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Lee RM, Donnan J, Harris N, Garland SN. A Cross Sectional Survey of Factors Related to Cannabis Use as a Sleep Aid Among Canadian Cancer Survivors. Behav Sleep Med 2024; 22:754-769. [PMID: 38804699 DOI: 10.1080/15402002.2024.2361015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
OBJECTIVES Poor sleep is a common side effect of cancer. Cannabis is increasingly used to manage cancer treatment-related symptoms, including sleep. This study investigated factors related to cannabis use for sleep among Canadian cancer survivors. METHOD Adult Canadian cancer survivors (N = 940) were recruited via the Angus Reid Institute and completed an online, cross-sectional survey. Univariate and multiple binomial logistic regression models identified factors associated with cannabis use for sleep. RESULTS Of the participants (Mage = 64.5 yrs; Women = 51.1%; White = 92.9%), 25.1% (n = 236) currently use cannabis for sleep. Participants were at greater odds of using cannabis for sleep if they identified as a gender other than man or woman (AOR = 11.132), were diagnosed with multiple medical conditions (2:AOR = 1.988; 3+:AOR = 1.902), two psychological conditions (AOR = 2.171), multiple sleep disorders (AOR = 2.338), insomnia (AOR = 1.942), bone (AOR = 6.535), gastrointestinal (AOR = 4.307), genitourinary (AOR = 2.586), hematological (AOR = 4.739), or an unlisted cancer (AOR = 3.470), received hormone therapy only (AOR = 3.054), drink heavily (AOR = 2.748), or had mild insomnia (AOR = 1.828). Older participants (AOR=.972) and those with sleep apnea were less likely to use cannabis for sleep (AOR=.560). CONCLUSION Given its prevalence, research is needed to understand how factors associated with cannabis use as a sleep aid among Canadian cancer survivors may influence its use and effectiveness and whether these factors are barriers to accessing evidence-based treatments.
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Affiliation(s)
- Rachel M Lee
- Department of Psychology, Faculty of Science, Memorial University, St. John's, NL, Canada
- Pharmacy, Beatrice Hunter Cancer Research Institute, Halifax, NS, Canada
| | - Jennifer Donnan
- School of Pharmacy, Memorial University, St. John's, NL, Canada
| | - Nick Harris
- Department of Psychology, Faculty of Science, Memorial University, St. John's, NL, Canada
| | - Sheila N Garland
- Department of Psychology, Faculty of Science, Memorial University, St. John's, NL, Canada
- Pharmacy, Beatrice Hunter Cancer Research Institute, Halifax, NS, Canada
- Discipline of Oncology, Faculty of Medicine, Memorial University, St. John's, NL, Canada
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2
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Braun IM, Bohlke K, Abrams DI, Anderson H, Balneaves LG, Bar-Sela G, Bowles DW, Chai PR, Damani A, Gupta A, Hallmeyer S, Subbiah IM, Twelves C, Wallace MS, Roeland EJ. Cannabis and Cannabinoids in Adults With Cancer: ASCO Guideline. J Clin Oncol 2024; 42:1575-1593. [PMID: 38478773 DOI: 10.1200/jco.23.02596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/20/2023] [Indexed: 04/28/2024] Open
Abstract
PURPOSE To guide clinicians, adults with cancer, caregivers, researchers, and oncology institutions on the medical use of cannabis and cannabinoids, including synthetic cannabinoids and herbal cannabis derivatives; single, purified cannabinoids; combinations of cannabis ingredients; and full-spectrum cannabis. METHODS A systematic literature review identified systematic reviews, randomized controlled trials (RCTs), and cohort studies on the efficacy and safety of cannabis and cannabinoids when used by adults with cancer. Outcomes of interest included antineoplastic effects, cancer treatment toxicity, symptoms, and quality of life. PubMed and the Cochrane Library were searched from database inception to January 27, 2023. ASCO convened an Expert Panel to review the evidence and formulate recommendations. RESULTS The evidence base consisted of 13 systematic reviews and five additional primary studies (four RCTs and one cohort study). The certainty of evidence for most outcomes was low or very low. RECOMMENDATIONS Cannabis and/or cannabinoid access and use by adults with cancer has outpaced the science supporting their clinical use. This guideline provides strategies for open, nonjudgmental communication between clinicians and adults with cancer about the use of cannabis and/or cannabinoids. Clinicians should recommend against using cannabis or cannabinoids as a cancer-directed treatment unless within the context of a clinical trial. Cannabis and/or cannabinoids may improve refractory, chemotherapy-induced nausea and vomiting when added to guideline-concordant antiemetic regimens. Whether cannabis and/or cannabinoids can improve other supportive care outcomes remains uncertain. This guideline also highlights the critical need for more cannabis and/or cannabinoid research.Additional information is available at www.asco.org/supportive-care-guidelines.
