I saw an article a few days ago that caught my attention. It's from The Guardian, written by an oncologist from Australia, and it's called "Patients keep asking if they should take cannabis for their cancer. The answer is still no."
That title -- with it's "No" at the end -- reminded me of a sign that I saw once in a doctor's office. The doctor was a pain specialist, and I was there with a loved one. The sign said, in big letters, "If you are using marijuana for any reason, WE WILL NOT TREAT YOU!"
Those are both very strong statements from doctors, and they show clearly how against cannabis use some doctors are.
I remember asking the second doctor (the one I had taken a loved one to see) why he was against marijuana use. "Are you using it?" he asked me and my loved one. "No," we said, which was true. "Good," he replied. And that was the end of the conversation.
That doesn't seem very helpful from a doctor, especially if they have such strong feelings about it. A sign like his should open a conversation, not shut it down. The whole interaction was, unfortunately, pretty typical of this doctor.
The first doctor, the one who wrote the article linked above, is a little less dramatic about the whole thing, and I think her article is worth reading. She also has strong beliefs, but is also clear about why (there is little evidence that cannabis helps with pain, nausea, sleep, or other cancer-related problems, at least in the research that she lays out). But she also links to the ASCO document that came out about a month ago, called "Cannabis and Cannabinoids in Adults With Cancer: ASCO Guideline."
The ASCO recommendation are pretty much what the author has to say, providing a "nonjudgmental" approach to patients, because patient use of cannabis has "outpaced the research." In other words, up to 40% of cancer patients are using it, whatever the research says.
And the problem is that there is so little research. Blame this on marijuana remaining a Schedule I substance in the United States, meaning it is considered to be among the most dangerous, addictive drugs we know. As a Schedule I substance, there are sever limits on the kinds of research tat can be done on it. It's been a catch-22 for a very long time -- there isn't enough research to show that it might have benefits for people, but there can't be more research because it's considered dangerous.
An FDA panel has suggested that it should be moved to a Schedule III substance, but so far that hasn't happened.
I'm fond of ASCO, as you all probably know, and their guidelines make sense to me.
There is no evidence that cannabis can cure any type of cancer. That might not be the case if and when it goes through more clinical trials, but for now, there's no evidence. I would never suggest cannabis in any form be used Alternative Medicine -- in place of an approved, tested treatment for cancer. I'm not a fan of Alternative Medicines.
But Complementary or Integrative Medicine? That's a different story. There is some evidence that some patients do get some benefit from cannabis use, whether for nausea, pain, sleep, anxiety, or other issues. If they get some benefit, and they obtain the cannabis legally, then what's the problem? Even if the positive effects are psychological rather than physical, there's a benefit there.
I hope oncologists are open to the conversation, and are clear about the ASCO guidelines and what they say -- cannabis is not a cure-all, and it can do some good, but doesn't work for everyone and does have some side effects that need to be considered. You can say that about any substance, and any Integrative practice.
I can't offer any experience with this -- I've never used cannabis for anything related to cancer. But I'd be very interested to hear about some of your experience, especially if it's used under a doctor's care (and it probably should be, just as your doctor should know about anything you take, from blood pressure meds vitamin D). I'd like to know if it's really as popular as research suggests, and if it really does work for people.
Share your stories if you're up for it.
9 comments:
Interestingly there does seem to be a (admittedly small) amount of evidence that cannabis products may be lymphocyte protective, which is obviously counter productive if someone is receiving treatment.
Source: https://ashpublications.org/blood/article/134/Supplement_1/5487/425270/A-Clinical-Trial-of-Cannabis-As-Targeted-Therapy (and yes I realize this is a very small study - just 23 patients)
Why Marijuana Can Be Dangerous
“Cannabis Use Disorder” is inability to stop marijuana use, in spite of vomiting or inability to function normally in school or at work (Clin Trials, 2007;4:245-53). Globally, more than 23.8 million people have cannabis use disorder (Lancet, 2020;396:1204-22). Cannabis use ranks third worldwide among consumed substances of misuse, after alcohol and tobacco (Nat Rev Dis Primers, 2021;7:16) and can affect up to 50 percent of people who use cannabis daily (N Engl J Med, 2014;370:2219-27). Approximately three in 10 people who use marijuana have marijuana use disorder in which they have to take it regularly even though it is causing health and social problems in their lives (JAMA Psychiatry, 2015;72(12):1235–1242). For people who began using marijuana before age 18, the risk of developing marijuana use disorder is quite high (Drug Alcohol Depend, 2011;115(1–2):120–130). Marijuana contains up to 500 chemicals, including tetrahydrocannabinol (THC), a mind-altering compound. Marijuana can be smoked, vaped, or eaten in oils, teas and food.
