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While doctor-patient interactions are a crucial venue for the communication of accurate information, many patients who use cannabis may find their primary sources of information outside this relationship. A survey of cannabis users [28] found that 76% reported learning about cannabis from internet research, family members, or friends. In the digital age, where 46% of adults use the internet as their first source of health information, the most trusted sources of online health information – doctors, medical universities, and the federal government [29] – still have the potential to influence public opinions. Given the prominence of online information – particularly for those with cancer [30] – it may be especially important for major oncology organizations to have a robust online engagement policy. However, we found that social media posts by these organizations are minimal and generated significantly less engagement than false news stories (Figure  3 ). While many of the high-impact news stories on cannabis in cancer use terms such as “CBD” and “CBD oil,” tweets and Facebook posts by leading cancer organizations used only “marijuana” or “cannabis,” potentially failing to engage and influence patients searching for newer cannabis products online. 

News stories with the most social media engagement

The results of this study have important implications for both physicians’ and cancer organizations’ clinical practice and online health communication. With the increasing use of online health information and the lack of reliable metrics to detect misleading medical news [8], there is a clear opportunity for the oncology community to leverage its online influence to debunk misleading medical news.

Conclusions

The online search volume for cannabis and cancer increased at 10 times the rate of standard therapies (RSV 0.10/month versus 0.01/month, p<0.001), more so in states where medical or recreational cannabis is legal. The use of cannabis as a cancer cure represented the largest category (23.5%) of social media content on alternative cancer treatments. The top false news story claiming cannabis as a cancer cure generated 4.26 million engagements on social media, while the top accurate news story debunking this false news generated 0.036 million engagements. Cancer organizations infrequently addressed cannabis (average 0.7 Tweets; 0.4 Facebook posts), with low influence compared to false news (average 5.6 versus 527 Twitter retweets; 98 versus 452,050 Facebook engagements, p<0.001).

Recent claims that cannabis can treat serious health conditions such as cancer have proliferated online, raising concerns within the Food and Drug Administration (FDA) and the oncology community [1]. These claims represent misleading or ‘false news’ [2], without basis in the medical literature [3]. Although cannabis and its derivatives may help to alleviate disease- and therapy-related symptoms, there is no clinical evidence of its anti-cancer efficacy [4].

There is increasing concern among healthcare communities about the misinformation online about using cannabis to cure cancer. We have characterized this online interest in using cannabis as a cancer treatment and the propagation of this information on social media.

This study has several limitations. Social media and online search activity around cannabis do not represent the actual use of cannabis. Further, not all states had RSV data available due to periods with low search volume, limiting generalizability. Finally, we could not determine what proportion of the audience of social media news stories about cannabis as a cancer cure were actual patients.

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The potential for cytochrome P450 interactions with highly concentrated oil preparations of delta-9-tetrahydrocannabinol and/or cannabidiol is a concern.[8] Few pharmacokinetic interaction studies have been conducted with Cannabis or cannabinoids and conventional cancer therapies. A small study investigated the effect of Cannabis tea in 24 patients who received irinotecan or docetaxel.[9] Administration of the Cannabis tea did not significantly influence exposure to and clearance of either intravenous agent.

Seventy-four patients with newly diagnosed head and neck cancer self-described as current Cannabis users were matched to 74 nonusers in a Canadian study investigating quality of life using the EuroQol-5D and Edmonton Symptom Assessment System instruments.[71] Cannabis 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. Cannabis users were also less tired, had more appetite, and better general well-being.

Another investigation into the antitumor effects of CBD examined the role of intercellular adhesion molecule-1 (ICAM-1).[12] ICAM-1 expression in tumor cells has been reported to be negatively correlated with cancer metastasis. In lung cancer cell lines, CBD upregulated ICAM-1, leading to decreased cancer cell invasiveness.

References

This summary contains the following key information:

Another study examined the effects of a plant extract with controlled cannabinoid content in an oromucosal spray. In a multicenter, double-blind, placebo-controlled study, the THC:CBD nabiximols extract and THC extract alone were compared in the analgesic management of patients with advanced cancer and with moderate-to-severe cancer-related pain. Patients were assigned to one of three treatment groups: THC:CBD extract, THC extract, or placebo. The researchers concluded that the THC:CBD extract was efficacious for pain relief in advanced cancer patients whose pain was not fully relieved by strong opioids.[61] In a randomized, placebo-controlled, graded-dose trial, opioid-treated cancer patients with poorly controlled chronic pain demonstrated significantly better control of pain and sleep disruption with THC:CBD oromucosal spray at lower doses (1–4 and 6–10 sprays/d), compared with placebo. Adverse events were dose related, with only the high-dose group (11–16 sprays/d) comparing unfavorably with the placebo arm. These studies provide promising evidence of an adjuvant analgesic effect of THC:CBD in this opioid-refractory patient population and may provide an opportunity to address this significant clinical challenge.[62] An open-label extension study of 43 patients who had participated in the randomized trial found that some patients continued to obtain relief of their cancer-related pain with long-term use of the THC:CBD oromucosal spray without increasing their dose of the spray or the dose of their other analgesics.[63]

Revised text to state that a small exploratory phase IB study was conducted in the United Kingdom that used nabiximols, a 1:1 ratio of delta-9-tetrahydrocannabinol:cannabidiol in a Cannabis-based medicinal extract oromucosal spray, in conjunction with dose-dense temozolomide in treating patients with recurrent glioblastoma multiforme (cited Twelves et al. as reference 27 and level of evidence 1iA). Also added that of the 27 patients enrolled, 6 were part of an open-label group and 21 were part of a randomized group. Progression-free survival at 6 months was seen in 33% of patients in both arms of the study. However, 83.3% of the patients who received nabiximols were alive at 1 year compared with 44.4% of the patients who received placebo and the investigators cautioned that this early-phase study was not powered for a survival endpoint; overall survival rates at 2 years continued to favor the nabiximols arm compared with the placebo arm.

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.