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Abstract

Background

Patients with cancer report increasing rates of cannabis use, often to manage symptoms and toxicities. The efficacy and safety of cannabis, however, for some use cases remains unclear. To better understand characteristics of patients with cancer who report using cannabis, we examined data from a cannabis use survey of among patients with cancer seen at a National Cancer Institute–Designated Cancer Center.

Methods

In late 2021, patients with cancer (N = 1608) treated between July 2017 and December 2019 provided cannabis use data. Additional data were obtained from medical records data and routine patient-reported outcomes collected for clinical purposes. Univariable analyses and multivariable regression analyses were conducted to identify correlates of cannabis use at different stages in the cancer care trajectory.

Results

Rates of self-reported cannabis use by patients with cancer were 59% before cancer diagnosis and 47% after diagnosis. Longitudinal rates of cannabis use were 29% for no cannabis use, 23% before diagnosis, 12% after diagnosis, and 35% for both before and after diagnosis. Demographic factors associated with cannabis use included age, sex, race, and educational achievement. Tobacco use and binge drinking were associated with higher odds of cannabis use. Cannabis use was also associated with greater self-reported interference with physical functioning due to pain and interference with social functioning due to health problems.

Conclusions

We found high rates of cannabis use among patients with cancer, both before and after their cancer diagnosis. Future studies should further investigate psychosocial factors associated with cannabis use among patients with cancer as well as psychosocial outcomes among patients with cancer using cannabis.

Patients with cancer commonly use cannabis to control cancer-related symptoms and treatment toxicities. Recent studies report rates of cannabis use after cancer diagnosis between 8% and 24% (1-6). Use of cannabis in this population is reported to have increased (2), likely because of state-level legalization of cannabis use for medical and recreational purposes. Commonly reported reasons for cannabis use in patients with cancer include alleviating pain, increasing appetite, improving sleep, and reducing anxiety (7). Mixed empirical evidence suggests that cannabis may be helpful for alleviating these symptoms and toxicities (8), but cannabis use may have limited efficacy and raise clinically important risks (9-11). Little is known about the different patterns of cannabis use before and after cancer diagnosis and factors related to them. Clinicians would benefit from understanding which patients are most likely to use or seek cannabis after diagnosis so that these patients can be counseled on empirically supported benefits and risks associated with cannabis.

To address this gap in the literature, we asked patients seen at a National Cancer Institute–Designated Cancer Center to complete a survey on cannabis use. These data were integrated with clinical and patient-reported outcomes data to identify predictors and correlates of cannabis use among individuals with cancer. We hypothesized that greater pain and worse quality of life (QOL) would be predictive of subsequent cannabis use and that cannabis use would be associated with comorbidities commonly reported as reasons for using cannabis among individuals with cancer.

Methods

Participants and procedure

Eligible patients were those who were diagnosed with cancer, were seen at Moffitt Cancer Center, had consented to an institutional biobanking protocol, had completed cancer treatment between July 2017 and December 2019, were at least 18 years old, were alive as of last follow-up, had indicated a language preference of English or Spanish, and had an email address on file. Between August and November 2021, a Research Electronic Data Capture (12) project developed by the Participant Research, Interventions, & Measurements Core at Moffitt Cancer Center sent eligible patients with cancer an e-mail inviting them to the study and 2 reminder e-mails 1 and 3 weeks later. No participant incentive payment was offered for this study. Those who wished to participate in the study provided informed consent, and then completed the online survey developed to capture details of cannabis use. The Collaborative Data Services Core at Moffitt Cancer Center provisioned medical records data, patient-reported outcomes data, and health behaviors from surveys routinely administered for clinical purposes to consenting patients with cancer. The study protocol was reviewed by the Moffitt Cancer Center’s Institutional Review Board (IRB) of record, Advarra IRB, and determined to be exempt from IRB oversight (Pro00014441).

Measures

Demographic and clinical characteristics

Demographic and clinical data from patients with cancer were collected from administrative datasets. Demographic characteristics included age, sex, race, ethnicity, marital status, education level, and employment. Clinical data included age at time of cancer diagnosis, primary cancer site, clinician-reported history of a sleep disorder, and clinician-reported history of pain.

