CBD may relieve ‘scanxiety’ among women with advanced breast cancer
Key takeaways:
- Cannabidiol may reduce scan-related anxiety among certain women with advanced breast cancer.
- Researchers plan to undertake an expanded version of the study.
Cannabidiol may reduce scan-related anxiety among women with advanced breast cancer, according to results of randomized phase 2 study results.
The double-masked, placebo-controlled trial included 50 women aged 18 years or older with advanced breast cancer and baseline clinical anxiety.
Researchers randomly assigned participants 1:1 to receive 400 mg of oral CBD (n = 25) or placebo (n = 25) within 48 hours of undergoing a scan to evaluate tumor burden.
Results showed a numeric improvement in change score on the Visual Analog Mood Scales (VAMS) “afraid” subscale — the study’s primary endpoint — in the CBD group (mean change [standard deviation], 19.1 [15.4] for CBD vs. 15 [10.9] for placebo). However, the difference did not reach statistical significance.
A between-group comparison of anxiety levels 2 to 4 hours after study drug ingestion showed significantly lower VAMS “afraid” T-scores with CBD vs. placebo (mean [standard deviation], 51.5 [12.8] vs. 58 [11.6]; P =.02).
Investigators observed no grade 3 or grade 4 toxic effects.
“Our hope is that this work paves the way for greater funding opportunities for cannabinoid research to be carried out in oncology,” Ilana M. Braun, MD, chief of the division of adult psychosocial oncology at Dana-Farber Cancer Institute, told Healio. “The field is in critical need of high-quality, randomized clinical drug trials to assess the clinical utility of cannabis and cannabinoids in oncologic populations.”
Healio spoke with Braun and Manan M. Nayak, PhD, research scientist at Dana-Farber Cancer Institute, about the rationale for the study, the implications of the findings and the next steps in research.
Healio: How problematic is “scanxiety” for women with advanced breast cancer?
Braun: “Scanxiety” is an evolving concept in the scientific literature that describes the anxiety that can develop around a cancer imaging procedure. Although exact rates are unknown, scanxiety is common among people facing cancer. Several aspects of a cancer scan can be upsetting. There sometimes are worries tied to the scan results to come. These results could indicate tumor growth, with implications for quality of life and longevity. Upcoming scans can also simply be a nagging reminder of a cancer diagnosis.
Healio: What motivated you to conduct this study?
Nayak: Benzodiazepines have been the standard of care for cancer-related anxiety for over a half-century. These medications — although effective — carry many risks, such as confusion, possibly dementia, falls, motor vehicle crashes, accidental overdoses and issues around benzodiazepine abuse. Oncology needs innovation in the pharmacologic management of in-the-moment anxiety. CBD, the second ingredient in cannabis, may have anti-anxiety properties without some of the untoward effects of benzodiazepines. For that matter, it also doesn’t seem to have the neuropsychiatric side effects that can go along with delta-9-tetrahydrocannabinol, the principal ingredient in cannabis.
Healio: How did you conduct the study?
Braun: We recruited women with advanced or metastatic breast cancer who experienced clinical anxiety. Our research team measured participants’ levels of anxiety using a VAMS, an easy-to-use standardized tool. It’s simply a line with two poles. At one pole is a neutral face. At the other is a face reflecting a particular mood state, labeled as such. This study focused on the “afraid” subscale of VAMS. Participants let us know where along the line between neutrality and afraid they rated themselves leading up to their scan. We dosed them with the study drug, we waited approximately 3 hours for the CBD to take full effect in their body and then retested them on the “afraid” subscale. We compared the average amount that anxiety levels changed between the two groups.
Healio: What did you find?
Braun: Women who received placebo demonstrated a considerable drop in anxiety levels — which we consider a placebo effect. Women who received CBD also demonstrated considerable drops in anxiety levels — more so than those who received placebo, but not enough to reach statistical significance. What we found most intriguing was that about 3 hours after the study drug was consumed, women who received CBD were significantly calmer than those who received placebo. Also, women assigned CBD experienced no significant adverse events.
Healio: Did the findings surprise you?
Nayak: We were surprised by the overall interest among patients and clinical providers in the study. It was conducted during the height of a global pandemic when much clinical research stagnated. Yet, the majority of women we approached altruistically reported desire to participate. Oncologists referred numerous patients to the study, including octogenarians and nonagenarians.
Healio: What is next in your research on this?
Nayak: This was a small study and we’re excited to undertake an expanded version with many more participants to be able to more accurately assess whether CBD is superior to placebo in improving anxiety in the cancer setting.
Reference:
For more information:
Ilana M. Braun, MD, can be reached at ilana.braun@dfci.harvard.edu.
Manan M. Nayak, PhD can be reached at manan_nayak@dfci.harvard.edu.
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