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Affiliation(s)
- Ilana M Braun
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Kari Bohlke
- American Society of Clinical Oncology, Alexandria, VA
| | - Donald I Abrams
- University of California San Francisco Osher Center for Integrative Health, San Francisco, CA
| | | | | | | | | | | | - Anuja Damani
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | | | | | | | - Chris Twelves
- University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Eric J Roeland
- Oregon Health and Science University, Knight Cancer Institute, Portland, OR
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3
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Troyer J, Tanco K. Review of the Use of Medicinal Cannabis Products in Palliative Care. Cancers (Basel) 2024; 16:1412. [PMID: 38611090 PMCID: PMC11011126 DOI: 10.3390/cancers16071412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/30/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
In this review, we discuss the potential role of cannabis and cannabinoids in the management of cancer-related symptoms. There is limited evidence demonstrating the effectiveness of cannabis-based products in treating cancer-related pain and gastrointestinal symptoms such as nausea, vomiting, and loss of appetite. Regarding the role of cannabis-based products in the treatment of insomnia and mood disorders, most studies looked at these symptoms as secondary outcomes with mixed results. Cannabis-based products have adverse effects, ranging from neuropsychiatric to systemic effects to potential drug interactions.
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Affiliation(s)
| | - Kimberson Tanco
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
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Pomey MP, Jutras-Aswad D, Paquette J, Saadi K, Taguemout M, Ikene DL, Arbour N, Zertal A, Fréjeau N, Morin D, Ouellette JS, Alami Marrouni K, Duquette P. Perceptions and engagement of patients with chronic conditions on the use of medical cannabis: a scoping review. Eur J Med Res 2024; 29:211. [PMID: 38561859 PMCID: PMC10983766 DOI: 10.1186/s40001-024-01803-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
CONTEXT Studies generally focus on one type of chronic condition and the effect of medical cannabis (MC) on symptoms; little is known about the perceptions and engagement of patients living with chronic conditions regarding the use of MC. OBJECTIVES This scoping review aims to explore: (1) what are the dimensions addressed in studies on MC that deal with patients' perceptions of MC? and (2) how have patients been engaged in developing these studies and their methodologies? Through these objectives, we have identified areas for improving future research. METHODS We searched five databases and applied exclusion criteria to select relevant articles. A thematic analysis approach was used to identify the main themes: (1) reasons to use, to stop using or not to use MC, (2) effects of MC on patients themselves and empowerment, (3) perspective and knowledge about MC, and (4) discussion with relatives and healthcare professionals. RESULTS Of 53 articles, the main interest when assessing the perceptions of MC is to identify the reasons to use MC (n = 39), while few articles focused on the reasons leading to stop using MC (n = 13). The majority (85%) appraise the effects of MC as perceived by patients. Less than one third assessed patients' sense of empowerment. Articles determining the beliefs surrounding and knowledge of MC (n = 41) generally addressed the concerns about or the comfort level with respect to using MC. Only six articles assessed patients' stereotypes regarding cannabis. Concerns about stigma constituted the main topic while assessing relationships with relatives. Some articles included patients in the research, but none of them had co-created the data collection tool with patients. CONCLUSIONS Our review outlined that few studies considered chronic diseases as a whole and that few patients are involved in the co-construction of data collection tools as well. There is an evidence gap concerning the results in terms of methodological quality when engaging patients in their design. Future research should evaluate why cannabis' effectiveness varies between patients, and how access affects the decision to use or not to use MC, particularly regarding the relationship between patients and healthcare providers. Future research should consider age and gender while assessing perceptions and should take into consideration the legislation status of cannabis as these factors could in fact shape perception. To reduce stigma and stereotypes about MC users, better quality and accessible information on MC should be disseminated.
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Affiliation(s)
- Marie-Pascale Pomey
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada.
- School of Public Health, Department of Health Management, Evaluation of Policy, Université de Montréal, 7101 Du Parc Avenue 3rd Floor, Montréal, QC, H3N 1X9, Canada.
- Centre of Excellence on Partnership with Patients and the Public, Montréal, QC, Canada.
