Marijuana use improves quality of life for patients with head, neck cancer
Patients newly diagnosed with head and neck cancer who used marijuana recreationally reported a modest improvement in quality-of-life outcomes compared with nonusers, according to results of a prospective cohort study.
Specifically, marijuana was associated with less pain/discomfort and anxiety/depression, results showed.
“In Canada we’re looking to legalize marijuana federally and we’re trying to get a better idea about marijuana use among the cancer population, including the quality-of-life factors presenting among patients with cancer,” Michael K. Gupta, MD, MSc, FRCSC, assistant professor in the division of otolaryngology and head & neck surgery at St. Joseph’s Healthcare in Hamilton, Ontario and McMaster University, told HemOnc Today. “We conducted a study to see if marijuana was effective for the management of pain and anxiety among patients with head and neck cancer. The study was prompted by a combination of upcoming changes in legislation and the fact that we were curious about the effects in our patients.”
Gupta and colleagues conducted a single-center study of patients enrolled at the time of head and neck cancer diagnosis from 2011 to 2015. The analysis included 74 patients (mean age, 62.3 years; 82% men) who used marijuana and 74 (mean age, 62.2 years; 85% men) case-matched controls who did not.
Researchers observed no statistically significant differences in age, sex, tumor subsite, clinical tumor staging, treatment modality or mean Karnofsky score between marijuana users and nonusers.
Investigators assessed quality of life using the EuroQol-5D and the Edmonton Symptom Assessment System questionnaires. They defined marijuana use as current use of loose-leaf marijuana at least weekly.
In a univariate analysis, marijuana use appeared associated with statistically significant lower EuroQol scores for anxiety and depression (1.34 vs. 2.08; difference, 0.74; 95% CI, 0.55-0.93) and pain and discomfort (1.53 vs. 1.82; difference 0.29; 95% CI, 0.03-1.54). A Wilcoxon rank sum test confirmed the results of the EuroQol questionnaires (anxiety/depression, z score = 6.71; pain/discomfort, z score = 2.6).
When assessing quality of life through the Edmonton Symptom Assessment System questionnaire, marijuana users appeared to have less pain (1.85 vs. 2.72; z score = 2.36), greater appetite (1.7 vs. 3.57; z score = 4.17), and better general well-being (4.05 vs. 2.12; z score = 4.43). They also reported less fatigue (1.66 vs. 3.88; z score = 5.02), anxiety (0.77 vs. 5.3; z score = 10.04), depression (0.72 vs. 3.19; z score = 5.96) and drowsiness (0.56 vs. 2.68; z score = 5.51).
“The novel thing this study does is that it finds that marijuana use is associated with both lower pain scores and lower anxiety scores,” Gupta said in an interview. “So, it seems to be an agent that will both reduce people’s anxiety surrounding their diagnosis of cancer, and it will also be effective in treating pain related to cancer.”
The limitations of the study included the inclusion of recreational users without controlled doses of marijuana and the fact that quality of life was assessed at the time of cancer diagnosis and not throughout treatment.
“Patients with head and neck cancer have some unique quality-of-life issues because the cancer tends to affect things like swallowing, breathing and speaking. It can be quite debilitating, and the pain can be significant and interfere with activities of daily living. Among this set of patients who have very acute and specific problems, [the findings] suggest that marijuana use is effective,” Gupta said.
“The use of marijuana for cancer pain is very much in its infancy, so we need more data,” he added. “The next thing to do is a randomized controlled trial. We need to look at these patients and randomly assign them to a fixed dose of some cannabinoid agent and assess anxiety and pain scores.” – by Cassie Homer
For more information:
Michael K. Gupta, MD, MSc, FRCSC, can be reached at St. Joseph’s Healthcare Hamilton, G836, 50 Charlton Ave. E, Hamilton, ON L8N4A6, Canada; email: firstname.lastname@example.org.
Disclosures: The authors report no relevant financial disclosures.