Behavioral factors

Health behavior data for patients with cancer were collected from surveys routinely administered to all patients at their first visit to Moffitt Cancer Center. Self-reported health behavior data included history of using alcohol and tobacco. Alcohol use data were used to determine whether patients with cancer reported binge drinking, as defined by the National Institute on Alcohol Abuse and Alcoholism (13). Patient-reported binge drinking was defined as reporting drinking more than 4 drinks in 1 day for women or more than 5 drinks in 1 day for men within the past month. Tobacco use data were used to determine whether patients were current smokers (ie, within the past 30 days), former smokers, or never smokers; data were derived from smoking status variables from cancer registry data for combustible tobacco.

Quality of life

QOL at the patient’s first visit (ie, near the time of diagnosis) was measured using items in the Medical Outcomes Study 12-item Short Form Health Survey (14). Self-reported overall health was assessed by a measure asking patients to rate their general health on a scale of “poor” to “excellent.” Patients also rated how much pain interfered with their physical functioning on a scale of “not at all” to “extremely.” Finally, patients reported how much any physical or emotional problems interfered with social activities on a scale of “none of the time” to “all of the time.”

Cannabis use

The study team administered a survey to assess cannabis use, defined as all products that contain ingredients from the cannabis plant, including “any marijuana, cannabis concentrates, edibles, lotions, ointments, tinctures containing cannabis, [cannabidiol] CBD-only products, pharmaceutical or prescription cannabinoids (eg, dronabinol, nabilone, Marinol, Syndros, Cesamet), and other products made with cannabis” and excluding hemp seed oil. This survey asked patients with cancer to self-report whether cannabis was used before their cancer diagnosis (“Prior to your cancer diagnosis, did you ever, even once, use cannabis for any reason?”) and after their cancer diagnosis (“Have you used cannabis at any time since your cancer diagnosis?”). Patients were also asked to self-report whether they used cannabis currently, which was defined as use in the prior 30 days. These questions were asked regardless of replies to previous questions so that patients with cancer had an opportunity to report cannabis use after diagnosis and currently, even if they did not report prediagnosis use of cannabis.

Patients with cancer were allocated to cannabis use groups in 2 ways. First, patients were categorized as those who did vs did not report using cannabis before their cancer diagnosis, after their cancer diagnosis, and currently (ie, at the time of the study survey). These groups were not mutually exclusive. The goal of analyses using these groupings was to examine associations with self-reported cannabis use at distinct periods in the cancer care trajectory.

The second grouping categorized patients into groups based on patterns of cannabis use. Patients were grouped as those who reported never using cannabis, only using cannabis before diagnosis, only using cannabis after diagnosis, and using cannabis before and after diagnosis. These groupings were mutually exclusive. The goal of analyses using these groupings was to examine associations with patients’ self-reported longitudinal pattern of cannabis use.

This survey also asked patients who used cannabis after diagnosis about their forms of cannabis use by the question, “Which one of the following ways do you, or did you, use cannabis most often since your cancer diagnosis?” with mutually exclusive options such as “Smoking such as in a joint, bong, pipe, or blunt” or “Eating it in food such as brownies, cakes, cookies, or candy.”

Reasons for use

Patients who used cannabis after diagnosis were asked about their reasons for use with the question, “What were your reasons for using cannabis after your cancer diagnosis?” with select-all-that-apply options such as “Pain” or “Difficulty sleeping.”

Statistical analyses

Statistical analyses were performed using SAS, version 9.4, statistical software (SAS Institute Inc, Cary, NC) and R (R Foundation for Statistical Computing, Vienna, Austria). Descriptive statistics (ie, means [SD], ranges, frequencies, percentages) were used to characterize patients’ demographic and clinical characteristics. T tests and χ2 tests were used to determine associations between cannabis use and demographic, clinical, behavioral, and QOL characteristics. Variables associated with cannabis use were considered for inclusion in subsequent multivariable analyses to identify factors associated with cannabis use while controlling for other factors. Variables with extremely small groups (<5%) were either dichotomized or excluded from additional analysis to maintain statistical power. Logistic regression analyses were used to identify factors associated with cannabis use at distinct periods in the cancer care trajectory (ie, before diagnosis, after diagnosis, currently). Three multinomial logistic regression analyses were used to compare patients with cancer who reported never using cannabis with those who reported using cannabis only before cancer diagnosis, only after cancer diagnosis, and before and after cancer diagnosis.

