Michael K Gupta
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
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