E409: Cancer Patients Want to Talk to Their Surgeons About Cannabis

Gastrointestinal (GI) cancer and its treatments (including surgery, chemotherapy, and radiation) are known to result in physical symptoms (e.g. pain, weight loss, vomiting) and neuropsychiatric symptoms (e.g. anxiety, poor sleep, depressed mood). In an era of increasing availability of medical and non-medical cannabis, it is increasingly important to understand regional variations in the rates of cannabis use, and patients' attitudes about cannabis use for palliation of their symptoms. 

Methods: Patients were recruited from surgical clinics and inpatient floors at a Midwest US Comprehensive Cancer Center. The cohort was enriched for patients who had undergone surgery during their cancer treatment. Patients completed a confidential, cross-sectional survey about their symptoms, their cannabis history, and their attitudes regarding cannabis for palliation of symptoms in cancer patients. Survey methods were modeled after the Theory of Planned Behavior, and patient opinions were quantified with a Likert scale

Results:

Respondents represented several GI cancers (37% colorectal; 32% pancreatic; 22% esophagogastric, 9% NET/other). 68.5% of respondents had undergone surgery. Many patients reported severe physical symptoms (38.9%), and/or severe neuropsychiatric symptoms (24.1%). 20% of surveyed patients were currently using some type of whole-plant cannabis product. Of those patients currently using cannabis, 90% listed “symptom relief” as their primary reason for use. Among patients that were not actively using cannabis products, 67% were interested in learning about medicinal cannabis. Overwhelmingly, both cannabis users and nonusers viewed cannabis favorably, with 74% strongly agreeing that cannabis can improve symptoms. Of patients who use cannabis, only about half had disclosed this information to their treating physician. Patients cited a perceived lack of support for cannabis use by their friends, their healthcare team, and/or society.

Conclusions: The incidence of cannabis use among our surgical cancer patient population is similar to reported values for cancer populations across North America. Cancer patients overwhelmingly believe that cannabis improves (or has potential to improve) their physical and neuropsychiatric symptoms. However, many patients do not discuss cannabis with their surgical or medical oncologists. Subjective and social norms partially explain the lack of communication between patient and provider. Our results suggest that effective communication could lead to improved quality of life for those cancer patients who derive symptom relief from cannabis use.