Disclosures: The authors report no relevant financial disclosures.
August 13, 2021
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Marijuana use less common among cancer survivors than general public

Disclosures: The authors report no relevant financial disclosures.
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Patients with cancer used marijuana less often than the general public despite increased legalization and social acceptance of the drug, according to results of a study published in Cancer.

Researchers at Virginia Commonwealth University Massey Cancer Center analyzed data collected over a 6-year period from more than 20,000 participants in a nationally representative, longitudinal survey.

Patients with cancer used marijuana less often than the general public despite increased legalization and social acceptance of the drug.
Data derived from Do EK, et al. Cancer. 2021;doi:10.1002/cncr.33794.

“Given the changing landscape of marijuana laws and some preliminary reports suggesting cancer survivors are using marijuana or cannabis to manage cancer-related symptoms, we were curious to know the extent of cannabis use in the population of survivors and if this was more or less than the general population without a history of cancer,” Bernard F. Fuemmeler, PhD, MPH, professor in the department of health behavior and policy at Virginia Commonwealth University School of Medicine, and associate director for population science and program co-leader in cancer prevention and control at Massey Cancer Center, told Healio.

Bernard F. Fuemmeler, PhD, MPH
Bernard F. Fuemmeler

“Prior to this study, there were only two other large national studies estimating the prevalence of cannabis use among cancer survivors and they were vastly different, with one study suggesting 38% used cannabis in the past 30 days and the other finding between 9% and 10% used cannabis in the past 30 days,” he continued. “Our findings corroborate the lower estimate.”

Fuemmeler and colleagues studied data collected in four annual waves between 2013 and 2018 as part of the Population Assessment of Tobacco and Health (PATH) study, a collaboration of NIH and FDA that tracks both tobacco and marijuana smoking behaviors of a representative sample of Americans.

Researchers used discrete time survival analyses to estimate baseline predictors — including physical health status, pain and demographic variables — of past-year engagement with marijuana among individuals who reported a cancer diagnosis during the first wave of the study (n = 1,022) and individuals who reported never having cancer at any wave (n = 19,702).

Most of the 20,724 individuals in the final weighted sample were white (78%), women (52%), had active health insurance (85%) and had at least some college education (59%).

Results showed patients with cancer reported significantly less marijuana use than people who never had cancer, even after correcting for factors such as age, race and sex. Only 8% of cancer survivors in the most recent survey reported past-year marijuana use, compared with 15% of those without a cancer history.

When Fuemmeler and colleagues analyzed data across the four time points, the results held: An estimated 3.8% of cancer survivors engaged with marijuana vs. 6.5% without a history of cancer. Additionally, they reported associations of older age and having health insurance with a lower likelihood of marijuana use among both groups. Greater levels of pain, on the other hand, appeared associated with a higher likelihood of marijuana use among both cancer survivors (OR = 1.14; 95% CI, 1.06-1.23) and those without a cancer history (OR = 1.07; 95% CI, 1.06-1.09).

Among those without a cancer history, being female (OR = 0.66; 95% CI, 0.61-0.72) and having a better self-rated mental health status (OR = 0.82; 95% CI, 0.79-0.85) appeared associated with a lower likelihood of marijuana use, and Black individuals appeared more likely to engage in marijuana use than white individuals (OR = 1.27; 95% CI, 1.13-1.43). Lower income appeared associated with higher odds of marijuana use among these individuals (OR = 0.89; 95% CI, 0.86-0.93).

Fuemmeler said researchers had anticipated the percentage of cancer survivors using marijuana might be slightly higher than, or at least similar to, those without a history of cancer, so he described the overall results as “a little surprising.”

“In general, cancer survivors may be more tuned into their health and the types of medicines or alternative medicines they are using,” Fuemmeler told Healio. “They may be more mindful about whether or not something like cannabis is helpful or harmful. It’s important to do these types of studies because we can begin to monitor the prevalence over time. As the legalization landscape changes in more states, it will be important to continue to monitor the prevalence.”

Study limitations included cancer diagnoses being self-reported and a lack of specific information in the PATH data set on cancer survivors, such as disease type and stage, time since diagnosis, cancer recurrence or prescribed treatments. Analysis of such information in future studies could help researchers identify specific causes for the trends in marijuana use among cancer survivors, researchers wrote

“Right now, the data do not show that cannabis is any better than traditional pharmaceuticals for managing some of the symptoms for which it is commonly used, like nausea, pain, anxiety or sleep,” Fuemmeler said. “It is important to continue to study this issue. There is a lot of variation in the potency and types of cannabis, and right now we don’t know much about whether cannabis can be potentially helpful or if it is harmful.

“The important thing is that patients consult with their providers before they decide to use alternative ways of dealing with symptoms,” he added. “And clinicians should be prepared to address these questions, especially now that more states are moving toward legalization.”

For more information:

Bernard F. Fuemmeler, PhD, MPH, can be reached at Department of Health Behavior and Policy, Virginia Commonwealth University, 830 E. Main St., Richmond, VA 23219; email: bernard.fuemmeler@vcuhealth.org.