG et al (2019) Medical oncologists’ views on the utility of medical marijuana across the cancer trajectory. J Pain Symptom Manage 57:e1–e4. https://doi.org/10.1016/j.jpainsymman.2019.02.001 [DOI: 10.1016/j.jpainsymman.2019.02.001]
  4. Hershman DL, Lacchetti C, Dworkin RH et al (2014) Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 32:1941–1967. https://doi.org/10.1200/JCO.2013.54.0914 [DOI: 10.1200/JCO.2013.54.0914]
  5. Roila F, Molassiotis A, Herrstedt J et al (2016) 2016 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting and of nausea and vomiting in advanced cancer patients. Ann Oncol 27:v119–v133. https://doi.org/10.1093/annonc/mdw270 [DOI: 10.1093/annonc/mdw270]
  6. Cathcart P, de Giorgio A, Stebbing J (2015) Cannabis and cancer: reality or pipe dream? Lancet Oncol 16:1291–1292. https://doi.org/10.1016/S1470-2045(15)00302-2 [DOI: 10.1016/S1470-2045(15)00302-2]
  7. The Danish Medicines Agency (2019) Medicinal cannabis pilot programme. https://laegemiddelstyrelsen.dk/en/special/medicinal-cannabis/citizens/medicinal-cannabis-pilot-programme/ . Accessed 27 Aug 2021
  8. Kvamme SL, Pedersen MM, Alagem-Iversen S, Thylstrup B (2021) Beyond the high: Mapping patterns of use and motives for use of cannabis as medicine. Nord Stud Alcohol Drugs 1455–0725. https://doi.org/10.1177/1455072520985967
  9. Kelkar AH, Smith NA, Martial A et al (2018) An outbreak of synthetic cannabinoid–associated coagulopathy in Illinois. N Engl J Med 379:1216–1223. https://doi.org/10.1056/NEJMoa1807652 [DOI: 10.1056/NEJMoa1807652]
  10. Cox EJ, Maharao N, Patilea-Vrana G et al (2019) A marijuana-drug interaction primer: precipitants, pharmacology, and pharmacokinetics. Pharmacol Ther 201:25–38. https://doi.org/10.1016/j.pharmthera.2019.05.001 [DOI: 10.1016/j.pharmthera.2019.05.001]
  11. Ligresti A, De Petrocellis L, Di Marzo V (2016) From phytocannabinoids to cannabinoid receptors and endocannabinoids: pleiotropic physiological and pathological roles through complex pharmacology. Physiol Rev 96:1593–1659. https://doi.org/10.1152/physrev.00002.2016 [DOI: 10.1152/physrev.00002.2016]
  12. Cassano T, Villani R, Pace L et al (2020) From Cannabis sativa to Cannabidiol: promising therapeutic candidate for the treatment of neurodegenerative diseases. Front Pharmacol 11:1–10. https://doi.org/10.3389/fphar.2020.00124 [DOI: 10.3389/fphar.2020.00124]
  13. Turner SE, Williams CM, Iversen L, Whalley BJ (2017) Molecular pharmacology of Phytocannabinoids. In: Progress in the chemistry of organic natural products. pp 61–101
  14. Abrams D, Guzman M (2015) Cannabis in cancer care. Clin Pharmacol Ther 97:575–586. https://doi.org/10.1002/cpt.108 [DOI: 10.1002/cpt.108]
  15. Bar-Sela G, Cohen I, Campisi-Pinto S et al (2020) Cannabis consumption used by cancer patients during immunotherapy correlates with poor clinical outcome. Cancers (Basel) 12:1–18. https://doi.org/10.3390/cancers12092447 [DOI: 10.3390/cancers12092447]
  16. Groenvold M, Klee MC, Sprangers MAG, Aaronson NK (1997) Validation of the EORTC QLQ-C30 quality of life questionnaire through combined qualitative and quantitative assessment of patient-observer agreement. J Clin Epidemiol 50:441–450. https://doi.org/10.1016/S0895-4356(96)00428-3 [DOI: 10.1016/S0895-4356(96)00428-3]
  17. Eckhoff L, Knoop A, Jensen MB, Ewertz M (2015) Persistence of docetaxel-induced neuropathy and impact on quality of life among breast cancer survivors. Eur J Cancer 51:292–300. https://doi.org/10.1016/j.ejca.2014.11.024 [DOI: 10.1016/j.ejca.2014.11.024]
