Introduction: One-of-three or -four adults with cancer turns to medicinal cannabis. Prior work suggests a disconnect between the clinical preferences of oncology teams and the cannabis therapeutics practices of patients. For instance, oncologists favor oral administration, while many cancer patients combust or vaporize. This investigation explored medicinal cannabis (MC) formulations, routes of administration, and dosing preferences among adults with cancer.
Methods: Semi-structured phone interviews across eight states with adults with cancer consuming MC in compliance of state law were conducted and analyzed using applied thematic analysis.
Results: Among study participants (N=24), mean age was 54 years. Sixty-seven percent were female. Forty-six percent resided in the Eastern United States and 51% described their cancer as metastatic or incurable. Across interviews, a powerful theme was of myriad MC product formulations available through a given dispensary storefront, triggering astonishment and sometime feelings of inundation. Common strategies among participants were to purchase and sample multiple store-bought formulations as well as to modify dispensary products at home, at times to alter intended routes of administration or to reduce financial toxicity. A trusted, preferred dispensary product was not always consistently available. Although oral was the top-cited administration mode, the wide array of cannabis consumption methods included topical, sublingual, vaporization, combustion, and rectal suppository. Three-quarters of participants alternated between modes of administration. Medicinal cannabis dosing imprecision constituted another powerful theme, thought to be due to lack of quality assurance at the level of the dispensary and measurement imprecision in the home.
Discussion: This investigation suggests that MC preparations, administration routes and dosing vary dramatically among individuals with cancer; and that the few commonalities in use patterns, for instance reliance on multiple routes of cannabis administration, tend not be rooted in scientific evidence. These qualitative finding should be interrogated quantitatively but indicate that lay-facing educational programs pertaining cannabis therapeutics in the setting of cancer, as well as a higher degree of dispensary product standardization may be warranted.
