First Ever National Survey on Patient-Reported Efficacy and Safety of Cannabis in Patients with Multiple Myeloma

Introduction: Cannabis use among cancer patients is increasing, supported by studies demonstrating its efficacy in alleviating cancer- and treatment-related symptoms such as pain and nausea, while offering a reduced risk of developing physiological dependence compared to opioid options. Despite this, provider implicit bias and lack of knowledge, absence of high-quality data, and regulatory challenges have caused hesitancy among providers in recommending its use. This survey aimed to improve our understanding of patient-reported efficacy and safety of cannabis among patients with multiple myeloma (MM).

Methods: Using the HealthTree Cure Hub platform, a prospectively administered 23-question survey was fielded from May 2023 to July 2024 to those with a diagnosis of a plasma cell dyscrasia and enrolled on the online platform.

Results: 505 participants completed the survey, with 98% having a diagnosis of symptomatic MM. Average age was 63 ± 10.5 years. Most were female (63%), and 88% were White. 197 (30%) patients reported using cannabis prior to their MM diagnosis, with 123 (62%) reporting regular use, defined in the survey as consistent use for least 1 month. While most indicated its use as recreational (n=123, 62%), 74 (38%) reported using it for medicinal purposes to treat an illness or a symptom of an illness.

240 (48%) reported cannabis use during MM treatment, with 115 (48%) describing use on a regular basis. Multiple logistic regression revealed that prior cannabis users were more likely to continue use during MM treatment (β=0.40, p<0.001). Patients reported using both THC- and CBD-containing products (59%) or THC-containing products alone (27%). Concern over high cost (25%) and side effects/drug interactions/dosing (38%) were identified as barriers experienced during cannabis use, while “fear of addiction” (3%) was rare. The most common formulations used were ‘edibles’ or cannabis-infused food products (75%), smoking/vaping (37%), tincture/oil (35%), and topical agents (33%). 181 (75%) obtained cannabis under a prohibitive policy or reported growing their own (n=48, 20%). Indications were pain (71%), sleep (75%), depression (34%), anxiety (32%), stress reduction (22%), appetite (21%), and numbness/tingling (20%). When used for pain, a majority administered it daily (n=54, 27%), 2-3 times/week (n=71, 36%), or 4-6 times/week (n=20, 10%).

More than half (52%) of respondents reported high efficacy of cannabis use for pain. 70 (30%) indicated that taking cannabis enabled them to “avoid taking opioids for pain,” while 42 (18%) reported they were able to reduce the dose of opioids. 39% reported that cannabis use resulted in reduced healthcare utilization, with “completely”/“mostly” effective improvement in physical symptoms (43%), mental health (38%), and quality of life (36%). A high prevalence of side effects was reported including dry mouth (44%), feeling foggy (48%), and dizziness (15%).

Of those who did not use cannabis during MM treatment, 129 (50%) considered its use for symptom control; however, barriers that prevented them from using included: not knowing it was an option/possible treatment (24%), lack of information/education (23%), or concerns over legal or work repercussions (19%). Overall, 280 (56%) reported never having a discussion with their oncologist about using cannabis. Among those who did, discussions were, for the most part, initiated by the patient (87%). Only 14% indicated that the oncologist recommended its use, with pain (68%), sleep (55%), nausea/vomiting (23%), anxiety (20%), or symptoms related to cancer (36%) being the major indications. Most reported that the oncologist was “somewhat” (38%) or “not at all” (25%) able to discuss the risks/benefits. Only 31 (14%) reported that the oncologist made a referral to another doctor (i.e. pain specialist) to discuss cannabis use.

Conclusion: Here we report results of the first national survey addressing patient-reported efficacy and safety of cannabis in MM. Patients have a high level of acceptance towards and benefit from the use of cannabis during MM treatment, in particular a positive impact on sparing or reducing the use of opioids. Involvement of the oncology provider in recommending, educating, and discussing cannabis was minimal, highlighting the need for improved training and education strategies. Based on these data, investigation of the potential medical benefits of cannabis in MM is warranted.