  18. Esser P, Hartung TJ, Friedrich M et al (2018) The Generalized Anxiety Disorder Screener (GAD-7) and the anxiety module of the Hospital and Depression Scale (HADS-A) as screening tools for generalized anxiety disorder among cancer patients. Psychooncology 27:1509–1516. https://doi.org/10.1002/pon.4681 [DOI: 10.1002/pon.4681]
  19. Pedersen SS, Mathiasen K, Christensen KB, Makransky G (2016) Psychometric analysis of the Patient Health Questionnaire in Danish patients with an implantable cardioverter defibrillator (The DEFIB-WOMEN study). J Psychosom Res 90:105–112. https://doi.org/10.1016/j.jpsychores.2016.09.010 [DOI: 10.1016/j.jpsychores.2016.09.010]
  20. Boren MT, Ramey J (2000) Thinking aloud: reconciling theory and practice. IEEE Trans Prof Commun. https://doi.org/10.1109/47867942 [DOI: 10.1109/47867942]
  21. Fayers P, Aaronson N, Bjordal K, et al (2001) The EORTC QLQ-C30 Scoring Manual (3rd Edition). Eur Organ Res Treat Cancer
  22. Efficace F, Cottone F, Sommer K et al (2019) Validation of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 Summary Score in Patients With Hematologic Malignancies. Value Heal 22:1303–1310. https://doi.org/10.1016/j.jval.2019.06.004 [DOI: 10.1016/j.jval.2019.06.004]
  23. Kroenke K, Spitzer RL, Williams JBW (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16:606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x [DOI: 10.1046/j.1525-1497.2001.016009606.x]
  24. Spitzer RL, Kroenke K, Williams JBW, Löwe B (2006) A brief measure for assessing generalized anxiety disorder. Arch Intern Med 166:1092. https://doi.org/10.1001/archinte.166.10.1092 [DOI: 10.1001/archinte.166.10.1092]
  25. Arrieta J, Aguerrebere M, Raviola G et al (2017) Validity and utility of the Patient Health Questionnaire (PHQ)-2 and PHQ-9 for screening and diagnosis of depression in rural Chiapas, Mexico: a cross-sectional study. J Clin Psychol 73:1076–1090. https://doi.org/10.1002/jclp.22390 [DOI: 10.1002/jclp.22390]
  26. Fann JR, Berry DL, Wolpin S et al (2009) Depression screening using the Patient Health Questionnaire-9 administered on a touch screen computer. Psychooncology 18:14–22. https://doi.org/10.1002/pon.1368 [DOI: 10.1002/pon.1368]
  27. Manea L, Gilbody S, McMillan D (2012) Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): a meta-analysis. Can Med Assoc J 184:E191–E196. https://doi.org/10.1503/cmaj.110829 [DOI: 10.1503/cmaj.110829]
  28. Benjamini Y, Hochberg Y (1995) Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc Ser B 57:289–300
  29. Cohen J (1988) Statistical Power Analysis for the Behavioral Sciences. Lawrence Erlbaum Associates, New York
  30. Hawley P, Gobbo M (2019) Cannabis use in cancer: a survey of the current state at BC Cancer before recreational legalization in Canada. Curr Oncol 26:425–432. https://doi.org/10.3747/co.26.4743 [DOI: 10.3747/co.26.4743]
  31. Blake EA, Ross M, Ihenacho U et al (2019) Non-prescription cannabis use for symptom management amongst women with gynecologic malignancies. Gynecol Oncol Reports 30:100497. https://doi.org/10.1016/j.gore.2019.100497 [DOI: 10.1016/j.gore.2019.100497]
  32. Calcaterra SL, Burnett-Hartman AN, Powers JD et al (2020) A population-based survey to assess the association between cannabis and quality of life among colorectal cancer survivors. BMC Cancer 20:1–6. https://doi.org/10.1186/s12885-020-06887-1 [DOI: 10.1186/s12885-020-06887-1]
