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Adley NC, Brasky TM, Conroy SR, Newton AM, Plascak JJ, Strassels SA, Hays JL, Krok-Schoen JL. Associations of Cancer Patients' Demographic and Clinical Characteristics With Cannabis-Related Interest and Behaviors. J Palliat Med 2024; 27:394-399. [PMID: 38157334 DOI: 10.1089/jpm.2023.0490] [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] [Indexed: 01/03/2024] Open
Abstract
Background: Cannabis interest and use is increasing in the United States, yet research on its use among cancer patients is limited. Methods: Individuals with cancer completed an anonymous cross-sectional questionnaire. Multivariable logistic regressions estimated odds ratios (OR) between patients' demographic and clinical characteristics with cannabis-related interest, current use, and provider recommendation. Results: Participants (n = 943) were, on average, 61.7 years old. Older patients were less likely to use cannabis products (OR = 0.42, confidence interval [95% CI]: 0.26-0.69) and less likely to be interested in cannabis (OR = 0.60, 95% CI: 0.44-0.84) than younger patients. Those with higher education were less likely to be using cannabis (OR = 0.41, 95% CI: 0.25-0.67) and less likely to have received a provider recommendation of cannabis use than the least educated (OR = 0.38, 95% CI: 0.19-0.76). Cancer spread and type were significant correlates of provider recommendation of cannabis use. Conclusions: Additional research is warranted to better understand cancer patients' motivations for cannabis use and interest.
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Affiliation(s)
- Neema C Adley
- Department of Neuroscience, The Ohio State University College of Arts and Sciences, Columbus, Ohio, USA
| | - Theodore M Brasky
- Division of Medical Oncology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Sara R Conroy
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Alison M Newton
- Division of Medical Oncology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jesse J Plascak
- Division of Cancer Prevention and Control, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | | | - John L Hays
- Division of Medical Oncology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jessica L Krok-Schoen
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Krok-Schoen JL, Plascak JJ, Newton AM, Strassels SA, Adib A, Adley NC, Hays JL, Wagener TL, Stevens EE, Brasky TM. Current cannabis use and pain management among US cancer patients. Support Care Cancer 2024; 32:111. [PMID: 38236449 PMCID: PMC10796435 DOI: 10.1007/s00520-024-08321-9] [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: 10/03/2023] [Accepted: 01/11/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND National studies reporting the prevalence of cannabis use have focused on individuals with a history of cancer without distinction by their treatment status, which can impact symptom burden. While pain is a primary motivation to use cannabis in cancer, the magnitude of its association with cannabis use remains understudied. METHODS We examined cannabis use and pain management among 5523 respondents of the Behavioral Risk Factor Surveillance System with a cancer history. Survey-weighted prevalence proportions of respondents' cannabis use are reported, stratified on cancer treatment status. Regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) of cancer-related pain and cannabis use. RESULTS Cannabis use was slightly more prevalent in those undergoing active treatment relative to those who were not undergoing active treatment (9.3% vs. 6.2%; P=0.05). Those under active treatment were more likely to use cannabis medicinally (71.6% vs. 50.0%; P=0.03). Relative to those without cancer-related pain, persons with pain under medical control (OR 2.1, 95% CI, 1.4-3.2) or uncontrolled pain were twice as likely to use cannabis (OR 2.0, 95% CI, 1.1-3.5). CONCLUSIONS Use of cannabis among cancer patients may be related to their treatment and is positively associated with cancer-related pain. Future research should investigate the associations of cannabis use, symptom burden, and treatment regimens across the treatment spectrum to facilitate interventions.
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Affiliation(s)
- Jessica L Krok-Schoen
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jesse J Plascak
- Division of Cancer Prevention and Control, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Alison M Newton
- Division of Medical Oncology, The Ohio State University College of Medicine-James Comprehensive Cancer Center, 420 W. 12th Ave., Suite 514B TRF, Columbus, OH, 43210, USA
| | | | - Anita Adib
- Division of Cancer Prevention and Control, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Neema C Adley
- Department of Neuroscience, The Ohio State University College of Arts and Sciences, Columbus, OH, USA
| | - John L Hays
- Division of Medical Oncology, The Ohio State University College of Medicine-James Comprehensive Cancer Center, 420 W. 12th Ave., Suite 514B TRF, Columbus, OH, 43210, USA
| | - Theodore L Wagener
- Division of Medical Oncology, The Ohio State University College of Medicine-James Comprehensive Cancer Center, 420 W. 12th Ave., Suite 514B TRF, Columbus, OH, 43210, USA
| | - Erin E Stevens
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Theodore M Brasky
- Division of Medical Oncology, The Ohio State University College of Medicine-James Comprehensive Cancer Center, 420 W. 12th Ave., Suite 514B TRF, Columbus, OH, 43210, USA.
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Osaghae I, Talluri R, Chido‐Amajuoyi OG, Tanco K, Shah DP, Pande M, Shete S. Awareness and interest in cannabis use for cancer management among cancer survivors. Cancer Med 2024; 13:e6902. [PMID: 38180296 PMCID: PMC10807618 DOI: 10.1002/cam4.6902] [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: 09/09/2023] [Revised: 11/16/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND We examined the awareness, interest, and information sources relating to cannabis use for cancer management (including management of cancer symptoms and treatment-related side effects) and determined factors associated with cancer survivors' awareness and interest in learning about cannabis use for cancer management. METHODS This was a cross-sectional study of adult cancer survivors (N = 1886) receiving treatment at a comprehensive cancer center. Weighted prevalence and multivariable logistic regression analyses were conducted. RESULTS Among cancer survivors, 88% were aware and 60% were interested in learning about cannabis use for cancer management. Common sources of information to learn about cannabis use for cancer management were cancer doctors/nurses (82%), other patients with cancer (27%), websites/blogs (26%), marijuana stores (20%), and family/friends (18%). The odds of being aware of cannabis use for cancer management was lower among male compared to female survivors (adjusted odds ratio [AOR]: 0.61; 95% confidence interval [CI]: 0.41-0.90), non-Hispanic Blacks compared to non-Hispanic Whites (AOR: 0.36; 95% CI: 0.21-0.62), and survivors who do not support the legalization of cannabis for medical use compared to those who do (AOR: 0.10; 95% CI: 0.04-0.23). On the other hand, the odds of being interested in cannabis use for cancer management was higher among non-Hispanic Blacks compared to non-Hispanic Whites (AOR: 1.65; 95% CI: 1.04-2.62), and among cancer survivors actively undergoing cancer treatment compared to patients on non-active treatment (AOR: 2.25; 95% CI: 1.74-2.91). CONCLUSION Awareness of cannabis use for cancer management is high within the cancer survivor population. Results indicated health care providers are leading information source and should receive continued medical education on cannabis-specific guidelines. Similarly, tailored educational interventions are needed to guide survivors on the benefits and risks of cannabis use for cancer management.
