A Population-Based Survey to Assess the Association between Cannabis and Quality of Life among Colorectal Cancer Survivors

Abstract

Background: As more states legalize cannabis for medical and recreational use, people increasingly use cannabis to treat medical conditions and associated symptoms. The prevalence and utility of cannabis for cancer-related symptoms may be clarified by examining cannabis use among patients with a common cancer diagnosis. We aimed to determine the prevalence of cannabis use among colorectal cancer (CRC) survivors and its associations with quality of life (QoL) and cancer-related symptomatology.Methods: A cross-sectional survey of patient-reported QoL outcomes and behaviors, including cannabis use, was conducted within the Patient Outcomes To Advance Learning network’s (PORTAL) CRC Cohort. The cohort included a population-based sample of healthcare system members ≥ 18 years old diagnosed with adenocarcinoma of the colon or rectum from 2010 through 2016. We assessed the association between cannabis use and QoL using the European Organization for Research and Treatment of Cancer QLQ-C30 summary score.Results: Of the 1,784 respondents, 293 (16.4%) reported cannabis use following CRC diagnosis. Current tobacco smokers were more likely to use cannabis compared to former or never tobacco smokers (adjusted odds ratio [aOR] 2.71, 95% confidence interval [CI] 1.56 to 4.70). Greater alcohol use (> 4 drinks per month versus ≤ 4 drinks per month) was associated with cannabis use (aOR 2.17, 95% CI 1.65 to 2.85). There was an association between cannabis use and cancer stage at diagnosis, with stage 3 or 4 CRC patients more likely to use cannabis than stage 1 or 2 CRC patients (aOR 1.68, 95% CI 1.25 to 2.25). After adjusting for demographics, medical comorbidities, stage and site of CRC diagnosis, and prescription opioid use, people who used cannabis had significantly lower QoL than people who did not use cannabis (difference of -6.14, 95% CI -8.07 to -4.20). Conclusion: Among CRC survivors, cannabis use was relatively common, associated with more advanced stages of disease, associated with tobacco and alcohol use, and not associated with better QoL. Clinicians should inquire about cannabis use among their patients and provide evidence-based recommendations for cancer-related symptoms.

A Coala‐T‐Cannabis Survey Study of breast cancer patients' use of cannabis before, during, and after treatment

“…Previous studies have investigated the percentage of patients with cancer using cannabis at individual treatment centers and have reported a wide range (16%‐56%) 3‐5 . Our study included a national sample, and we found that 42% of patients with breast cancer were using cannabis.…”

“…Our study is subject to inherent survey study limitations. Selection biases can result in the overrepresentation of cannabis users, symptomatic patients under treatment with more advanced disease, and residents of states with legalized cannabis 4,6 . Conversely, underreporting of cannabis use can result from its illegal status and social stigma.…”

“…However, patients still experience symptoms and side effects that impair their quality of life; this can reduce treatment adherence and worsen the prognosis 2 . Many patients with cancer turn to cannabis for symptomatic relief 3‐5 because of its reported ability to lessen pain, nausea, and anorexia from cancer or its treatments 6 . Cancer is specified as a qualifying condition in nearly all states with medical cannabis programs 7 .…”

The siren's song of anonymous web‐based sampling

“…However, they fail to put this finding into proper context: the authors note that a prior study reported a 56% prevalence of cannabis use among patients with colorectal cancer 1 . The cited study, in fact, observed a 16% cannabis prevalence, and among the 16% of users, 56%—9% overall—reported using cannabis in the past 30 days 4 . Indeed, with prior studies reporting prevalence estimates ranging from 8% to 24%, the results of the current report are nearly double the upper range of any prior study among general oncology patients 5‐10 or patients diagnosed with cancers at specific anatomic sites 4,11,12 .…”

“…The cited study, in fact, observed a 16% cannabis prevalence, and among the 16% of users, 56%—9% overall—reported using cannabis in the past 30 days 4 . Indeed, with prior studies reporting prevalence estimates ranging from 8% to 24%, the results of the current report are nearly double the upper range of any prior study among general oncology patients 5‐10 or patients diagnosed with cancers at specific anatomic sites 4,11,12 . To our knowledge, only Pergam et al 8 have reported on cannabis use among patients with breast cancer at a single cancer center in Seattle, Washington, where adult medical and nonmedical cannabis use is legal.…”