  33. Macari DM, Gbadamosi B, Jaiyesimi I, Gaikazian S (2020) Medical cannabis in cancer patients. Am J Clin Oncol 43:636–639. https://doi.org/10.1097/COC.0000000000000718 [DOI: 10.1097/COC.0000000000000718]
  34. Loeppenthin K, Dalton SO, Johansen C et al (2020) Total burden of disease in cancer patients at diagnosis—a Danish nationwide study of multimorbidity and redeemed medication. Br J Cancer 123:1033–1040. https://doi.org/10.1038/s41416-020-0950-3 [DOI: 10.1038/s41416-020-0950-3]
  35. Hawley P, Gobbo M, Afghari N (2020) The impact of legalization of access to recreational Cannabis on Canadian medical users with Cancer. BMC Health Serv Res 20:977. https://doi.org/10.1186/s12913-020-05756-8 [DOI: 10.1186/s12913-020-05756-8]
  36. Karim S, Cheung WY, Bu J et al (2020) Medical cannabis authorization in patients with cancer in the prelegalization era: a population-based study. J Pain Symptom Manage 59:1223–1231. https://doi.org/10.1016/j.jpainsymman.2019.12.367 [DOI: 10.1016/j.jpainsymman.2019.12.367]
  37. Stirland LE, Gregory S, Russ TC, et al (2020) Associations between midlife chronic conditions and medication use with anxiety and depression: a cross-sectional analysis of the PREVENT Dementia study. J Comorbidity 10:2235042X2092044. https://doi.org/10.1177/2235042X20920443
  38. Balducci L, Goetz-Parten D, Steinman MA (2013) Polypharmacy and the management of the older cancer patient. Ann Oncol 24:vii36–vii40. https://doi.org/10.1093/annonc/mdt266 [DOI: 10.1093/annonc/mdt266]
  39. Meng H, Dai T, Hanlon JG et al (2020) Cannabis and cannabinoids in cancer pain management. Curr Opin Support Palliat Care 14:87–93. https://doi.org/10.1097/SPC.0000000000000493 [DOI: 10.1097/SPC.0000000000000493]
  40. Smith LA, Azariah F, Lavender VTC, et al (2015) Cannabinoids for nausea and vomiting in adults with cancer receiving chemotherapy. Cochrane database Syst Rev 2015:CD009464. https://doi.org/10.1002/14651858.CD009464.pub2
  41. Lucas CJ, Galettis P, Schneider J (2018) The pharmacokinetics and the pharmacodynamics of cannabinoids. Br J Clin Pharmacol 84:2477–2482. https://doi.org/10.1111/bcp.13710 [DOI: 10.1111/bcp.13710]
  42. Bar-Lev Schleider L, Mechoulam R, Lederman V et al (2018) Prospective analysis of safety and efficacy of medical cannabis in large unselected population of patients with cancer. Eur J Intern Med 49:37–43. https://doi.org/10.1016/j.ejim.2018.01.023 [DOI: 10.1016/j.ejim.2018.01.023]
  43. Webster EM, Yadav GS, Gysler S et al (2020) Prescribed medical cannabis in women with gynecologic malignancies: a single-institution survey-based study. Gynecol Oncol Reports 34:100667. https://doi.org/10.1016/j.gore.2020.100667 [DOI: 10.1016/j.gore.2020.100667]
  44. Whiting PF, Wolff RF, Deshpande S et al (2015) Cannabinoids for medical use. JAMA 313:2456. https://doi.org/10.1001/jama.2015.6358 [DOI: 10.1001/jama.2015.6358]
  45. Hobbs GS, Landrum MB, Arora NK et al (2015) The role of families in decisions regarding cancer treatments. Cancer 121:1079–1087. https://doi.org/10.1002/cncr.29064 [DOI: 10.1002/cncr.29064]

MeSH Term

Adult
Cannabis
Cross-Sectional Studies
Denmark
Humans
Neoplasms
Patient Outcome Assessment
Quality of Life
Journal Article
Article has an altmetric score of 12

Word Cloud

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