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Affiliation(s)
- Ikponmwosa Osaghae
- Department of EpidemiologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Division of Cancer Prevention and Population SciencesThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Rajesh Talluri
- Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Department of Data ScienceUniversity of Mississippi Medical CenterJacksonMississippiUSA
| | | | - Kimberson Tanco
- Department of Palliative, Rehabilitation and Integrative MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Dimpy P. Shah
- Mays Cancer Center, UT Health San Antonio MD Anderson Cancer CenterSan AntonioTexasUSA
| | - Mala Pande
- Department of Gastroenterology, Hepatology and NutritionThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Sanjay Shete
- Department of EpidemiologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Division of Cancer Prevention and Population SciencesThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
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Lertaroonchai C, Jeerakornpassawat D, Tongsong T, Muangmool T. Factors Affecting the Decision on Cannabis Use in Gynecologic Cancer Patients After the Legalization of Cannabis. Integr Cancer Ther 2024; 23:15347354241261363. [PMID: 38874388 PMCID: PMC11179454 DOI: 10.1177/15347354241261363] [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: 02/01/2024] [Revised: 04/27/2024] [Accepted: 05/28/2024] [Indexed: 06/15/2024] Open
Abstract
OBJECTIVE To characterize the patterns of cannabis use among gynecologic cancer patients, in terms of potential factors influencing their decision-making on cannabis use, the reasons for use or non-use, and sources of information on cannabis use. METHODS From March to July 2022, gynecologic cancer patients at a clinic were interviewed and classified into 3 groups: current users, ex-users, and never-users. The received data included: demographic data, cannabis use details, reasons for using and not using, adverse events, satisfaction, and intent to use. Univariate and multivariate analysis were used to identify risk factors influencing decision-making. RESULT Among 240 participants, 11.67% were classified as current users, 28.33% as ex-users, and 60% as never-users. The significant factors influencing cannabis use decisions were advanced stage and receiving information on cannabis, regardless of the information source. The satisfaction derived from cannabis was due to the enhancement of mood and physical activity, improvement in sleep quality, stimulation of appetite, and mitigation of adverse events associated with cancer treatment. Approximately 60% of users aimed for a cancer cure. The main reasons for quitting were inability to obtain cannabis and absence of persistent cancer symptoms. CONCLUSION Among Thai patients with gynecologic cancer, 40% had a history of cannabis use. Advanced cancer stage was an independent factor for decision-making on cannabis use. Sources of information on cannabis are non-healthcare providers. Many patients intended to use cannabis for cancer cure. Also, many were satisfied with use because of a relief of unwanted symptoms, indirectly suggesting improvement in quality of life. The main reason for quitting was unavailability. The main reason for never trying was a concern of interference with treatment. Our results may guide the direction of strategy of cannabis use among patients with gynecologic cancers.
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Osaghae I, Chido-Amajuoyi OG, Talluri R, Shete S. Prevalence, reasons for use, perceived benefits, and awareness of health risks of cannabis use among cancer survivors - implications for policy and interventions. J Cancer Surviv 2023:10.1007/s11764-023-01526-7. [PMID: 38158514 DOI: 10.1007/s11764-023-01526-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND There is increasing discourse on the use of cannabis as a palliative for cancer/cancer-treatment-related symptoms. We described the prevalent reasons for use, perceived benefits, and awareness of health risks from cannabis use for cancer management among cancer survivors. METHODS Cross-sectional survey of adult (≥ 18 years) cancer survivors from 41 US states receiving treatment at a comprehensive cancer center. RESULTS Of 1,886 cancer survivors included, 17.4% were current users, 30.5% were former users, and 52.2% were never users of cannabis. Among survivors who currently or formerly used cannabis after their cancer diagnosis (n = 510), the reasons for cannabis use in cancer management were; sleep disturbance (60%), pain (51%), stress (44%), nausea (34%), and mood disorder/depression (32%). Also, about a fifth (91/510) of survivors used cannabis to treat their cancer. Across the different symptoms assessed, over half of the survivors who reported a reason for using cannabis currently or after their cancer diagnosis perceived that cannabis was helpful to a great extent in improving their symptoms. However, of the 167 survivors who reported awareness of potential health risks from cannabis use, the awareness of adverse health risks associated with cannabis use was low: suicidal thoughts (5%), intense nausea and vomiting (6%), depression (11%), anxiety (14%), breathing problems (31%), and interaction with cancer drugs (35%). CONCLUSION Prevalence of cannabis use among survivors was notable, with most reporting a great degree of symptomatic improvement for the specified reason for use. However, only a few were aware of the health risks of cannabis use during cancer management. IMPLICATIONS FOR CANCER SURVIVORS With more cancer survivors using cannabis as a palliative in managing their cancer-related symptoms, future guidelines and policies on cannabis use in cancer management should incorporate cannabis-based interventions to minimize the inadvertent harm from cannabis use during cancer treatment among survivors.
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Affiliation(s)
- Ikponmwosa Osaghae
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Rajesh Talluri
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Sanjay Shete
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, 1400 Pressler Dr., FCT4.6002, Houston, TX, 77030, USA.
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Brasky TM, Newton AM, Conroy S, Adib A, Adley NC, Strassels SA, Hays JL, Cooper ZD, Wagener TL, Stevens E, Plascak JJ, Krok-Schoen JL. Marijuana and Cannabidiol Use Prevalence and Symptom Management Among Patients with Cancer. CANCER RESEARCH COMMUNICATIONS 2023; 3:1917-1926. [PMID: 37772996 PMCID: PMC10515742 DOI: 10.1158/2767-9764.crc-23-0233] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/07/2023] [Accepted: 08/30/2023] [Indexed: 09/30/2023]
Abstract
Symptoms such as pain, nausea, and anxiety are common in individuals with cancer. Treatment of these issues is often challenging. Cannabis products may be helpful in reducing the severity of these symptoms. While some studies include data on the prevalence of cannabis use among patients with cancer, detailed data remain limited, and none have reported the prevalence of cannabidiol (CBD) use in this population. Adult patients with cancer attending eight clinics at a large, NCI-designated Comprehensive Cancer Center completed a detailed, cannabis-focused questionnaire between 2021 and 2022. Eligible participants were diagnosed with invasive cancer and treated in the past 12 months. Summary statistics were calculated to describe the sample regarding cannabis use. Approximately 15% (n = 142) of consented patients (n = 934) reported current cannabis use (defined as use within the past 12 months). Among which, 75% reported cannabis use in the past week. Among current cannabis users, 39% (n = 56; 6% overall) used CBD products. Current users reported using cannabis a median of 4.5 (interquartile range: 0.6–7.0) days/week, 2.0 (1.0–3.0) times per use/day, and for 3 years (0.8–30.0). Use patterns varied by route of administration. Patients reported moderate to high relief of symptoms with cannabis use. This study is the most detailed to date in terms of cannabis measurement and provides information about the current state of cannabis use in active cancer. Future studies should include complete assessments of cannabis product use, multiple recruitment sites, and diverse patient populations. SIGNIFICANCE Clinicians should be aware that patients are using cannabis products and perceive symptom relief with its use.
