Promoting MMJ Among Cancer Patients in the USA

John Taenzler, Ph.D.

In October 2018, a survey was conducted among 92 patients currently being treated for cancer in 17 of the States where medical marijuana (MMJ) has been approved and available.  An objective of this research was to assess the depth of knowledge about cannabis claims, logistics for acquiring/using MMJ, and attitudes of their physicians toward MMJ.

In examining and assessing the perceptions and attitudes of these cancer patients towards MMJ, each was asked about their current use of MMJ and given their current knowledge-base how likely they are to use MMJ in the future to treat their cancer or side effects of their cancer therapy.  These questions were used to segment cancer patients based on their use MMJ.

• Cancer patients currently using MMJ (n=21)
• Cancer patients who used MMJ in the past, but not currently (n=21)
• Cancer patients who have never used MMJ (n=50)

Use of MMJ

Cancer patients have multiple issues that could potentially be addressed with the administration of MMJ. Over half (54%) of cancer patients say they have pain that requires medication, with one-third of these patients directly attributing their pain to their cancer and/or anti-malignancy treatment. As many as two-thirds (64%) of these cancer patients take an opioid for their pain, where as one-third (34%) have used MMJ.  Besides pain, cancer patients are also commonly dealing with other comorbidities including mood disorder (e.g., anxiety 38% and depression 33%) and/or reflux disease (25%).

Multiple studies have shown that uncontrolled side effects can significantly impair oncologists’ ability to deliver the most effective cancer treatments.  MMJ can mediate the impact of these side effects, thus increasing compliance with cancer treatment and improving outcomes.

Among cancer patients who have used MMJ, nearly half (48%) began using MMJ without first discussing it with their physician(s).  Further, 11% of these patients have not discussed their MMJ use with ANY physician. Cancer patients say they did not discuss their MMJ use with their physician(s) as they did not see the relevance of their use on their cancer treatment (57%), and they were concerned that their physicians would not approve (36%).

For those cancer patients who have never used MMJ, only 30% have discussed MMJ with a physician.  When asked why they have not used MMJ to-date, the most common reason was not wanting to expose their lungs to smoke or vapor (showing a lack of knowledge of other forms of ingestion).  Other reasons for not using MMJ are based on lack of basic information (e.g., cause of the “high”, not aware of benefits, concerns about safety/addiction) and the logistics of obtaining MMJ is too difficult.

When seeking information about MMJ, cancer patients have turned most often to their physician, to social media, and general information cannabis sites (e.g., Leafly, WeedMaps, etc.). Overall, these patients say their Oncologist has been the best source of information and social media has been the worst.  Furthermore, for those who say they turned to a salesperson/counselor at a dispensary, most say the information obtained was poor and often biased (e.g., salesperson pushing products rather than seeking details about the patient’s needs).

Paradoxically, while cancer patients say their Oncologist is the best source of information about MMJ, when actually having a discussion with their physicians, very little information is provided. However, patients are told to report any side effects of MMJ. Only one-third (30%) of patients who discussed MMJ with their physician say they were provided information about MMJ. Topics covered most often include[1]:

• Medical benefits of CBD
• Medical benefits of THC
• How to get a MMJ card from the state

Conversely, a number of topics were not discussed by the enquiring patient and their physician, including[2]:

• Interactions of THC-CBD-Terpenes
• Medical benefits of terpenes
• How cannabis is tested
• How cannabis is classified
• Short-term risks of using cannabis
• How much cannabis costs

In addition to lack of basic information about the benefits, risks and logistics about MMJ, even if a patient decides to begin using it, there are often frustrated in their struggle to find the strain and or form of consumption that works best for them.  On average, cancer patients turning to MMJ, and tried 7.5 strains over more than 2 months before they found the strain that works. Cancer patients also have tried an average of 5 different forms of consumption before finding the solution that works best for them.  With an average expenditure of $117.00 per month for MMJ, these costs can be burdensome for many.

The question is then raised, what can be done to 1) encourage current users to keep using MMJ, 2) encourage former users of the benefits of MMJ so that they will consider using it again, and 3) overcome barriers faced by unwilling users.

