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Cannabis to alleviate the nausea and vomiting associated with cancer treatments is considered one of the medical applications most strongly supported by research, according to the National Academies of Sciences, Engineering and Medicine’s report on the Health Effects of Cannabis and Cannabinoids. But cancer encompasses an entire range of diseases, with treatments – and side-effects – that vary as well.
Dr. Marisa Weiss, an oncologist and breast cancer specialist, recently conducted the first study ever to evaluate the underlying reasons that women with breast cancer use cannabis as part of their treatment regimen. Interestingly, nausea was not at the top of the list.
Pain as a side-effect of treatment
Dr. Marisa Weiss
Dr. Weiss is the founder of non-profit Breastcancer.org, which according to the organization’s website, is “the leading patient-focused resource for breast health and breast cancer information and support”. The organization also manages the world’s largest online breast cancer peer community.
Weiss, who is based in Philadelphia, decided to incorporate cannabis into her pain management program in 2018 when Pennsylvania first opened its medical marijuana program. Even more than nausea associated with their treatments, women with breast cancer experience pain.
Complications exacerbated for older women
Over half the women diagnosed with breast cancer, Dr. Weiss explains, are over the age of 50. Furthermore, the medical conditions of older age can exacerbate the side-effects associated with treatment. Women after menopause with arthritis, for example, may be disproportionately affected by treatments that include muscle and joint discomfort as side effects.
Neuropathy, or pain in the hands and feet, is another common side-effect of chemotherapies that can be particularly problematic for older adults, interfering with their ability to perform simple functions like buttoning a shirt. These side-effects can so drastically impact a patient’s quality of life that they choose to stop treatment, which, as Weiss explains, can ultimately affect their survival.
The study of Dr. Weiss’ own practice at Lankenau Medical Center, which was presented at the recent San Antonio Breast Cancer Symposium, addressed the symptoms for which women with breast cancer sought medical cannabis during the first 10 months of Pennsylvania’s medical marijuana program. The median age of the study group was 64, of which 22 women had early stage disease, and nine had metastatic disease. The main findings were:
• Women with early stage and metastatic disease sought medical cannabis for symptomatic management of pain (73% and 89%, resp.), anxiety (45% and 89%, resp.), insomnia (50% and 33%, resp.), nausea (4% and 33%, resp.), and anorexia (0% and 33%, resp.).
• Most patients suffered an average of 3 symptoms. Pain was rarely experienced alone; insomnia and anxiety were frequently combined.
• Beyond symptomatic management, other benefits of medical cannabis included the utilization of safer products, for example, with less fungus, heavy metals, and pesticides than unregulated sources; and safer methods of delivery, for example, sublingual preparations instead of smoking or vaping, especially in patients receiving breast/lymph node radiation and chemotherapy. Fear of opioids motivated many patients to avoid, reduce or stop opioids.
• To improve quality of care, oncologists are encouraged to participate in their state’s medical marijuana training programs, and physician and dispensary databases must be integrated.
While the findings may not be earth-shattering, Weiss emphasizes that they shed important light where information is still sorely lacking. In fact, a 2018 study of clinical oncologists’ attitudes about cannabis for therapeutic use found that, while 80% were discussing cannabis with their patients, only about 30% said they knew anything significant about it, although almost half recommended it clinically. Tellingly, the oncologists reported that the topic of cannabis use was most often raised by the patient.
In her study, Weiss is looking at medical cannabis and cancer treatment from the patient’s perspective, which doctors – and other patients – can learn from. Because, as Weiss points out, “those are the people whose lives are at stake. And they are the ones who initiate the conversation. We need to know what they are thinking and how they are feeling.”
A good match
Dr. Weiss: “I wanted to know and be able to share with other people in the field – doctors and patients – what the symptoms are for which women are seeking medical cannabis, and if they align with the evidence showing its efficacy. Basically, is there a good match between why people are seeking cannabis, and what it has to offer? And there is.”
We found that most of the patients who were seeking medical cannabis as part of the program did have pain. But the other symptoms that were most common were anxiety and insomnia. And in fact, most people have a combination of the two – which makes sense. So there’s also a high level of evidence that medical cannabis helps with those symptoms as well.”
One of the benefits of cannabis that Weiss has observed in her practice is that it helps patients lower their dose of opioids, get off of them altogether, or even avoid starting them in the first place. She cites a study that found that, about 15% of women in this country who go through mastectomy and reconstruction and are given opioids up front are still taking opioids one year later. “So we want to avoid that avoidable scenario where people are exposed to something that could potentially ruin their lives.”
Do patients report that cannabis is helping and that they are feeling better?
Weiss: “Definitely. Most patients report this. Sometimes people go to the “candy shop” – the dispensary – and they get too many things, and they’re not using them in a careful, methodical way, starting low and going slow. They get impatient, and may have unrealistic expectations, like believing if you take something, you are going to feel better right away. Cannabis doesn’t necessarily work like that. Sublingual or oral preparations usually take a least an hour to kick in. So there’s a lot of trial and error, and a need for education. But there’s also a lot of reason to believe that it has benefits in people who might need help.”
Future research
Breastcancer.org recently opened a nationwide scientific-based survey among women with breast cancer to ascertain their knowledge and attitudes about cannabis – both marijuana and hemp, as well as their product choices and outcomes. The survey also covers whether women are talking to their doctors about their cannabis use and how that dialogue is perceived. The insights generated from that study will be used to create new educational content and inform that doctor-patient shared decision-making.
Weiss is also about to launch a randomized controlled trial for Ananda Hemp gelcaps for the treatment for chemotherapy-induced peripheral neuropathy for patients with breast, ovarian or colon cancer. She is also a co-investigator on a study out of Columbia University, testing cannabinoids for peripheral neuropathy caused by chemotherapy in breast cancer.