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Affiliation(s)
- Theodore M. Brasky
- Division of Medical Oncology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Alison M. Newton
- Division of Medical Oncology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Sara Conroy
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Anita Adib
- Division of Cancer Prevention and Control, The Ohio State University College of Medicine, Columbus, Ohio
| | - Neema C. Adley
- Department of Neuroscience, The Ohio State University College of Arts and Sciences, Columbus, Ohio
| | | | - John L. Hays
- Division of Medical Oncology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Ziva D. Cooper
- UCLA Center for Cannabis and Cannabinoids, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, California
| | - Theodore L. Wagener
- Division of Medical Oncology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Erin Stevens
- Department of Internal Medicine, The Ohio State University College of Medicine; Columbus, Ohio
| | - Jesse J. Plascak
- Division of Cancer Prevention and Control, The Ohio State University College of Medicine, Columbus, Ohio
| | - Jessica L. Krok-Schoen
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, Ohio
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Michel A, Lee RT, Salehi E, Accordino MK. Improving Quality of Life During Chemotherapy: Cannabinoids, Cryotherapy, and Scalp Cooling. Am Soc Clin Oncol Educ Book 2023; 43:e390428. [PMID: 37267515 DOI: 10.1200/edbk_390428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
There have been significant advances in the treatment of cancer in the past decade. However, patients continue to suffer from significant side effects of antineoplastic agents that greatly affect their quality of life (QOL), including chemotherapy-induced nausea and vomiting (CINV), chemotherapy-induced peripheral neuropathy (CIPN), and chemotherapy-induced alopecia (CIA). This review aims to provide an updated overview of emerging strategies for the management and prevention of these immediate and long-lasting side effects. The use of integrative medicine including cannabis continues to evolve in the realm of CINV and cancer-related anorexia. Although no pharmaceutical agent has been approved for the prevention of CIPN, cryotherapy, compression therapy and, more recently, cryocompression therapy have shown benefit in small trials, but there are concerns with tolerability especially related to cryotherapy. More data are necessary to determine an effective and tolerable option to prevent CIPN in large, randomized studies. Scalp cooling (SC), which has a similar mechanism to cryotherapy and compression therapy for CIPN prevention, has proven to be an effective and tolerable approach in randomized studies and has significantly limited CIA, an entity that definitively affects the QOL of patients living with cancer. Taken together, cannabis, cryotherapy, compression and cryocompression therapy, and SC all strive to improve the QOL of patients living with cancer by minimizing the side effects of chemotherapeutic agents.
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Affiliation(s)
- Alissa Michel
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | | | | | - Melissa K Accordino
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
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Brasky TM, Krok-Schoen JL, Conroy S, Newton AM, Strassels SA, Hays JL, Wagener TL. The siren's song of anonymous web-based sampling. Cancer 2022; 128:1871-1872. [PMID: 35194797 DOI: 10.1002/cncr.34097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/09/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Theodore M Brasky
- James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
- Division of Medical Oncology, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Jessica L Krok-Schoen
- James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
- Division of Health Sciences, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Sara Conroy
- Department of Bioinformatics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Alison M Newton
- James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
- Division of Medical Oncology, College of Medicine, The Ohio State University, Columbus, Ohio
| | | | - John L Hays
- James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
- Division of Medical Oncology, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Theodore L Wagener
- James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
- Division of Medical Oncology, College of Medicine, The Ohio State University, Columbus, Ohio
- Center for Tobacco Research, The Ohio State University, Columbus, Ohio
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Vinette B, Côté J, El-Akhras A, Mrad H, Chicoine G, Bilodeau K. Routes of administration, reasons for use, and approved indications of medical cannabis in oncology: a scoping review. BMC Cancer 2022; 22:319. [PMID: 35331185 PMCID: PMC8953058 DOI: 10.1186/s12885-022-09378-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/07/2022] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Some patients diagnosed with cancer use medical cannabis to self-manage undesirable symptoms, including nausea and pain. To improve patient safety and oncological care quality, the routes of administration for use of medical cannabis, patients' reasons, and prescribed indications must be better understood. METHODS Based on the Joanna Briggs Institute guidelines, a scoping review was conducted to map the current evidence regarding the use of medical cannabis in oncological settings based on the experiences of patients diagnosed with cancer and their healthcare providers. A search strategy was developed with a scientific librarian which included five databases (CINAHL, Web of Science, Medline, Embase, and PsycINFO) and two grey literature sources (Google Scholar and ProQuest). The inclusion criteria were: 1) population: adults aged 18 and over diagnosed with cancer; 2) phenomena of interest: reasons for cannabis use and/or the prescribed indications for medical cannabis; 3) context: oncological setting. French- or English-language primary empirical studies, knowledge syntheses, and grey literature published between 2000 and 2021 were included. Data were extracted by two independent reviewers and subjected to a thematic analysis. A narrative description approach was used to synthesize and present the findings. RESULTS We identified 5,283 publications, of which 163 met the eligibility criteria. Two main reasons for medical cannabis use emerged from the thematic analysis: limiting the impacts of cancer and its side effects; and staying connected to others. Our results also indicated that medical cannabis is mostly used for three approved indications: to manage refractory nausea and vomiting, to complement pain management, and to improve appetite and food intake. We highlighted 11 routes of administration for medical cannabis, with oils and oral solutions the most frequently reported. CONCLUSION Future studies should consider the multiple routes of administration for medical cannabis, such as inhalation and edibles. Our review highlights that learning opportunities would support the development of healthcare providers' knowledge and skills in assessing the needs and preferences of patients diagnosed with cancer who use medical cannabis.
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Affiliation(s)
- Billy Vinette
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada.
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada.
- Quebec Network On Nursing Intervention Research, Montreal, QC, Canada.