Cancer Patient Profiles

During the survey, cancer patients were presented with a list of topics regarding MMJ, and each was asked to rate their familiarity with each topic, specify which topics they have discussed with their physician(s), and indicate which topics would most impact their future use of MMJ.  These topics ranged across a number of themes, including:

• Cannabis Pharmacology
• Cannabis Regulations
• Cannabis Logistics

Analysis reveals key distinguishing characteristics among the three segments of cancer patients.

Cancer patients who are currently using MMJare most familiar with the benefits of cannabis and are more familiar with regulations and logistics than other cancer patients. Most (86%) current users have spoken with a physician about MMJ topics.

The factors that will most encourage current users’ future use of MMJ include (in priority order):

1. Requirements to get/renew a MMJ Card and location of dispensaries
2. Cost comparisons for MMJ
3. How Terpenes-THCs-CBD interact with each other
4. How the human body processes cannabis
5. How cannabis is tested

Profile:  Cancer patients who are currently using MMJ are moderately well-informed about the purported benefits of MMJ but are looking for ways to make the acquisition of MMJ easier and cheaper.  They are also interested in a deeper understanding of MMJ, how the components work together, and how MMJ works in the body.

Cancer patients who used marijuana in the past but no longer are using itare more familiar with the pharmacology and logistics of cannabis than are non-users (but less familiar than users), and at par with non-users regarding cannabis regulations.

The factors that will most influence former users’ future use of MMJ include (in priority order):

1. The medical benefits of CBD
2. Requirements and logistics for getting a MMJ Card
3. Costs of MMJ
4. Medical benefits of THC and CBNs
5. How the human body processes MMJ
6. Short-term risks of MMJ

Profile:  Cancer patients who are former users of MJ are moderately informed about cannabis, but unlike current users are less familiar with the logistics of obtaining a MMJ Card and the MMJ itself.   Former users have a strong interest in CBDs and CBNs, suggesting that they are looking for outcomes beyond the psychoactive properties of THC. 

Cancer patients who have never used MJare the least familiar with various topics about cannabis.  Interestingly, 56% have spoken with a physician regarding this topic.  Additionally, more non-users have discussed the medical benefits with CBNs with physicians (22%) than former or current users (11% and 14%, respectively).

The factors that will most influence non-users’ use of MMJ include (in priority order):

1. Long-term risk of MMJ
2. Requirements and logistics for getting a MMJ Card
3. Costs of MMJ
4. How the body processes cannabis
5. Short-term risks of MMJ

Profile:  Cancer patients who have never used MJ are poorly informed about cannabis and just more than half have ever spoken with a physician about it.  Safety and logistics are the hurdles to overcome for this patient group. The non-users do seem to be particularly interested in CBD, perhaps as they are not interested in feeling high. 

Conclusions

As shown in the study findings, cancer patients have multiple issues that may be mediated with MMJ. However, the evidence for using MMJ during cancer treatment is scant, and the full risk profile has not been studied. The National Cancer Institute[3]offers a number of suggested used of MMJ for the cancer patient, but they also call into question the impact of MMJ as an anti-malignancy drug.  Further, due to the hemostatic impact of MMJ, some oncologists suggest that using MMJ while taking an anti-malignancy immunotherapy may have a lowered response rate to their anti-cancer immunotherapy[4].

Thus, it is imperative that cancer patients considering MMJ consult closely with their oncologist to identify potential issues.  In addition, it is the responsibility of dispensaries and/or salespersons to thoroughly discuss potential risks with cancer patients, and to build channels of communication with the patients’ oncology team.  When dealing with cancer, the patient’s oncologist is (and should remain) the gatekeeper of healthcare decisions.  By better educating oncologists as to the pharmacology, benefits and risks of medical cannabis, they will be better equipped to provide recommendations to patients that increase their odds of a full recovery from cancer while preserving the patient’s quality of life.  Cancer patients echo this, with over half saying a better educated physician would encourage their use of MMJ.

[1]Topics for which at least 25% of patients who enquire about MMJ have discussed with their physician.

[2]Topics for which fewer than 5% of patients who enquire about MMJ have discussed with their physician.

[3]https://www.cancer.gov/about-cancer/treatment/cam/patient/cannabis-pdq

[4]Taha T, Talhamy S, Wollner M, et al. The effect of cannabis use on tumor response to nivolumab in patients with advanced malignancies. Oral presentation at: ESMO 2017 Congress; September 8-12, 2017; Madrid, Spain. Abstract 1545PD.