Results

Patient characteristics

Overall, 9043 eligible cancer patients were invited to participate in the study. Of these, 1592 completed the survey, and an additional 16 provided usable cannabis use data and were included in this study, yielding a total sample size 1608. Demographic and clinical characteristics of the overall sample are shown in Table 1. The sample was approximately balanced between female (52%) and male (48%) patients. Most patients were White (76%) and non-Hispanic (78%). Most were married (59%) and did not live alone (73%). The average (SD) age at diagnosis was 60 (13) years (range = 18-89 years), and the average (SD) year from survey time to diagnosis was 3 (0.8) years. The most common cancer types were hematologic (15%) and breast (15%).

Table 1.
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Demographic, clinical, behavioral, and quality-of-life characteristics and associations with cannabis use among patients with cancer throughout the cancer care trajectorya

VariableOverall sample (N = 1608)Cannabis use before diagnosis
Cannabis use after diagnosis
Current cannabis use
No (n = 659)Yes (n = 942)PNo (n = 846)Yes (n = 762)PNo (n = 1115)Yes (n = 487)P
Age at cancer diagnosis, mean (SD), y60 (13)62 (13)59 (12)<.00163 (12)57 (13)<.00162 (13)57 (13)<.001
Sex, No. (%)<.01.09.21
 Female843 (52)373 (57)465 (49)426 (50)417 (55)596 (54)243 (50)
 Male765 (48)286 (43)477 (51)420 (50)345 (45)519 (46)244 (50)
Race, No. (%)<.01.55.36
 Asian10 (1)9 (1)1 (0)5 (1)5 (1)9 (1)1 (0)
 Black/African American65 (4)34 (5)31 (3)33 (4)32 (4)45 (4)20 (4)
 White1499 (93)604 (92)888 (94)795 (94)704 (92)1042 (93)452 (93)
 American Indian, Alaska Native, Native Hawaiian, Pacific Islander, more than one race, or prefer not to answer31 (2)11 (2)20 (2)12 (1)19 (2)17 (2)13 (3)
 Missing3 (0)1 (0)2 (0)1 (0)2 (0)2 (0)1 (0)
Race (dichotomized), No. (%).10.40.90
 Non-White106 (7)54 (8)52 (6)50 (6)56 (7)71 (6)34 (7)
 White1499 (93)604 (92)888 (94)795 (94)704 (92)1042 (93)452 (93)
 Missing3 (0)1 (0)2 (0)1 (0)2 (0)2 (0)1 (0)
Ethnicity, No. (%).11.25.38
 Non-Hispanic/non-Latino1504 (94)609 (92)889 (94)796 (94)708 (93)1050 (94)450 (92)
 Hispanic/Latino102 (6)50 (8)51 (5)50 (6)52 (7)64 (6)36 (7)
 Missing2 (0)0 (0)2 (0)0 (0)2 (0)1 (0)1 (0)
Marital status, No. (%).04<.01<.01
 Not married450 (28)171 (26)273 (29)212 (25)238 (31)294 (26)154 (32)
 Married1134 (71)483 (73)650 (69)625 (74)509 (67)809 (73)321 (66)
 Missing24 (1)5 (1)19 (2)9 (1)15 (2)12 (1)12 (2)
Living alone, No. (%).91.10.12
 Live with other people1165 (72)481 (73)679 (72)621 (73)544 (71)817 (73)343 (70)
 Live alone156 (10)63 (10)91 (10)89 (11)67 (9)113 (10)43 (9)
 Missing287 (18)115 (17)172 (18)136 (16)151 (20)185 (17)101 (21)
Education, No. (%).49<.01<.01
 ≤High school403 (25)157 (24)244 (26)194 (23)209 (27)261 (23)139 (29)
