Journal Article Annotations
2023, 4th Quarter

Palliative Care

Annotations by Richard Key, MD
January, 2024

Cannabis in Cancer Survivors Who Report High Impact Chronic Pain: Findings from a 1500+ Patient Survey

PUBLICATION #1 — Palliative Care

Cannabis in Cancer Survivors Who Report High Impact Chronic Pain: Findings from a 1500+ Patient Survey

Lindsey M Philpot, Priya Ramar, Aminah Jatoi, Jordan Rosedahl, Rachel Canning, Jon O Ebbert

Abstract: Am J Hosp Palliat Care. 2023 Nov;40(11):1196-1204. doi: 10.1177/10499091221143098. Epub 2022 Dec 5.

Background:
Chronic pain in cancer survivors negatively impacts quality of life. This study sought to investigate the relationship between high-impact chronic pain (HICP) — defined as chronic pain that limits life or work activities on most days or every day in the past 3 months — and cannabis in cancer survivors.

Methods:
An electronic survey was developed in conjunction with the National Cancer Institute Comprehensive Cancer Centers in the United States. This survey was distributed to cancer survivors within a multi-site, single institution setting.

Results:
The survey response rate was 23.0% (2304/10,000); 72.7% of these patients (1676/2304) did in fact have a confirmed cancer diagnosis. Among these cancer survivors, 16.5% (unweighted 278/1676) had HICP, and 12.4% (208/1676) reported cannabis use since their cancer diagnosis. The prevalence of past 30-day cannabis use was 12.3% (206/1676). Compared to cancer survivors without pain, those with HICP were more likely to believe in the benefits of cannabis (unweighted 92.1% vs. 74.7%; age-adjusted odds ratio [OR] = 3.1; 95% CI: 1.9-5.1) and less likely to believe in its risks (unweighted 48.2% vs. 58.4%; age-adjusted OR = 0.6; 95% CI: 0.4-0.7).

Conclusions:
Cancer survivors with HICP have a higher prevalence of cannabis use compared to those patients without pain. More research is needed to advance pain and symptom management among cancer survivors and to identify clinical scenarios in which benefit is greater than potential harm.

Keywords:
cancer; cannabis; chronic pain; surveys.

Annotation

The finding:
People with high impact cancer pain (HICP), defined as chronic pain that limits life or work activities on most days or every day in the past three months, tend to have higher rates of cannabis use. This population is most likely to believe more relief of symptoms with cannabis use that include pain and also sleep problems, mood changes, stress, anxiety, depression, and fatigue. People with HICP are more likely than those without HICP to support the potential benefits of cannabis and less likely to be skeptical of the risks of cannabis use.

Strength and weaknesses:
The major strength of this survey is that it investigates patterns and purpose of cannabis use in cancer survivors. Weaknesses are significant and include a low response rate with some skewing towards older, retired, and educated respondents and thus results may not generalize well. The cross-sectional design cannot definitively determine that the cause of pain in patients was cancer. It is best considered as a very small pilot on which further investigation is warranted.

Relevance:
C-L psychiatrists often provide care for cancer patients dealing with HICP in both inpatient and outpatient settings. It is important for us to be aware of patterns and purpose of cannabis use, and to be proactive in discussing the patients their cannabis use. We are well positioned to provide education on known risks to those using cannabis to minimize harm.