Use and Perceptions of Opioids Versus Marijuana among Cancer Survivors

Evaluating racial disparities in cancer patient-provider communication about cannabis in a state without a legal cannabis marketplace

PURPOSE

Cancer survivors in a state with no legal access to cannabis may be hesitant to discuss their cannabis use with providers, particularly in light of legal consequences which disproportionately affect certain racial groups. This study examined potential racial disparities in the relationship of cannabis use status with patient-provider discussions of and attitudes toward cannabis in a state where there is no legal cannabis marketplace.

METHODS

Survivors of cancer (N = 1003, Mage = 62.36; 13% Black/African-American; 41% male) completed a cross-sectional survey. Weight-adjusted regressions examined racial differences in the relationship between cannabis use status with (a) comfort and discussion of cannabis with providers, and (b) beliefs about impact of legalization on patients' and providers' comfort discussing cannabis.

RESULTS

No racial differences were observed in rates of cannabis use or discussion, and patients who used cannabis were more comfortable discussing cannabis. Black patients who had used cannabis reported the greatest comfort discussing cannabis with providers, but also the greatest perceived improvement in comfort in the event of legalization.

CONCLUSIONS

Results highlight comfort and willingness to discuss cannabis with cancer care providers, particularly among Black patients who already use cannabis, which was not the hypothesized direction of findings. Further work is needed to inform recommendations for provider-led communication about cannabis.

Perceptions and engagement of patients with chronic conditions on the use of medical cannabis: a scoping review

CONTEXT

Studies generally focus on one type of chronic condition and the effect of medical cannabis (MC) on symptoms; little is known about the perceptions and engagement of patients living with chronic conditions regarding the use of MC.

OBJECTIVES

This scoping review aims to explore: (1) what are the dimensions addressed in studies on MC that deal with patients' perceptions of MC? and (2) how have patients been engaged in developing these studies and their methodologies? Through these objectives, we have identified areas for improving future research.

METHODS

We searched five databases and applied exclusion criteria to select relevant articles. A thematic analysis approach was used to identify the main themes: (1) reasons to use, to stop using or not to use MC, (2) effects of MC on patients themselves and empowerment, (3) perspective and knowledge about MC, and (4) discussion with relatives and healthcare professionals.

RESULTS

Of 53 articles, the main interest when assessing the perceptions of MC is to identify the reasons to use MC (n = 39), while few articles focused on the reasons leading to stop using MC (n = 13). The majority (85%) appraise the effects of MC as perceived by patients. Less than one third assessed patients' sense of empowerment. Articles determining the beliefs surrounding and knowledge of MC (n = 41) generally addressed the concerns about or the comfort level with respect to using MC. Only six articles assessed patients' stereotypes regarding cannabis. Concerns about stigma constituted the main topic while assessing relationships with relatives. Some articles included patients in the research, but none of them had co-created the data collection tool with patients.

CONCLUSIONS

Our review outlined that few studies considered chronic diseases as a whole and that few patients are involved in the co-construction of data collection tools as well. There is an evidence gap concerning the results in terms of methodological quality when engaging patients in their design. Future research should evaluate why cannabis' effectiveness varies between patients, and how access affects the decision to use or not to use MC, particularly regarding the relationship between patients and healthcare providers. Future research should consider age and gender while assessing perceptions and should take into consideration the legislation status of cannabis as these factors could in fact shape perception. To reduce stigma and stereotypes about MC users, better quality and accessible information on MC should be disseminated.

Cannabis use among cancer patients and survivors in the United States: a systematic review

BACKGROUND

How cannabis products are being used by cancer patients and survivors in the United States is poorly understood. This study reviewed observational data to understand the modes, patterns, reasons, discontinuation, and adverse experiences of cannabis use.

METHODS

PubMed and PsycINFO database searches were conducted between May 2022 and November 2022. Of the 1162 studies identified, 27 studies met the inclusion criteria. The intercoder agreement was strong (0.81).

RESULTS

The majority (74%) of the studies were cross-sectional in design. Study samples were approximately equal proportions of men and women and majority White participants. The prevalence of cannabis use based on national samples ranged between 4.8% and 22%. The most common modes of cannabis intake were topical application (80%), smoking (73%), vaping (12%), and ingestion of edible products (10%). Younger age, male gender, being a current or former smoker, and higher socioeconomic status were associated with greater likelihood of cannabis use. The main motive for cannabis use was management of symptoms due to cancer or cancer treatment such as pain, nausea, lack of sleep, and anxiety. A majority of the participants across studies reported that cannabis helped reduce these symptoms. Lack of symptom improvement, side effects such as fatigue and paranoia, cost, and social stigma were identified as some of the reasons for discontinuing cannabis use.

CONCLUSIONS

It appears that cannabis may help cancer patients and survivors manage symptoms. However, more longitudinal studies are needed to determine whether positive experiences of cannabis use outweigh adverse experiences over time in this vulnerable population.

