Tobacco-cannabis co-use among cancer patients and survivors: findings from 2 US cancer centers

Prevalence and determinants of cigarette-cannabis co-use among US cancer survivors

PURPOSE

We estimated the prevalence of cigarette-cannabis co-use and investigated the individual-level factors associated with cigarette-cannabis co-use among adult (aged ≥ 18) cancer survivors.

METHODS

We used population-based data from the 2022 Behavioral Risk Factor Surveillance System. The sample included 9,323 (weighted 2,711,650) adult cancer survivors residing in 16 US states and two US territories. The outcome was cigarette-cannabis co-use, examined using multinomial multivariable logistic regression models.

RESULTS

Overall, 81.83% self-reported as white, 58.97% women, and 57.69% aged ≥ 65. About 12.00% reported current cigarette use, 10.36% past 30-day cannabis use, and 3.28% cigarette-cannabis co-use. The odds of cigarette-cannabis co-use were greater for younger survivors (18-49 years), those with high school or less education, not in the workforce, and divorced, separated, widowed, or never married individuals. Further, survivors with ≥ 3 comorbidities (vs. no-comorbidity), ≥ 14 days of poor mental health days (vs. none), and ≥ 14 days of poor physical health (vs. none) in the past month also had increased odds of cigarette-cannabis co-use.

CONCLUSIONS

The study findings suggest that certain subgroups of cancer survivors are more likely to engage in cigarette-cannabis co-use, and these patterns are associated with individual-level factors.

IMPLICATIONS FOR CANCER SURVIVORS

New strategies and tailored interventions targeting cigarette-cannabis co-use among cancer survivors are critically needed to improve the overall well-being of cancer survivors. Future research should explore additional factors to fully understand cigarette-cannabis co-use in cancer survivors.

Pretreatment Quality of Life and Substance Use Among Patients Diagnosed With Head and Neck Cancer

BACKGROUND

There is a paucity of research on the effects of commonly used substances, such as cannabis and other drugs, on quality of life as a contributor to head and neck cancer (HNC) prognosis. We examined associations between non-alcohol or tobacco substance use (cannabis and other illicit drug) and self-reported quality of life in patients with HNC prior to starting treatment.

METHODS

This was a cross-sectional study of patients who presented for routine psych-oncologevaluation prior to treatment between 11/2015 and 9/2022. Primary exposures were cannabis use (never, past, or current users) and current illicit drug use (yes/no). The primary outcome measure was the Functional Assessment of Cancer Therapy-Head and Neck (FACT-HN) subscales (physical, social/family, functional and emotional). Linear regression models examined associations between pretreatment substance use and FACT-HN subscales adjusting for demographic, socioeconomic, and clinical factors.

RESULTS

Of 570 patients, 13.9% endorsed current cannabis and 13.9% current illicit drug use. The mean (SD) scores for FACT-HN subscales were physical well-being = 22.8 (5.0), social well-being = 22.7 (5.5), emotional well-being = 17.5 (4.5), and functional well-being = 18.7 (6.9). In the adjusted models, cannabis use was not independently associated with any FACT-HN subscales. However, patients who currently used illicit drugs reported worse emotional well-being (β = -1.32; 95% CI -2.45 to -0.20). No independent association was found between current illicit drug use and other subscales (physical, social, and functional).

CONCLUSIONS

Illicit drug use, but not cannabis use, is negatively associated with pretreatment emotional well-being in patients with HNC. Further research exploring the relationships between longitudinal cannabis and illicit drug use and methods of consumption on QoL and cancer outcomes in patients with head and neck cancer is warranted.

Overview of cancer patient perspectives on cannabis use during treatment

Expanding legal access to medical cannabis across the United States increases availability and use of cannabis products to manage cancer-related symptoms and treatment side effects despite the lack of research-based evidence on its potential benefits and harms. To address knowledge gaps in how cancer patients access and use cannabis, their perceived risks and benefits with its use, and whether cancer patients discuss cannabis use with their healthcare providers during treatment, the National Cancer Institute (NCI) supported 12 NCI-designated comprehensive cancer centers to conduct surveys, which included NCI standardized core questions on cannabis use during treatment, among their cancer patient populations. This overview highlights key results from the articles contained in the monograph, which includes a summary of the results of core questions across all centers and reports from individual or groups of cancer centers on survey results related to the sourcing of cannabis, associated cost, behavioral factors associated with cannabis use (such as smoking, drinking, or using other substances), patient-provider communication on cannabis use during treatment, ethnic variations in patterns, sources, and reasons for cannabis use as well as methodologic concerns related to survey data analysis. The results of these surveys of cannabis use after the diagnosis of cancer lay the groundwork for much-needed research to answer the questions of benefits and harms, including potential interactions with cancer treatments for cancer patients.