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Association of Marijuana Use With Psychosocial and Quality of Life Outcomes Among Patients With Head and Neck Cancer

Educational Objective To review If there is a difference in quality of life and psychosocial outcomes between marijuana users and nonusers who have newly diagnosed head and neck cancer.
1 Credit CME
Key Points

Question  Is there a difference in quality of life and psychosocial outcomes between marijuana users and nonusers who have newly diagnosed head and neck cancer?

Findings  In this case-matched cohort study, 74 patients with newly diagnosed head and neck cancer who were marijuana users appeared to have quality of life differences compared with 74 who did not use marijuana, including decreased anxiety, pain, and depression and increased appetite and generalized feelings of well-being on the Edmonton Symptom Assessment System and the EuroQol-5D questionnaires.

Meaning  Recreational marijuana use potentially improves quality of life and psychosocial symptoms among patients with newly diagnosed head and neck cancer.


Importance  Cannabis sativa, the most widely used illicit substance in Canada, has a unique ability to facilitate relaxation and relieve anxiety while reducing pain. However, no study to date has examined quality of life (QOL) and psychosocial issues in relation to the use of this drug among patients with newly diagnosed head and neck cancer (HNC).

Objective  To examine the differences in QOL and psychosocial outcomes between marijuana users and nonusers with newly diagnosed HNC.

Design, Setting, and Participants  This prospective cohort study was conducted at a tertiary care cancer center. Patients were enrolled consecutively and prospectively at the time of HNC diagnosis from January 1, 2011, to January 1, 2015. Seventy-four patients who were current marijuana users were case matched to 74 nonusers in a 1:1 scheme based on age, sex, and tumor subsite. All patient demographic and QOL data were collected prospectively, and data analysis was conducted from November 1 to December 1, 2017.

Main Outcomes and Measure  The QOL outcome was assessed using the EuroQol-5D (EQ5D) and the Edmonton Symptom Assessment System (ESAS) questionnaires.

Results  A total of 148 patients were included in this study: 74 in the marijuana user group (mean [SD] age, 62.3 [10.3] years; male sex, 61 patients [82%]) and 74 in the marijuana nonuser group (mean age, 62.2 years; male sex, 63 patients [85%]). There was no statistically significant difference in age, sex, tumor subsite, clinical TNM staging, treatment modality, or mean Karnofsky score between the 2 groups. On univariate analysis, there was no statistically significant difference in the mobility, self-care, and usual activities domains of the EQ5D. Marijuana users had significantly lower scores in the anxiety/depression (difference, 0.74; 95% CI, 0.557-0.930) and pain/discomfort (difference, 0.29; 95% CI, 0.037-1.541) domains. Wilcoxon rank sum test confirmed the results of the EQ5D with improvements in the pain/discomfort (z score, −2.60) and anxiety/depression (z score, −6.71) domains. Marijuana users had less pain, were less tired, were less depressed, were less anxious, had more appetite, were less drowsy, and had better general well-being according to the ESAS. A Wilcoxon rank sum test confirmed a statistically significant improvement in ESAS scores within the domains of anxiety (z score, −10.04), pain (z score, −2.36), tiredness (z score, −5.02), depression (z score, −5.96), drowsiness (z score, −5.51), appetite (z score, −4.17), and general well-being (z score, −4.43).

Conclusions and Relevance  This prospective case-matched study suggests that there may be significant QOL benefits, including decreased anxiety, pain, and depression and increased appetite and generalized feelings of well-being, associated with marijuana use among patients with newly diagnosed HNC.

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Article Information

Accepted for Publication: March 31, 2018.

Corresponding Author: Michael K. Gupta, MD, MSc, FRCSC, St Joseph’s Healthcare Hamilton, G836, 50 Charlton Ave E, Hamilton, ON L8N4A6, Canada (michaelkgupta@hotmail.com).

Published Online: August 2, 2018. doi:10.1001/jamaoto.2018.0486

Author Contributions: Dr Gupta had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Zhang, Archibald, Gupta.

Acquisition, analysis, or interpretation of data: Zhang, Xie, Jackson, Gupta.

Drafting of the manuscript: Zhang, Xie, Gupta.

Critical revision of the manuscript for important intellectual content: Zhang, Archibald, Jackson, Gupta.

Statistical analysis: Zhang, Gupta.

Obtained funding: Zhang.

Administrative, technical, or material support: Zhang, Jackson, Gupta.

Study supervision: Zhang, Archibald, Gupta.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Meeting Presentation: This study was presented at the AHNS 2018 Annual Meeting; April 18, 2018; National Harbor, Maryland.

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