Factors Affecting the Decision on Cannabis Use in Gynecologic Cancer Patients After the Legalization of Cannabis

OBJECTIVE

To characterize the patterns of cannabis use among gynecologic cancer patients, in terms of potential factors influencing their decision-making on cannabis use, the reasons for use or non-use, and sources of information on cannabis use.

METHODS

From March to July 2022, gynecologic cancer patients at a clinic were interviewed and classified into 3 groups: current users, ex-users, and never-users. The received data included: demographic data, cannabis use details, reasons for using and not using, adverse events, satisfaction, and intent to use. Univariate and multivariate analysis were used to identify risk factors influencing decision-making.

RESULT

Among 240 participants, 11.67% were classified as current users, 28.33% as ex-users, and 60% as never-users. The significant factors influencing cannabis use decisions were advanced stage and receiving information on cannabis, regardless of the information source. The satisfaction derived from cannabis was due to the enhancement of mood and physical activity, improvement in sleep quality, stimulation of appetite, and mitigation of adverse events associated with cancer treatment. Approximately 60% of users aimed for a cancer cure. The main reasons for quitting were inability to obtain cannabis and absence of persistent cancer symptoms.

CONCLUSION

Among Thai patients with gynecologic cancer, 40% had a history of cannabis use. Advanced cancer stage was an independent factor for decision-making on cannabis use. Sources of information on cannabis are non-healthcare providers. Many patients intended to use cannabis for cancer cure. Also, many were satisfied with use because of a relief of unwanted symptoms, indirectly suggesting improvement in quality of life. The main reason for quitting was unavailability. The main reason for never trying was a concern of interference with treatment. Our results may guide the direction of strategy of cannabis use among patients with gynecologic cancers.

Routes of administration, reasons for use, and approved indications of medical cannabis in oncology: a scoping review

INTRODUCTION

Some patients diagnosed with cancer use medical cannabis to self-manage undesirable symptoms, including nausea and pain. To improve patient safety and oncological care quality, the routes of administration for use of medical cannabis, patients' reasons, and prescribed indications must be better understood.

METHODS

Based on the Joanna Briggs Institute guidelines, a scoping review was conducted to map the current evidence regarding the use of medical cannabis in oncological settings based on the experiences of patients diagnosed with cancer and their healthcare providers. A search strategy was developed with a scientific librarian which included five databases (CINAHL, Web of Science, Medline, Embase, and PsycINFO) and two grey literature sources (Google Scholar and ProQuest). The inclusion criteria were: 1) population: adults aged 18 and over diagnosed with cancer; 2) phenomena of interest: reasons for cannabis use and/or the prescribed indications for medical cannabis; 3) context: oncological setting. French- or English-language primary empirical studies, knowledge syntheses, and grey literature published between 2000 and 2021 were included. Data were extracted by two independent reviewers and subjected to a thematic analysis. A narrative description approach was used to synthesize and present the findings.

RESULTS

We identified 5,283 publications, of which 163 met the eligibility criteria. Two main reasons for medical cannabis use emerged from the thematic analysis: limiting the impacts of cancer and its side effects; and staying connected to others. Our results also indicated that medical cannabis is mostly used for three approved indications: to manage refractory nausea and vomiting, to complement pain management, and to improve appetite and food intake. We highlighted 11 routes of administration for medical cannabis, with oils and oral solutions the most frequently reported.

CONCLUSION

Future studies should consider the multiple routes of administration for medical cannabis, such as inhalation and edibles. Our review highlights that learning opportunities would support the development of healthcare providers' knowledge and skills in assessing the needs and preferences of patients diagnosed with cancer who use medical cannabis.

Association between daily and non-daily cannabis use and depression among United States adult cancer survivors

BACKGROUND

Cancer survivors are vulnerable to Cannabis Use (CU) and at increased risk for depression. Yet, the relationship between CU and depression among cancer survivors is unknown.

PURPOSE

The purpose of this study was to estimate the prevalence of daily/non-daily CU, investigate the association between CU and depression and evaluate CU reasons and methods of administration among cancer survivors.

METHOD

Population-based, nationally representative sample of cancer survivors aged ≥18 (n = 10,799) from 2018 Behavioral Risk Factor Surveillance System Survey was used. Weighted descriptive statistics and multivariate logistic regression were conducted.

FINDINGS

Overall, 4.2% reported daily and 4.1% non-daily CU. Those who self-reported depression had higher prevalence of daily and non-daily CU than those not reporting depression. Daily CU was associated with 120% increased odds of depression (odds ratio = 2.2, 95% confidence interval [1.3, 3.7]) compared with none-users.

DISCUSSION

Efforts to improve open communications and evidence-informed discussions regarding benefits and risks of CU and reasons for using cannabis between clinicians and cancer survivors are imperative.