- Center for Innovation in Nursing Education, Montreal, QC, Canada.
| | - José Côté
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada
- Quebec Network On Nursing Intervention Research, Montreal, QC, Canada
- Research center of the Montreal University Hospital Center, Montreal, QC, Canada
| | - Ali El-Akhras
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
| | - Hazar Mrad
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
| | - Gabrielle Chicoine
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
- Research Chair in Innovative Nursing Practices, Montreal, QC, Canada
- Quebec Network On Nursing Intervention Research, Montreal, QC, Canada
- Center for Innovation in Nursing Education, Montreal, QC, Canada
- Research center of the Montreal University Hospital Center, Montreal, QC, Canada
| | - Karine Bilodeau
- Faculty of Nursing, University of Montreal, Montreal, QC, Canada
- Quebec Network On Nursing Intervention Research, Montreal, QC, Canada
- Center for Innovation in Nursing Education, Montreal, QC, Canada
- Research center of the Montreal University Hospital Center, Montreal, QC, Canada
- Research Center of the Centre Intégré Universitaire de Santé Et de Services Sociaux de L'Est-de-L'Île-de-Montréal, Montreal, QC, Canada
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Schoeman R, de la Harpe A, Beukes N, Frost CL. Cannabis with breast cancer treatment: propitious or pernicious? 3 Biotech 2022; 12:54. [PMID: 35127309 PMCID: PMC8807790 DOI: 10.1007/s13205-021-03102-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/25/2021] [Indexed: 02/03/2023] Open
Abstract
Cannabis has been used for various medicinal applications including, but not limited to, cancer: most commonly to treat chemotherapy-associated side effects. Cannabis is often used for its palliative effects in the form of purified cannabinoids, or as extracts. This study was conducted using two breast cancer cell lines and aimed to evaluate potential anti-proliferative "intra-entourage effects" between purified phytocannabinoids resembling the THC and CBD ratios of medicinal and recreational cannabis strains, as well as to investigate potential "inter-entourage effects" between the different ratios and the phytochemicals found in a Cannabis sativa extract. This study also aimed to evaluate the potential interaction between cannabinoids and chemotherapeutic agents. The data identified an intra-entourage effect present in the MCF-7 cells when treated with a recreational, but not a medicinal, cannabis formulation. This effect may be due to THC partially exerting its anti-proliferative effects through the estrogen receptor (ER), present in the MCF-7 cell line. Little to no intra-entourage effects were observed in the MDA-MB-231 cell line and no inter-entourage effects were observed in either cell line. The simultaneous treatment of the MCF-7 cell line with various cannabinoid formulations and the common breast cancer treatment, tamoxifen, resulted in the diminished anti-proliferative activity of tamoxifen, an effect that was more evident when combined with recreational cannabis formulations. Since cannabis is commonly used in palliative care to treat chemotherapy-associated side effects, further research is required to investigate the potential interference of various cannabis formulations to ensure that the efficacy of chemotherapeutic agents is not compromised. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s13205-021-03102-1.
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Affiliation(s)
- Recardia Schoeman
- grid.412139.c0000 0001 2191 3608Department of Biochemistry and Microbiology, Nelson Mandela University, Port Elizabeth, 6031 South Africa ,grid.412219.d0000 0001 2284 638XPresent Address: Department of Pharmacology, Faculty of Health Science, University of the Free State, Bloemfontein, 9301 South Africa
| | - Amy de la Harpe
- grid.412139.c0000 0001 2191 3608Department of Biochemistry and Microbiology, Nelson Mandela University, Port Elizabeth, 6031 South Africa
| | - Natasha Beukes
- grid.412139.c0000 0001 2191 3608Department of Biochemistry and Microbiology, Nelson Mandela University, Port Elizabeth, 6031 South Africa
| | - Carminita L. Frost
- grid.412139.c0000 0001 2191 3608Department of Biochemistry and Microbiology, Nelson Mandela University, Port Elizabeth, 6031 South Africa
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Weiss MC, Hibbs JE, Buckley ME, Danese SR, Leitenberger A, Bollmann-Jenkins M, Meske SW, Aliano-Ruiz KE, McHugh TW, Larson SL, Le EH, Green NL, Gilman PB, Kaklamani VG, Chlebowski RT, Martinez DM. A Coala-T-Cannabis Survey Study of breast cancer patients' use of cannabis before, during, and after treatment. Cancer 2022; 128:160-168. [PMID: 34636036 PMCID: PMC9413357 DOI: 10.1002/cncr.33906] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/16/2021] [Accepted: 08/12/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND The goal of this study was to characterize cannabis use among patients with breast cancer, including their reasons for and timing of use, their sources of cannabis information and products, their satisfaction with the information found, their perceptions of its safety, and their dialogue about cannabis with their physicians. METHODS United States-based members of the Breastcancer.org and Healthline.com communities with a self-reported diagnosis of breast cancer within 5 years (age ≥ 18 years) were invited to participate in an anonymous online survey. After informed consent was obtained, nonidentifiable data were collected and analyzed. RESULTS Of all participants (n = 612), 42% (n = 257) reported using cannabis for relief of symptoms, which included pain (78%), insomnia (70%), anxiety (57%), stress (51%), and nausea/vomiting (46%). Furthermore, 49% of cannabis users believed that medical cannabis could be used to treat cancer itself. Of those taking cannabis, 79% had used it during treatment, which included systemic therapies, radiation, and surgery. At the same time, few (39%) had discussed it with any of their physicians. CONCLUSIONS A significant percentage of survey participants (42%) used cannabis to address symptoms; approximately half of these participants believed that cannabis could treat cancer itself. Most participants used cannabis during active cancer treatment despite the potential for an adverse event during this vulnerable time. Furthermore, most participants believed that cannabis was safe and were unaware that product quality varied widely and depended on the source. This study reviews the research on medicinal cannabis in the setting of these findings to help physicians to recognize its risks and benefits for patients with cancer. LAY SUMMARY Almost half of patients with breast cancer use cannabis, most commonly during active treatment to manage common symptoms and side effects: pain, anxiety, insomnia, and nausea. However, most patients do not discuss cannabis use with their physicians. Instead, the internet and family/friends are the most common sources of cannabis information. Furthermore, most participants believe that cannabis products are safe and are unaware that the safety of many products is untested.