| | - Didier Jutras-Aswad
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
- Department of Psychiatry and Addiction, Université de Montréal, Montréal, QC, Canada
| | - Jesseca Paquette
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
| | - Kamilla Saadi
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
- Department of Anthropology, Université de Montréal, Montréal, QC, Canada
| | - Mélissa Taguemout
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Dina-Liza Ikene
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Nathalie Arbour
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Amel Zertal
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Nathalie Fréjeau
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
| | - Danielle Morin
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
| | - Jean-Sylvain Ouellette
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
- Multiple Sclerosis Society of Canada, Toronto, ON, Canada
| | - Kanza Alami Marrouni
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Pierre Duquette
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, QC, Canada
- Department of Neurosciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
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Lee RM, Donnan J, Harris N, Garland SN. A cross-sectional survey of the prevalence and patterns of using cannabis as a sleep aid in Canadian cancer survivors. J Cancer Surviv 2023:10.1007/s11764-023-01474-2. [PMID: 37837502 DOI: 10.1007/s11764-023-01474-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/22/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE Poor sleep is one of the most common side effects of cancer. It can persist for years beyond treatment and negatively impact quality of life and health. Cannabis is increasingly used to manage cancer treatment-related symptoms, including sleep. This study investigated the use and perceived effects of cannabis as a sleep aid in Canadian cancer survivors. METHODS Adult Canadian cancer survivors (N = 1464) were recruited via the Angus Reid Institute and completed an online, cross-sectional survey including the Insomnia Severity Index and questions about cannabis use for sleep. Standard descriptive statistics, such as means, standard deviations, and ranges were produced for measured variables to assess the ways cancer survivors use cannabis for sleep. Frequencies were tabulated for categorical and ordinal variables. RESULTS On average, participants (Mage = 61.1 years; Women = 50%: Men = 48%) received their cancer diagnosis 12.5 years prior. Of participants, 23.5% (n = 344) currently use cannabis as a sleep aid, with reported benefits including relaxation, reduced time to fall asleep, fewer nocturnal awakenings and improved sleep quality. Two thirds (68.3%, n = 235) only began using cannabis for sleep after their cancer diagnosis. Over a third of participants (36.3%, n = 125) use cannabis as a sleep aid every day. Among the 344, the most common other reasons for using cannabis were pain (31.4%, n = 108), recreational use (24.4%, n = 84), and anxiety (12.5%, n = 43). CONCLUSIONS Given the prevalence and potential impact, research is needed to examine the actual efficacy of cannabis as a sleep aid. IMPLICATIONS FOR CANCER SURVIVORS It is important that cancer survivors have information on methods to help their sleep to avoid impairments to quality of life and health.
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Affiliation(s)
- Rachel M Lee
- Department of Psychology, Faculty of Science, Memorial University, St. John's, NL, Canada
- Beatrice Hunter Cancer Research Institute, Halifax, NS, Canada
| | - Jennifer Donnan
- School of Pharmacy, Memorial University, St. John's, NL, Canada
| | - Nick Harris
- Department of Psychology, Faculty of Science, Memorial University, St. John's, NL, Canada
| | - Sheila N Garland
- Department of Psychology, Faculty of Science, Memorial University, St. John's, NL, Canada.
- Beatrice Hunter Cancer Research Institute, Halifax, NS, Canada.
- Discipline of Oncology, Faculty of Medicine, Memorial University, St. John's, NL, Canada.
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Libman H, Zhou ES, Heckman E, Smetana GW. How Would You Manage This Patient With Chronic Insomnia? : Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Ann Intern Med 2022; 175:1746-1753. [PMID: 36508740 DOI: 10.7326/m22-2817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Insomnia, which is characterized by persistent sleep difficulties in association with daytime dysfunction, is a common concern in clinical practice. Chronic insomnia disorder is defined as symptoms that occur at least 3 times per week and persist for at least 3 months. The American Academy of Sleep Medicine (AASM) published recent guidelines on behavioral and psychological treatment as well as pharmacologic therapy for chronic insomnia disorder. Regarding behavioral and psychological approaches, the only intervention strongly recommended was multicomponent cognitive behavioral therapy for insomnia. Regarding pharmacologic treatment, the AASM, based on weak evidence, suggested a limited number of medications that might be useful and others that probably are not. Here, 2 clinicians with expertise in sleep disorders-one a clinical psychologist and the other a physician-debate the management of a patient with chronic insomnia who has been treated with medications. They discuss the role of behavioral and psychological interventions and pharmacologic therapy for chronic insomnia and how the primary care practitioner should approach such a patient.
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Affiliation(s)
- Howard Libman
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts (H.L., E.H., G.W.S.)
| | - Eric S Zhou
- Dana Farber Cancer Institute, Boston Children's Hospital, and Harvard Medical School, Boston, Massachusetts (E.S.Z.)
| | - Eric Heckman
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts (H.L., E.H., G.W.S.)
| | - Gerald W Smetana
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts (H.L., E.H., G.W.S.)
