For many cancer survivors, cannabis has become part of how they manage symptoms such as pain, nausea and anxiety. Medical cannabis is now legal in 47 states, Washington, D.C., and three U.S. territories, and its use continues to grow among both the general population and cancer survivors. Yet despite its increasing use, little is known about how survivors and their healthcare providers view medical cannabis or how comfortable they are discussing it.
A new study from VCU Massey Comprehensive Cancer Center surveyed 395 cancer survivors and 62 cancer care providers to better understand those perspectives. Published in the Journal of Cancer Education , the study found that while survivors and providers agreed on many aspects of medical cannabis, they differed in their awareness of potential risks and their comfort discussing it.
"Both cancer survivors and healthcare providers share some similarities in their perceptions about using medical cannabis, but there are also gaps in perceived risk awareness and patient-provider communication," said Sunny Jung Kim, Ph.D., the study's corresponding author, a researcher in the Cancer Prevention and Control program at VCU Massey and an associate professor at the VCU School of Public Health.
For Kim, whose research focuses on cancer survivorship and pain management, the study grew out of a broader effort to identify alternatives to opioid-based care.
"People are seeking different approaches to avoid or reduce long-term opioid use, and cannabis is one of them," Kim said.
The research findings
The study found that cancer care providers were significantly more likely than survivors to report awareness of the potential risks of cannabis use (25% vs. 8.4%). At the same time, cancer survivors were far more likely to say they felt comfortable discussing cannabis with their care team than providers were to say they felt comfortable bringing it up with patients (68.5% vs. 46.7%). Providers also held more negative attitudes toward recreational cannabis use than survivors did.
Among survivors, those who had used cannabis reported greater social well-being than those who had never used it, but also reported lower physical and emotional well-being, greater mistrust in the healthcare system and lower use of healthcare services overall. Cannabis-using survivors also had higher rates of smoking, vaping, anxiety and depression than non-users, though the two groups did not differ in chronic pain, alcohol use or sleep quality. Whether cannabis was legal in a survivor's state did not appear to influence whether they used it.
Notably, more than half (57.9%) of the survivors who used cannabis had started before their cancer diagnosis, while the rest began using it specifically in response to their diagnosis, a distinction Kim said may be clinically important.
"I see a similar pattern with opioids. Cancer survivors who were already using opioids before diagnosis are more likely to develop dependency or opioid-related problems," Kim said. "I think something similar might apply to cannabis. People who were already using it recreationally before their cancer diagnosis may be more inclined to develop dependency or chronic cannabis use problems, so I think that group may need more careful attention."
What's next?
"There should be stronger clinical evidence that clearly shows the benefits outweigh the potential risks. Standardized clinical guidelines regarding cannabis use for cancer survivors would also be helpful, and more education and training on this topic would give providers more confidence in discussing and recommending medical cannabis when appropriate," Kim said.
Looking ahead, Kim said future studies should build that evidence through longitudinal research using biomarkers and other objective measures rather than relying solely on self-reported survey data.
"We need longitudinal studies establishing causality with biomarkers and objective measures," Kim said. "The data shouldn't just be self-reported outcomes. It should be based on longitudinal follow-up data incorporating biomarkers and objective measures to evaluate the actual outcomes of medical cannabis use rather than perceived outcomes."
Ultimately, Kim hopes the findings encourage more open conversations between cancer survivors and their healthcare providers about medical cannabis.
"Patient-provider communication is really critical. Having open discussions with providers will help reach informed decisions," Kim said.
What is medical cannabis?
Medical cannabis refers to marijuana and its derivatives, including cannabis concentrates and cannabis-infused edibles, used to help manage symptoms or side effects of a medical condition.
Patients commonly use cannabis to try to manage pain, nausea, anxiety, depression, fatigue and loss of appetite, though evidence in cancer survivors is still evolving.
In this study, more than half of the survivors who used cannabis had started using it before their cancer diagnosis.
Collaborators
- Vanessa B. Sheppard, Ph.D., Professor and Theresa A. Thomas Memorial Chair in Cancer Prevention and Control, VCU Massey and VCU School of Public Health
- Farnese M. Motto, MSPH, Department of Social and Behavioral Sciences, VCU School of Public Health
- Susan Hong, M.D., director of the Cancer Survivorship Program, VCU Massey and VCU School of Medicine
- Aron H. Lichtman, Ph.D., Department of Pharmacology and Toxicology, VCU School of Medicine
- Hannah Ming, Ph.D., alumna of VCU
- Viktor Clark, Ph.D., research assistant professor, the University of Rochester Medical Center