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Affiliation(s)
- Marisa C. Weiss
- Breastcancer.org, Ardmore, Pennsylvania,Socanna, Narberth, Pennsylvania,Radiation Oncology, Lankenau Medical Center, Wynnewood, Pennsylvania,Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
| | | | - Meghan E. Buckley
- Center for Population Health Research, Main Line Health, Wynnewood, Pennsylvania
| | | | | | | | - Sam W. Meske
- Lankenau Institute for Medical Research, Wynnewood, Pennsylvania,Center for Population Health Research, Main Line Health, Wynnewood, Pennsylvania
| | | | | | - Sharon L. Larson
- Center for Population Health Research, Main Line Health, Wynnewood, Pennsylvania
| | | | | | - Paul B. Gilman
- Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
| | - Virginia G. Kaklamani
- Medical Oncology, Internal Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Rowan T. Chlebowski
- Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, Torrance, California
| | - Diana M. Martinez
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
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12
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Shapiro YN, Peppercorn JM, Yee AJ, Branagan AR, Raje NS, Donnell EKO. Lifestyle considerations in multiple myeloma. Blood Cancer J 2021; 11:172. [PMID: 34702799 PMCID: PMC8548591 DOI: 10.1038/s41408-021-00560-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/08/2021] [Accepted: 10/01/2021] [Indexed: 12/12/2022] Open
Abstract
As the prognosis for multiple myeloma (MM) has significantly improved and patients remain on therapy longer, there is a need for supportive care interventions to optimize patient quality of life (QOL) and functional status over the course of cancer treatment. MM is characterized by a significant symptom burden and a relatively lower QOL compared to other cancers. This review evaluates the role of healthy lifestyle behaviors in improving both the physical functioning and psychological well-being of the MM population. We (1) describe the current literature on physical activity, weight management, diet, sleep, and substance use in the context of MM, (2) present important considerations for incorporating lifestyle factors into clinical practice, and (3) identify directions for future research. Developing MM-specific guidelines for modifiable lifestyle changes that take into account both the length of treatment and the unique disease features (i.e. osteolytic lesions and anemia) may provide a promising path for improved patient QOL and functioning.
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Affiliation(s)
| | - Jeffrey M Peppercorn
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Andrew J Yee
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Andrew R Branagan
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Noopur S Raje
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Elizabeth K O' Donnell
- Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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13
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Westmaas JL, Strollo SE, Newton CC, Carter BD, Diver WR, Flanders WD, Stevens VL, Patel AV, Alcaraz KI, Thrul J, Jacobs EJ. Association between Smoking Cannabis and Quitting Cigarettes in a Large American Cancer Society Cohort. Cancer Epidemiol Biomarkers Prev 2021; 30:1956-1964. [PMID: 34348959 PMCID: PMC9398124 DOI: 10.1158/1055-9965.epi-20-1810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/19/2021] [Accepted: 07/30/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Cannabis use is increasing, including among smokers, an at-risk population for cancer. Research is equivocal on whether using cannabis inhibits quitting cigarettes. The current longitudinal study investigated associations between smoking cannabis and subsequently quitting cigarettes. METHODS Participants were 4,535 adult cigarette smokers from a cohort enrolled in the American Cancer Society's Cancer Prevention Study-3 in 2009-2013. Cigarette quitting was assessed on a follow-up survey in 2015-2017, an average of 3.1 years later. Rates of quitting cigarettes at follow-up were examined by retrospectively assessed baseline cannabis smoking status (never, former, recent), and by frequency of cannabis smoking among recent cannabis smokers (low: ≤3 days/month; medium: 4-19 days/month; high: ≥20 days/month). Logistic regression models adjusted for sociodemographic factors, smoking- and health-related behaviors, and time between baseline and follow-up. RESULTS Adjusted cigarette quitting rates at follow-up did not differ significantly by baseline cannabis smoking status [never 36.2%, 95% confidence interval (CI), 34.5-37.8; former 34.1%, CI, 31.4-37.0; recent 33.6%, CI, 30.1-37.3], nor by frequency of cannabis smoking (low 31.4%, CI, 25.6-37.3; moderate 36.7%, CI, 30.7-42.3; high 34.4%, CI, 28.3-40.2) among recent baseline cannabis smokers. In cross-sectional analyses conducted at follow-up, the proportion of cigarette smokers intending to quit smoking cigarettes in the next 30 days did not differ by cannabis smoking status (P = 0.83). CONCLUSIONS Results do not support the hypothesis that cannabis smoking inhibits quitting cigarette smoking among adults. IMPACT Future longitudinal research should include follow-ups of >1 year, and assess effects of intensity/frequency of cannabis use and motivation to quit on smoking cessation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Johannes Thrul
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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14
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Jugl S, Okpeku A, Costales B, Morris EJ, Alipour-Haris G, Hincapie-Castillo JM, Stetten NE, Sajdeya R, Keshwani S, Joseph V, Zhang Y, Shen Y, Adkins L, Winterstein AG, Goodin A. A Mapping Literature Review of Medical Cannabis Clinical Outcomes and Quality of Evidence in Approved Conditions in the USA from 2016 to 2019. Med Cannabis Cannabinoids 2021; 4:21-42. [PMID: 34676348 PMCID: PMC8525213 DOI: 10.1159/000515069] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 02/03/2021] [Indexed: 12/15/2022] Open
Abstract
In 2017, a National Academies of Sciences, Engineering, and Medicine (NASEM) report comprehensively evaluated the body of evidence regarding cannabis health effects through the year 2016. The objectives of this study are to identify and map the most recently (2016-2019) published literature across approved conditions for medical cannabis and to evaluate the quality of identified recent systematic reviews, published following the NASEM report. Following the literature search from 5 databases and consultation with experts, 11 conditions were identified for evidence compilation and evaluation: amyotrophic lateral sclerosis, autism, cancer, chronic noncancer pain, Crohn's disease, epilepsy, glaucoma, human immunodeficiency virus/AIDS, multiple sclerosis (MS), Parkinson's disease, and posttraumatic stress disorder. A total of 198 studies were included after screening for condition-specific relevance and after imposing the following exclusion criteria: preclinical focus, non-English language, abstracts only, editorials/commentary, case studies/series, and non-U.S. study setting. Data extracted from studies included: study design type, outcome definition, intervention definition, sample size, study setting, and reported effect size. Few completed randomized controlled trials (RCTs) were identified. Studies classified as systematic reviews were graded using the Assessing the Methodological Quality of Systematic Reviews-2 tool to evaluate the quality of evidence. Few high-quality systematic reviews were available for most conditions, with the exceptions of MS (9 of 9 graded moderate/high quality; evidence for 2/9 indicating cannabis improved outcomes; evidence for 7/9 indicating cannabis inconclusive), epilepsy (3 of 4 graded moderate/high quality; 3 indicating cannabis improved outcomes; 1 indicating cannabis inconclusive), and chronic noncancer pain (12 of 13 graded moderate/high quality; evidence for 7/13 indicating cannabis improved outcomes; evidence from 6/7 indicating cannabis inconclusive). Among RCTs, we identified few studies of substantial rigor and quality to contribute to the evidence base. However, there are some conditions for which significant evidence suggests that select dosage forms and routes of administration likely have favorable risk-benefit ratios (i.e., epilepsy and chronic noncancer pain). The body of evidence for medical cannabis requires more rigorous evaluation before consideration as a treatment option for many conditions, and evidence necessary to inform policy and treatment guidelines is currently insufficient for many conditions.