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7
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Braun IM, Nayak MM, Roberts JE, Chai PR, Tulsky JA, Abrams DI, Pirl W. Backgrounds and Trainings in Cannabis Therapeutics of Dispensary Personnel. JCO Oncol Pract 2022; 18:e1787-e1795. [PMID: 35969815 PMCID: PMC9653199 DOI: 10.1200/op.22.00129] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE A growing body of scientific research indicates that oncology teams tend to offer individuals with cancer little clinical advice regarding medicinal cannabis (MC) and that individuals with cancer instead turn to cannabis dispensaries for MC guidance. Our objective was to investigate dispensary personnel's backgrounds and trainings in MC advising. METHODS The study design was semistructured interviews across 13 states with cannabis dispensary personnel in managerial or client-facing positions. Of 38 recruited, 26 (68%) completed interview. The primary outcome was training in MC advising. Researchers targeted thematic saturation and adhered to Consolidated Criteria for Reporting Qualitative Research. RESULTS Of 26 participants, 54% were female, with an average age of 40 (range: 22-64) years. Half worked in client-facing roles; half worked in managerial ones. Study participants endorsed passionate commitment to their profession, often motivated by personal experience with MC therapeutics. Cannabis dispensaries often privileged sales skills over cannabis therapeutics knowledge when hiring, resulting in uneven baseline levels of cannabis therapeutics expertise among staff. Most participants reported workplace cannabis therapeutics training to be unstandardized and weak. They described dispensary personnel as resourceful in pursuing cannabis knowledge, self-financing learning in off-hours, sampling dispensary products, and exchanging knowledge. Nearly half the participants called for quality, standardized cannabis therapeutics training for dispensary personnel. CONCLUSION The many oncology teams who defer to dispensary personnel regarding MC advising rely on a workforce who views themselves as unevenly trained. Further research should include a national survey of cannabis dispensary personnel to learn whether these findings hold true in a larger sample. If so, the oncology community must determine the best approach to clinically advising individuals with cancer about MC.
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Affiliation(s)
- Ilana M. Braun
- Harvard Medical School, Boston, MA,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA,Department of Psychiatry, Brigham and Women's Hospital, Boston, MA,Ilana M. Braun, MD, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215; e-mail:
| | - Manan M. Nayak
- Harvard Medical School, Boston, MA,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA,Phyllis F. Cantor Center for Research in Nursing, Dana-Farber Cancer Institute, Boston, MA
| | - Jane E. Roberts
- Harvard Medical School, Boston, MA,Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA
| | - Peter R. Chai
- Harvard Medical School, Boston, MA,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA,Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA,The Fenway Institute, Boston, MA
| | - James A. Tulsky
- Harvard Medical School, Boston, MA,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA,Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Donald I. Abrams
- Department of Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA
| | - William Pirl
- Harvard Medical School, Boston, MA,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA,Department of Psychiatry, Brigham and Women's Hospital, Boston, MA
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8
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Camacho-Rivera M, Islam JY, Rodriguez DL, Vidot DC. Cannabis Use among Cancer Survivors amid the COVID-19 Pandemic: Results from the COVID-19 Cannabis Health Study. Cancers (Basel) 2021; 13:3495. [PMID: 34298708 PMCID: PMC8303109 DOI: 10.3390/cancers13143495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/01/2021] [Accepted: 07/06/2021] [Indexed: 12/18/2022] Open
Abstract
Clinical indications for medicinal cannabis use include those with cancer, a subgroup advised to avoid exposure to COVID-19. This study aims to identify changes to cannabis use, methods of cannabis delivery, and coping strategies among cancer survivors since the pandemic by cancer status. Chi-squared tests were used for univariate comparisons of demographic characteristics, cannabis use patterns, COVID-19 symptoms, and coping behaviors by cancer survivor status. Data included 158 responses between 21 March 2020 and 23 March 2021, from medicinal cannabis users, categorized as cancer survivors (n = 79) along with age-matched medicinal cannabis users without a history of cancer (n = 79). Compared to adults without a history of cancer, cancer survivors were more likely to report use of cannabis as a way of managing nausea/vomiting (40.5% versus 20.3%, p = 0.006), headaches or migraines (35.4% versus 19.0%, p = 0.020), seizures (8.9% versus 1.3%, p = 0.029), and sleep problems (70.9% versus 54.4%, p = 0.033), or as an appetite stimulant (39.2% versus 17.7%, p = 0.003). Nearly 23% of cancer survivors reported an advanced cannabis supply of more than 3 months compared to 14.3% of adults without a history of cancer (p = 0.002); though the majority of cancer survivors reported less than a one-month supply. No statistically significant differences were observed by cancer survivor status by cannabis dose, delivery, or sharing of electronic vaping devices, joints, or blunts. Cancer survivors were more likely to report a fear of being diagnosed with COVID-19 compared to adults without a history of cancer (58.2% versus 40.5%, p = 0.026). Given the frequency of mental and physical health symptoms reported among cancer survivors, clinicians should consider conversations about cannabis use with their patients, in particular among cancer survivors.
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Affiliation(s)
- Marlene Camacho-Rivera
- Department of Community Health Sciences, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA;
| | - Jessica Y. Islam
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA;
| | - Diane L. Rodriguez
- Morsani College of Medicine, University of South Florida, Tampa, FL 33602, USA;
| | - Denise C. Vidot
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL 33146, USA
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
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