Marijuana Use Tied to Less Pain/Anxiety in Head and Neck Cancer

Pam Harrison

August 10, 2018

UPDATED WITH ADDITIONAL COMMENTS August 17, 2018 // Patients with newly diagnosed head and neck cancer who used marijuana had strikingly less pain and anxiety than their matched counterparts who did not use the drug, a prospective cohort study found.

Marijuana use was also associated with a more robust appetite and a greater sense of well-being than nonuse, the observational research indicates.

"The issue with head and neck cancer that makes it unique is that it really does affect some very basic functions, like speaking, swallowing, facial appearance, and a patient's ability to breathe, so it can interfere with basic functions of communication, eating, and really our sense of self when it changes the way your face looks," Michael Gupta, MD, McMaster University, Hamilton, Ontario, Canada, told Medscape Medical News.

Gupta said that a randomized controlled trial is now needed in this setting. He also believes that, in the meantime, cannabinoids could become part of standard care in treating these patients' anxiety and pain.

The new study was published online August 2 in JAMA Otolaryngology — Head and Neck Cancer.

For the study, researchers identified 74 patients with head and neck cancer who were using marijuana at the time of their diagnosis.

These patients were then matched to 74 other head and neck cancer patients who were not using marijuana at the time of diagnosis. The mean age of both groups was 62.3 years. More than 80% of both groups of patients were male.

Sixty-four percent of the patients who used marijuana had oropharyngeal cancer. Virtually all of these cases were p16 positive.

Similar proportions of patients who did not use marijuana had p16-positive disease, and the groups were well-matched for tumor site, T and N stage, and the treatment modalities they underwent.

Both the Edmonton Symptom Assessment System (ESAS) and the EuroQOL-5D (EQ5D) were used to assess quality of life (QOL). Importantly, most of the baseline QOL assessments were performed prior to the patients' receiving cancer treatment, Gupta said.

Significant Differences

On the basis of EQ5D scores, the researchers detected no significant differences between the two groups in terms of patients' mobility, self-care, or their ability to carry out usual activities.

However, the mean score in the anxiety/depression domain of the EQ5D was significantly lower for the marijuana users than for the patients who did not use marijuana, at 1.34 vs 2.08.

There were also significant differences in EQ5D scores in the pain/discomfort domains for the two groups, at 1.53 for marijuana users vs 1.82 for those who did not use the drug.

Results remained significant for both domains when the data were subjected to an additional robust statistical analysis (Wilcoxon rank sum test), report the study authors.

"All domains of the ESAS showed improved QOL for the marijuana user group," the investigators state.

For example, scores for pain on the ESAS were significantly lower for cannabis users, at a mean of 1.85, than for the for non–cannabis users, at 2.72.

This was also true for anxiety. The mean score in the anxiety domain was significantly lower for cannabis users than for nonusers, at 0.77 vs 5.30.

In addition, the ESAS mean depression score was significantly lower for marijuana users, at 0.72, than for nonusers, at 3.19.

In the domain of general well-being, cannabis users scored significantly higher compared to those who did not use cannabis, at 4.05 vs 2.12.

According to results from the additional statistical model, results for all domains, including pain, depression, anxiety, and general well-being, were significantly better for those who used marijuana compared to those who did not, the investigators write.

"There are lots of benefits to marijuana that seem to fit very nicely in the head and neck population," Gupta noted.

"Marijuana also helps with appetite," he said. "If you have your oropharynx radiated, frankly, you don't feel like eating very much, you lose your taste, so I think we are going to see marijuana as a big part of what we use helping people cope going forward," Gupta suggested.

Lower Socioeconomic Status

Asked by Medscape Medical News to comment on the findings, Mehran Afshar, MB, PhD, consultant uro-oncologist and clinical lead for acute oncology services, St. Georges University Hospital, National Health Service Foundation Trust, London, United Kingdom, said that oncologists know that head and neck cancer is more common in men who have a history of heavy smoking and excessive use of alcohol.

"Both of these two factors are related to lower socioeconomic status and underlying psychosocial disparity," which in themselves may contribute to the psychosocial distress experienced by head and neck cancer patients, he stated in an email.

In addition, a study conducted at of the University of California, Los Angeles, School of Public Health nearly 2 decades ago showed that marijuana use was related to an increased risk of developing head and neck cancer.

That study showed that smoking more than one marijuana joint per day increased the risk for head and neck cancer five times compared to not smoking marijuana — "and it would not be surprising if rates of use of other recreational drugs was higher in this cohort of patients as well," Afshar noted.

He also felt that although in the future there may be a place for marijuana use by patients with cancer, he agreed with the authors that there is need for a randomized controlled clinical trial before physicians can advocate a change in the way they treat patients with this malignancy, if not others.

Afshar pointed out that resources are currently available in most cancer centers for patients who experience psychological distress as a result of their cancer and that early referral to psychiatric services that specialize in the care of cancer patients is always advised.

The authors and Dr Afshar have disclosed no relevant financial relationships.

JAMA Otolaryngol Head Neck Surg. Published online August 2, 2018. Abstract

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