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Affiliation(s)
- Sebastian Jugl
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Aimalohi Okpeku
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Brianna Costales
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Earl J. Morris
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Golnoosh Alipour-Haris
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Juan M. Hincapie-Castillo
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | | | - Ruba Sajdeya
- Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Shailina Keshwani
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Verlin Joseph
- Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Yahan Zhang
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Yun Shen
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Lauren Adkins
- Health Sciences Center Libraries, University of Florida, Gainesville, Florida, USA
| | - Almut G. Winterstein
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Amie Goodin
- Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
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15
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Ananth P, Revette A, Reed-Weston A, Das P, Wolfe J. Parent and patient perceptions of medical marijuana in the childhood cancer context. Pediatr Blood Cancer 2021; 68:e28830. [PMID: 33258215 DOI: 10.1002/pbc.28830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Medical marijuana (MM) is legal in 34 US jurisdictions. Yet, little is known about patient and parent perceptions of MM in pediatric cancer care. We examined attitudes, beliefs, and experiences regarding MM among parents of children with cancer and adolescent and young adult (AYA) patients, to help frame future research initiatives. PROCEDURE In this qualitative study, we conducted semi-structured, one-on-one interviews with parents and AYAs at a comprehensive cancer center. Interviews were audio-recorded, transcribed, and coded using both descriptive and inductive coding approaches. We used content and framework analysis to identify key themes. RESULTS Fifteen parents and 15 AYAs enrolled. Participants were generally receptive to MM use, concurrently weighing benefits and risks. Participants most often endorsed MM use for relief of nausea, anorexia, and pain. Simultaneously, participants identified concerns about MM, including potential physiologic and psychological effects on children and lack of research. However, concerns were frequently minimized, relative to chemotherapy or supportive care medications with perceived greater side effect profiles. Many participants expressed uncertainty regarding legal access, citing complex processes to obtain MM. Few participants had discussed MM with their oncologist, instead seeking guidance from the internet, family, or peers. Importantly, we elicited several misconceptions regarding MM, including its utility as cancer-directed therapy. CONCLUSION Patients and families are receptive to using MM, motivated by potential for symptom relief and cancer-directed effects. Yet, lack of empiric evidence is a barrier, underscoring the need for robust clinical trial data to support MM recommendations and use.
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Affiliation(s)
- Prasanna Ananth
- Section of Pediatric Hematology/Oncology, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Anna Revette
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Anne Reed-Weston
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Porag Das
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute and Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
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16
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Webster EM, Yadav GS, Gysler S, McNamara B, Black J, Tymon-Rosario J, Zeybek B, Han C, Arkfeld CK, Andikyan V, Menderes G, Huang G, Azodi M, Silasi DA, Santin AD, Schwartz PE, Ratner ES, Altwerger G. Prescribed medical cannabis in women with gynecologic malignancies: A single-institution survey-based study. Gynecol Oncol Rep 2020; 34:100667. [PMID: 33204797 PMCID: PMC7653050 DOI: 10.1016/j.gore.2020.100667] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/19/2020] [Accepted: 10/26/2020] [Indexed: 12/13/2022] Open
Abstract
Patients with gynecologic malignancies perceive medical cannabis relieves multiple cancer-related symptoms. Medical cannabis is well-tolerated and perceived to have a favorable side effect profile. Patients using medical cannabis for pain control report an associated reduction in opioid use.
Research within a gynecologic oncology population has lagged behind the uptake in use of medical cannabis for symptom control. This study seeks to evaluate patient experience with prescribed medical cannabis obtained through licensed dispensaries in women with gynecologic malignancies. A 43-item survey exploring patient experience with medical cannabis was administered to women with gynecologic malignancies who used medical cannabis prescribed by a gynecologic oncologist. Thirty-six eligible patients were approached for consent, and 31 patients returned completed surveys (86%). Ninety-three percent had advanced or recurrent disease; 74% were receiving chemotherapy or immunotherapy. Eighty-three percent reported medical cannabis provided relief from cancer or treatment-related symptoms including decreased appetite (41%), insomnia (41%), neuropathy (41%), anxiety (35%), nausea (29%), joint pain (29%), bone pain (29%), abdominal pain (25%), and depression (19%). Eighty percent of patients reported medical cannabis worked the same or better than other traditional medications for management of their cancer or treatment-related symptoms, and 83% reported medical cannabis had an equivalent or better side effect profile. Of the subset of patients using medical cannabis for pain, 63% reported a reduction in opioid use. Patients perceive that medical cannabis was useful for relief of cancer and treatment-related symptoms, suggesting medical cannabis may be a reasonable alternative or adjunct therapy. Medical cannabis was well tolerated and may have the potential to improve neuropathic pain and decrease opioid use.
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Affiliation(s)
- Emily M Webster
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale New Haven Hospital, New Haven, CT 06510, United States.,Yale University, New Haven, CT 06510, United States
| | - Ghanshyam S Yadav
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Stefan Gysler
- Hospital of the University of Pennsylvania / University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Blair McNamara
- UCSF Medical Center/University of California, San Francisco, San Francisco, CA 94143, United States
| | - Jonathan Black
- The Center for Gynecologic Oncology, Miramar, FL 33027, United States
| | - Joan Tymon-Rosario
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale New Haven Hospital, New Haven, CT 06510, United States
| | - Burak Zeybek
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale New Haven Hospital, New Haven, CT 06510, United States
| | - Chanhee Han
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale New Haven Hospital, New Haven, CT 06510, United States
| | - Christopher K Arkfeld
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale New Haven Hospital, New Haven, CT 06510, United States.,Yale University, New Haven, CT 06510, United States
| | - Vaagn Andikyan
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale New Haven Hospital, New Haven, CT 06510, United States
| | - Gulden Menderes
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale New Haven Hospital, New Haven, CT 06510, United States
| | - Gloria Huang
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale New Haven Hospital, New Haven, CT 06510, United States
| | - Masoud Azodi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale New Haven Hospital, New Haven, CT 06510, United States
| | - Dan-Arin Silasi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale New Haven Hospital, New Haven, CT 06510, United States
| | - Alessandro D Santin
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale New Haven Hospital, New Haven, CT 06510, United States
| | - Peter E Schwartz
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale New Haven Hospital, New Haven, CT 06510, United States
| | - Elena S Ratner
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale New Haven Hospital, New Haven, CT 06510, United States
| | - Gary Altwerger
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale New Haven Hospital, New Haven, CT 06510, United States
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17
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Abstract
OBJECTIVE To review pharmacology, available dosage forms, efficacy, and safety of cannabis and cannabinoids in cancer patients. DATA SOURCES In PubMed (1965 to June 2020) the search was conducted using the search terms cannabidiol, cannabis, CBD, dronabinol, endocannabinoids, medical marijuana, nabiximols, nabilone, THC, and cancer. Abstracts from article bibliographies were reviewed. STUDY SELECTION AND DATA EXTRACTION Relevant English-language studies conducted in humans evaluating cannabis and cannabinoids for cancer treatment or related symptoms were considered. Reference lists in relevant articles, package inserts, guidance documents, and addditional articles evaluating cannabis and cannabinoids were identified. DATA SYNTHESIS Cannabis and cannabinoid effectiveness can be attributed to active components delta-9-tetrahydrocannabinol and cannabidiol. Multiple dosage forms exist, each with different properties contributing to efficacy and safety differences. No data supports use as anticancer agents, and mixed efficacy results have been reported when used in cancer patients with nausea, pain, and anorexia. Inclusion of medicinal and synthetic products, small sample sizes, varying patient populations, and different dosage forms, doses, and drug combinations. These products are well tolerated, and adverse effects depend on the main active component. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Healthcare professionals need to identify appropriateness, monitor, and document use of cannabis and cannabinoids similar to other drug therapies as well as educate the patients/ caregivers about potential benefits and risks. CONCLUSIONS Current evidence for use of medical cannabis and cannabinoids in cancer patients is weak. However, healthcare professionals are in an ideal role to monitor and educate patients using medical cannabis and cannabinoids.
