Interest in the therapeutic use of Cannabis species for cancer patients is growing1. International reports note that almost half of all patients receiving cancer care are actively using cannabis in some form, for symptom control or perceived anti-cancer properties1. Rapid legislative changes within the United States and internationally continue to blur the distinction of whether cannabis is an illicit substance or an adjuvant medical therapeutic option. Due to the federal restrictions on cannabis and FDA Schedule 1 designation, clinical research is often prohibitively challenging.
Cancer patients may potentially derive meaningful benefits from use of cannabis, particularly regarding the management of side effects of their cancer or cancer related treatments. A Canadian study of over 2000 cancer patients reported that 43% had used cannabis in their lifetime, and that close to 20% of respondents currently use it for cancer related symptoms.2 The most common symptoms cancer patients report using cannabis to treat are pain, sleep problems, nausea and anorexia.3
Evidence about the efficacy of cannabis in various symptom management strategies remains mixed. A systematic review of cannabinoids in medical care found that one of the most successful applications of the plant is for chemotherapy induced nausea and vomiting.4 A recent interventional trial examining the effect of a plant-based oromucosal cannabis spray on refractory cancer pain showed no effect.5 However, several large observational trials have shown benefit with the use of cannabis for a myriad of cancer-related symptoms, including pain.6,7
While cannabis use continues to increase, most oncologists report minimal comfort discussing this with patients. Only 30% felt comfortable with their knowledge of this alternative therapy, but still felt unprepared to make recommendations for its use.8 This knowledge gap often means that patients may seek out and use cannabis without engaging in any conversations with their care teams.
While there are observational trials in both cancer and non-cancer patients examining patient-reported outcomes associated with cannabis use, there are very few studies looking at cancer patient experience in state-regulated cannabis programs. There is need for better understanding of the symptomatic and financial impact of a state-regulated medical cannabis program on cancer patient quality of life and tolerability due to increasing public interest and use. To access a dispensary via a medical cannabis program, patients must have at least one interaction with a medical professional to examine the patient and certify their eligibility. There is little existing research about the effect of this requirement on safe, effective, affordable cannabis use.
This study aims to assess the impact of medical cannabis certification on the quality of life for cancer patients, as facilitated by an interprofessional team consisting of a physician and a social worker. Specifically, we examined the patient-reported impact of state-regulated medical cannabis on cancer pain, nausea and vomiting, quality of life as well the cost impact in cancer patients.