Source: Dr. Mirkin website
Peter and William, thank you both for the resources. I think they all speak to the same thing -- a lack of long-term, broad research on cannabis and cancer. I hope that changes soon. I don't have any skin in this game -- I'm not hoping for one outcome or another from any future research. But there's so much anecdotal information, with wildly varying personal experiences showing good and bad effects. I'd love to see some solid research that people can hang on to.
Hey Bob, I'm from Germany, and they've just legalized cannabis here. Two years after my diagnosis, I'm still watching & waiting, which I must admit is somewhat stressful. Perhaps cannabis could be helpful in this situation. Personally, I have no experience with cannabis use, but I'm considering trying it in the coming months.
Lympho Bob - yeah I’m in the same boat: am neither pro- nor anti- marijuana. I have enjoyed it recreationally in the past, but not for many years (and not since diagnosis, and given the study I cited I’m unlikely to do so). I suspect like you I am fully invested in high quality scientific evidence, whatever that ends up showing. There is no place for woo in medicine.
Hello my German friend. Yes, watching and waiting is stressful. It got a little easier for me after about 6 months, but there was always part of me that was just waiting -- knowing something was coming down. Talk to your oncologist. Maybe cannabis is an option, but maybe the oncologist has some other options. It's not easy to be where you are, I know. I hope you stay healthy and without need of treatment for a long time.
Bob
Peter, indeed -- no woo. I'm still a believer in integrative medicine, but not alternative. Science has to come first.
Take care.
Bob
I'm struck by the negative tone of these comments. I wonder if the type of cancer one has affects one's view of the value of cannabis in living with cancer? I'm a Stage 4 lung cancer survivor, blessed by a positive response to a targeted therapy; I've not (yet) developed resistance to it. My cancer friends all have lung cancer, too.
One dear friend is emerging from a terrible time with another recurrence, in his bones. The worst of it has been an excruciatingly painful issue with his jaw. It turns out the bone was being eaten away, to the point that he couldn't open his mouth. He lost 25 pounds. Luckily, his oncologist found a new trial and successfully petitioned that he receive the drugs under the FDA's compassionate use policy. The good news: his cancer has responded to the drugs; his jaw began to heal and he could begin to eat solid food again. Not so good: relentless nausea prevented him from eating and regaining the weight he couldn't afford to lose.
Because we live in a state where cannabis is legal, he could go into a shop, have a long conversation about options and effects, and buy some cannabis gummies. He took one. The nausea stopped. For the first time in 6 months, the nausea stopped. Not appreciating the high, he cut the dose in half, then in half again, still retaining the relief from nausea. He has been able to eat, and to gain weight.
Others in my lung cancer circle have used cannabis to deal with pain, anxiety, nausea. Cannabis has enabled them to have some semblance of a life.
Yes, this is all anecdotal. Yes, scientific research is the foundation on which remission (or a longer life) rests. But when oxycodone or fentanyl patches plus NSAIDS and other medicines delivers no relief from pain, or anxiety or nausea makes it almost impossible to live, it's good to know there's something that could help.
Each of us forges our own unique path through the horror that is cancer. I may not always agree with what someone chooses, but I work hard to not judge their actions. I hope none of us gets to the point where we are desperate for relief and there is nothing left for us to try. I may be opposed to cannabis and other drugs, for a myriad of reasons, but if if I have a choice between no cannabis and suffering or using cannabis and having some quality of life, I know what I'm choosing.
Karen, thanks for the comment. I think, ultimately, this is what I mean when I say I favor integrative or complimentary medicine. Science should guide our treatment decisions. But beyond that, there's lots of open space to try things, especially things that will help with side effects like nausea -- cannabis, yoga, meditation, acupuncture, music therapy. All of them can help with nausea or pain or sleeplessness or anxiety -- or maybe they won't. But there's enough anecdotal evidence to suggest that they are worth a try, especially when the downsides are fairly minimal. We do forge our own paths, and I always encourage other patients to take advantage of whatever integrative services are available to them at their cancer centers. But all of this also underscores the problem with cannabis being classified the way it is, because it does limit research. My own state allows recreational and medicinal cannabis, which I am in favor of; it is also in the middle of a lawsuit by someone challenging its legality, based on the federal prohibition. We'll see where it goes. Very interesting question about cancer types and cannabis use, though. I know for our type, there is less and less traditional chemotherapy being used, and more targeted therapy, so nausea is a less common side effect than it was 20 years ago. Maybe that influences things? FL also has an older median age at diagnosis -- it happens most often to patients in their 60s and 70s. So maybe the "War on Drugs" had an impact on attitudes? A fascinating question. Thanks again for the comment -- I hope you're doing well. (And I hope the friend you mention is doing well, too.) Bob
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