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Affiliation(s)
| | - Lisa M Holle
- UConn School of Pharmacy, Storrs, CT, USA.,UConn Health Neag Cancer Center, Farmington, CT, USA
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18
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Macari DM, Gbadamosi B, Jaiyesimi I, Gaikazian S. Medical Cannabis in Cancer Patients: A Survey of a Community Hematology Oncology Population. Am J Clin Oncol 2020; 43:636-639. [PMID: 32889833 DOI: 10.1097/coc.0000000000000718] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Cancer patients are using medical cannabis (MC) to address symptoms; however, little data exist to guide clinicians when counseling patients. We seek to define the patterns of MC use among cancer patients, as well as efficacy and safety of MC. MATERIALS AND METHODS Cancer patients attending oncology office visits at Beaumont Hospital, Michigan from July to December 2018 were anonymously surveyed. The survey included data regarding demographics, diagnosis, treatment, symptom burden, and MC use. Patients who reported MC use since their cancer diagnosis completed a section on patterns of use, efficacy, and safety. RESULTS The response rate was 188 of 327 (57.5%). MC use was reported by 46 of 188 (24.5%). A median composite baseline symptom score ranging from 8 (best) to 32 (worst) was higher in patients using MC versus nonusers; 17.5 versus 14.4 (P<0.001). Pain was the symptom with the highest frequency of improvement 34/42 (81%), followed by appetite 34/44 (77.3%), and anxiety 32/44 (73%). MC improved the ability to tolerate treatment in 24/44 (54.5%). Cloudy thinking is the symptom that worsened the most 7/42 (16.7%), with decreased energy being experienced by 4/41 (9.8%) of the users. CONCLUSIONS MC was utilized by a significant portion of cancer patients in this sample, across age, diagnosis, stage, and treatment. Patients with a higher severity of baseline symptoms were more likely to use MC and report a favorable efficacy profile of MC. Minimal toxicity was reported in this cohort. Prospective studies are needed to define the efficacy and safety of MC.
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Affiliation(s)
- David M Macari
- Department of Hematology Oncology, Beaumont Health, Royal Oak, MI
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19
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Wickham RJ. Nausea and Vomiting Not Related to Cancer Therapy: Intractable Problem or Clinical Challenge? J Adv Pract Oncol 2020; 11:476-488. [PMID: 32974072 PMCID: PMC7508252 DOI: 10.6004/jadpro.2020.11.5.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Unlike therapy-related nausea and vomiting (chemotherapy or radiotherapy induced), nausea and vomiting (N/V) in patients with advanced cancer is often multicausal and thus presents unique challenges. Few professional guidelines address the palliative management of N/V, and those that do are insufficiently detailed to bolster clinical decision-making. Nonetheless, oncology advanced practitioners (APs) are frequently challenged to manage these high-impact symptoms. This requires collaborating with other oncology care providers and cultivating a knowledge base to educate and mentor professional colleagues to optimize N/V unrelated to treatment. METHODS Literature reviewed included current and classic articles that address the physiologic bases of N/V related to disease and with malignant bowel obstruction, agents used to alleviate nausea or N/V, and nonpharmacologic adjunctive measures. This information was framed within palliative care and symptom management clinical experience. RESULTS This review article summarizes what is known about the neuropharmacology of N/V in advanced disease. Focused assessment, pharmacologic agents (antiemetics, central neuromodulators, and peripheral prokinetic agents), and nondrug adjunctive measures that may be useful for N/V are included. CONCLUSIONS Managing N/V in advanced cancer is a quality-of-life imperative that requires persistence and interprofessional collaboration among oncology APs and other clinicians to personalize management. This work can change the perception that N/V related to progressive disease is frequently intractable to one that considers it as a manageable clinical challenge.
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20
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Karim S, Cheung WY, Bu J, Jess E, Kerba M. Medical Cannabis Authorization in Patients With Cancer in the Prelegalization Era: A Population-Based Study. J Pain Symptom Manage 2020; 59:1223-1231. [PMID: 31887404 DOI: 10.1016/j.jpainsymman.2019.12.367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 11/16/2022]
Abstract
CONTEXT Studies show that patients with cancer use cannabis to manage symptoms and side effects. Medical cannabis is regulated by Health Canada; authorization patterns among cancer patients have not been well described. OBJECTIVES The aim of the study is to describe medical cannabis authorization in Alberta, Canada. METHODS The Alberta Cancer Registry was used to identify all patients aged 18 years and older diagnosed with invasive cancer from April 1, 2014 to December 31, 2016. These cases were linked to records from the College of Physicians and Surgeons of Alberta. Univariate and multivariate logistic regression models were constructed to determine factors associated with medical cannabis authorization. RESULTS We identified 41,889 patients with cancer between April 1, 2014 and December 31, 2016. Of these patients, 1070 (2.6%) had a medical cannabis authorization. Fifty-one percent (541 of 1070) were authorized to use medical cannabis within one year of diagnosis, 52% (248 of 549) within one year of the start of systemic therapy, and 41% (128 of 312) within one year of the start of radiation therapy. Patients aged 18-29 (odds ratio [OR] 12.4; 95% CI 7.8-19.8), patients living in the Calgary zone (OR 1.8; 95% CI 1.6-2.1), those with advanced disease (Stage III/IV: OR 1.2; 95% CI 1.0-1.4), and those receiving systemic therapy (OR 2.0; 95% CI 1.7-2.4) were more likely to have an authorization for medical cannabis (P < 0.001). CONCLUSION A small proportion of patients with cancer were authorized to use medical cannabis between 2014 and 2016 in Alberta. Authorization was associated with a cancer diagnosis and receiving treatment. Younger patients, those with advanced stage disease, and those undergoing systemic treatment were predictors of medical cannabis authorization.
