Many patients with breast cancer use cannabis but do not notify their physician
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More than 40% of patients with breast cancer reported using cannabis to manage their treatment symptoms, yet most patients did not discuss cannabis use with a physician, according to survey results published in Cancer.
“Our study highlights an important opportunity for providers to initiate informed conversations about medical cannabis with their patients, as the evidence shows that many are using medical cannabis without our knowledge or guidance,” Marisa Weiss, MD, founder and president of Breastcancer.org and director of breast radiation oncology and breast health outreach at Lankenau Medical Center in Pennsylvania, said in a press release.
Weiss and colleagues received 612 anonymous online survey responses from patients in the U.S. who were members of the Breastcancer.org and Healthline communities between Dec. 16, 2019, and Jan. 19, 2020. The survey consisted of 47 questions on demographic information, breast cancer diagnoses and treatment, cannabis use and willingness to discuss cannabis use with providers. To qualify for the study, adult patients self-reported a diagnosis of breast cancer within 5 years. The mean age of respondents was 57 years; 605 of the 612 respondents were women.
Addressing cannabis use in a medical setting
Among the respondents, 42% reported having used cannabis to address medical issues but 23% of these users reported using cannabis solely for medical purposes, according to Weiss and colleagues. Also, 64% of the study cohort reported that they were very or extremely interested in cannabis, 23% were somewhat interested and 13% were minimally or not interested. Yet, 50% of all respondents had sought information on medical cannabis. For the most helpful sources of information on this topic, few respondents reported clinicians as valuable sources. Most respondents said they were unsatisfied with the information they received on medical cannabis use from various sources, including websites and other patients with breast cancer, according to the researchers.
Overall, only 39% of respondents discussed cannabis with any of their physicians and 76% of these conversations were initiated by the patient. Patients older than 66 years were more likely to bring up cannabis use with their physician (87%) compared with patients aged 50 years to 65 years (76%) and patients younger than 50 years (69%). Weiss and colleagues also found that 28% of respondents felt uncomfortable discussing cannabis with their physician. Meanwhile, younger patients who discussed cannabis use most often felt supported by their physician (72%) compared with patients aged 50 years to 65 years (52%) and patients aged 66 years and older (46%).
Symptom relief
Patients who used cannabis for medical purposes most often used it for pain (78%), anxiety (57%), stress (51%) and nausea (46%). Also, three out of four cannabis users considered it extremely or very helpful for relieving their symptoms and 57% of users had found no alternative for treating their symptoms.
A majority of patients used cannabis during treatment (79%) compared with before (24%) and after treatment (54%). Also, Weiss and colleagues noted that more than 70% of respondents believed that the benefits of cannabis outweighed the risks. However, cannabis use during treatment is a “significant concern” due to limited data on potential interactions, the researchers wrote.
Respondents reported obtaining cannabis from various sources, including dealers, family or friends and state-regulated dispensaries. Yet, according to a separate study published in JAMA Network Open, most customers who obtained medical cannabis from a dispensary received recommendations on cannabis use from budtenders, managers or pharmacists. Only 5% of respondents received recommendations from a physician, nurse practitioner or physician assistant, Healio Primary Care previously reported.
“Not knowing whether or not our cancer patients are using cannabis is a major blind spot in our ability to provide optimal care, and as health care providers, we need to do a better job of initiating informed conversations about medical cannabis with our patients to make sure their symptoms and side effects are being adequately managed while minimizing the risk of potential adverse effects, treatment interactions, or non-adherence to standard treatments due to misinformation about the use of medical cannabis to treat cancer,” Weiss said.
References:
Many adults with breast cancer use cannabis but don’t tell their doctors. https://www.eurekalert.org/news-releases/930787. Published Oct. 12, 2021. Accessed Oct. 12, 2021.
Weiss MC, et al. Cancer. 2021;doi:10.1002/cncr.33906.
Perspective
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Ellie Grossman, MD, MPH
This study provides results that are both unsurprising and disturbing for health professionals. What is unsurprising is that many patients with breast cancer are using cannabis products, and what is disturbing is that many of them know little about its health effects and do not routinely discuss it with their health care providers.
Despite the limitations of any study of self-reported data, this study provides information useful for health professionals, whether in oncology or not:
- Many patients with serious health conditions are using cannabis products for medical purposes (in this study, 42% of respondents).
- Many users of cannabis for medical purposes are not aware of the evidence supporting the use of cannabis and use it for reasons that are not supported by science, which opens them up to potential risks (as well as wasting money) without likelihood of benefit. Of note, even in this study, the authors cite evidence supporting use of cannabis to treat insomnia or anxiety, which is not supported by large systematic reviews, including the comprehensive National Academy of Sciences, Engineering and Medicine review.
- Patients with cancer may be using cannabis in hopes of having anti-tumor effect, which is not supported by science.
- Many patients are not aware of potential drug-drug interactions with cannabis, or the potential for contaminants in a non-regulated supply.
As health professionals, we need to ask all our patients about their use of cannabis, acknowledge the areas where there is evidence supporting use (chronic pain, chemotherapy-induced nausea/vomiting and spasticity induced by multiple sclerosis) as well as the significant areas lacking science, and warn our patients about the potential for harm.
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