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Affiliation(s)
- Safiya Karim
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada.
| | - Winson Y Cheung
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Jingyu Bu
- Surveillance & Reporting, Cancer Research and Analytics, CancerControl Alberta, Alberta Health Services, Alberta, Canada
| | - Ed Jess
- College of Physicians and Surgeons of Alberta, Edmonton, Alberta, Canada
| | - Marc Kerba
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
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21
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Tanco K, Farinholt P, Bruera E. Response to Casarett et al. (doi: 10.1089/jpm.2018.0658): Benefit of Tetrahydrocannabinol versus Cannabidiol for Common Palliative Care Symptoms. J Palliat Med 2019; 22:1301. [PMID: 31661397 DOI: 10.1089/jpm.2019.0459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kimberson Tanco
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Paige Farinholt
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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22
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Tanco K, Dumlao D, Kreis R, Nguyen K, Dibaj S, Liu D, Marupakula V, Shaikh A, Baile W, Bruera E. Attitudes and Beliefs About Medical Usefulness and Legalization of Marijuana among Cancer Patients in a Legalized and a Nonlegalized State. J Palliat Med 2019; 22:1213-1220. [PMID: 31386595 DOI: 10.1089/jpm.2019.0218] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: There is a growing preference for the use of marijuana for medical purposes, despite limited evidence regarding its benefits and potential safety risks. Legalization status may play a role in the attitudes and preferences toward medical marijuana (MM). Objectives: The attitudes and beliefs of cancer patients in a legalized (Arizona) versus nonlegalized state (Texas) regarding medical and recreational legalization and medical usefulness of marijuana were compared. Settings/Subjects: Two hundred adult cancer patients were enrolled from outpatient Palliative Care centers at Banner MD Anderson Cancer Center in Gilbert, AZ (n = 100) and The University of Texas MD Anderson Cancer Center in Houston, TX (n = 100). Design and Measurements: Adult cancer patients seen by the Palliative Care teams in the outpatient centers were evaluated. Various physical and psychosocial assessments were conducted, including a survey of attitudes and beliefs toward marijuana. Results: The majority of individuals support legalization of marijuana for medical use (Arizona 92% [85-97%] vs. Texas 90% [82-95%]; p = 0.81) and belief in its medical usefulness (Arizona 97% [92-99%] vs. Texas 93% [86-97%]; p = 0.33) in both states. Overall, 181 (91%) patients supported legalization for medical purposes whereas 80 (40%) supported it for recreational purposes (p < 0.0001). Patients preferred marijuana over current standard treatments for anxiety (60% [51-68%]; p = 0.003). Patients found to favor legalizing MM were younger (p = 0.027), had worse fatigue (p = 0.015), appetite (p = 0.004), anxiety (p = 0.017), and were Cut Down, Annoyed, Guilty, and Eye Opener-Adapted to Include Drugs (CAGE-AID) positive for alcohol/drugs (p < 0.0001). Conclusion: Cancer patients from both legalized and nonlegalized states supported legalization of marijuana for medical purposes and believed in its medical use. The support for legalization for medical use was significantly higher than for recreational use in both states.
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Affiliation(s)
- Kimberson Tanco
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Donato Dumlao
- Subspecialty Palliative Care in Medical Oncology, Banner MD Anderson Cancer Center, Gilbert, Arizona
| | - Rebecca Kreis
- Subspecialty Palliative Care in Medical Oncology, Banner MD Anderson Cancer Center, Gilbert, Arizona
| | - Kristy Nguyen
- Department of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Seyedeh Dibaj
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Diane Liu
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Ayesha Shaikh
- Subspecialty Palliative Care in Medical Oncology, Banner MD Anderson Cancer Center, Gilbert, Arizona
| | - Walter Baile
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
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23
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Kleckner AS, Kleckner IR, Kamen CS, Tejani MA, Janelsins MC, Morrow GR, Peppone LJ. Opportunities for cannabis in supportive care in cancer. Ther Adv Med Oncol 2019; 11:1758835919866362. [PMID: 31413731 PMCID: PMC6676264 DOI: 10.1177/1758835919866362] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/03/2019] [Indexed: 12/17/2022] Open
Abstract
Cannabis has the potential to modulate some of the most common and debilitating symptoms of cancer and its treatments, including nausea and vomiting, loss of appetite, and pain. However, the dearth of scientific evidence for the effectiveness of cannabis in treating these symptoms in patients with cancer poses a challenge to clinicians in discussing this option with their patients. A review was performed using keywords related to cannabis and important symptoms of cancer and its treatments. Literature was qualitatively reviewed from preclinical models to clinical trials in the fields of cancer, human immunodeficiency virus (HIV), multiple sclerosis, inflammatory bowel disease, post-traumatic stress disorder (PTSD), and others, to prudently inform the use of cannabis in supportive and palliative care in cancer. There is a reasonable amount of evidence to consider cannabis for nausea and vomiting, loss of appetite, and pain as a supplement to first-line treatments. There is promising evidence to treat chemotherapy-induced peripheral neuropathy, gastrointestinal distress, and sleep disorders, but the literature is thus far too limited to recommend cannabis for these symptoms. Scant, yet more controversial, evidence exists in regard to cannabis for cancer- and treatment-related cognitive impairment, anxiety, depression, and fatigue. Adverse effects of cannabis are documented but tend to be mild. Cannabis has multifaceted potential bioactive benefits that appear to outweigh its risks in many situations. Further research is required to elucidate its mechanisms of action and efficacy and to optimize cannabis preparations and doses for specific populations affected by cancer.
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Affiliation(s)
- Amber S Kleckner
- Cancer Control and Survivorship, University of Rochester Medical Center, CU 420658, 265 Crittenden Blvd., Rochester, NY 14642, USA
| | - Ian R Kleckner
- Cancer Control and Survivorship, University of Rochester Medical Center, Rochester, NY, USA
| | - Charles S Kamen
- Cancer Control and Survivorship, University of Rochester Medical Center, Rochester, NY, USA
| | - Mohamedtaki A Tejani
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Michelle C Janelsins
- Cancer Control and Survivorship, University of Rochester Medical Center, Rochester, NY, USA
| | - Gary R Morrow
- Cancer Control and Survivorship, University of Rochester Medical Center, Rochester, NY, USA
| | - Luke J Peppone
- Cancer Control and Survivorship, University of Rochester Medical Center, Rochester, NY, USA
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