 ≥Some college920 (57)388 (59)527 (56)517 (61)403 (53)671 (60)247 (51)
 Missing285 (18)114 (17)171 (18)135 (16)150 (20)183 (16)101 (21)
Employment, No. (%).18.11.11
 Not employed735 (46)318 (48)411 (44)402 (48)333 (44)516 (46)217 (45)
 Employed588 (37)227 (34)360 (38)309 (37)279 (37)416 (37)169 (35)
 Missing285 (18)114 (17)171 (18)135 (16)150 (20)183 (16)101 (21)
Sleep disorder, No. (%).80.22.33
 Past 30 d25 (2)9 (1)16 (2)12 (1)13 (2)17 (2)8 (2)
 Former384 (24)154 (23)228 (24)188 (22)196 (26)255 (23)128 (26)
 Never1199 (75)496 (75)698 (74)646 (76)553 (73)843 (76)351 (72)
Pain, No. (%).56<.01.04
 Past 30 d96 (6)35 (5)61 (6)45 (5)51 (7)62 (6)33 (7)
 Former837 (52)350 (53)483 (51)416 (49)421 (55)562 (50)272 (56)
 Never675 (42)274 (42)398 (42)385 (46)290 (38)491 (44)182 (37)
Binge drinking,b No. (%)225 (14)56 (8)169 (18)<.00195 (11)130 (17)<.001128 (11)96 (20)<.001
Combustible tobacco use, No. (%)<.001<.001<.001
 Past 30 d155 (10)33 (5)120 (13)50 (6)105 (14)78 (7)77 (16)
 Former717 (45)224 (34)492 (52)361 (43)356 (47)477 (43)236 (48)
 Never733 (46)400 (61)329 (35)433 (51)300 (39)557 (50)174 (36)
 Missing3 (0)2 (0)1 (0)2 (0)1 (0)3 (0)0 (0)
Cancer region, No. (%).70.13.22
 Breast242 (15)110 (17)131 (14)124 (15)118 (15)172 (15)69 (14)
 Central nervous system22 (1)10 (2)11 (1)10 (1)12 (2)15 (1)7 (1)
 Connective/soft tissue44 (3)21 (3)23 (2)21 (2)23 (3)28 (3)16 (3)
 Digestive197 (12)72 (11)125 (13)99 (12)98 (13)130 (12)66 (14)
 Female genital87 (5)38 (6)47 (5)50 (6)37 (5)67 (6)20 (4)
 Head and neck82 (5)30 (5)52 (6)48 (6)34 (4)61 (5)21 (4)
 Hematologic236 (15)95 (14)140 (15)116 (14)120 (16)166 (15)70 (14)
 Lymphoma91 (6)31 (5)60 (6)45 (5)46 (6)65 (6)24 (5)
 Male genital134 (8)51 (8)83 (9)78 (9)56 (7)99 (9)35 (7)
 Musculoskeletal13 (1)7 (1)6 (1)5 (1)8 (1)7 (1)6 (1)
 Skin146 (9)62 (9)83 (9)92 (11)54 (7)105 (9)40 (8)
 Thoracic168 (10)71 (11)97 (10)79 (9)89 (12)107 (10)60 (12)
 Thyroid and other endocrine44 (3)20 (3)24 (3)29 (3)15 (2)33 (3)11 (2)
 Urinary system95 (6)37 (6)57 (6)46 (5)49 (6)56 (5)39 (8)
 Other7 (0)4 (1)3 (0)4 (0)3 (0)4 (0)3 (1)
Time since diagnosis, mean (SD), y2.9 (0.8)2.9 (0.8)2.8 (0.8).232.9 (0.8)2.9 (0.8).712.9 (0.8)2.8 (0.8).25
Physical interference due to pain,c mean (SD)2.1 (1.2)2.1 (1.2)2.1 (1.2).861.9 (1.1)2.3 (1.3)<.0012.0 (1.2)2.4 (1.3)<.001
General health,d mean (SD)3.6 (1.0)3.6 (1.0)3.6 (1.0).293.7 (.9)3.5 (1.0)<.0013.6 (1.0)3.4 (1.1)<.01
Social interference due to health,e mean (SD)2.1 (1.4)2.0 (1.4)2.2 (1.5)<.011.9 (1.3)2.4 (1.5)<.0012.0 (1.3)2.5 (1.6)<.001
VariableOverall sample (N = 1608)Cannabis use before diagnosis
Cannabis use after diagnosis
Current cannabis use
No (n = 659)Yes (n = 942)PNo (n = 846)Yes (n = 762)PNo (n = 1115)Yes (n = 487)P
Age at cancer diagnosis, mean (SD), y60 (13)62 (13)59 (12)<.00163 (12)57 (13)<.00162 (13)57 (13)<.001
Sex, No. (%)<.01.09.21
 Female843 (52)373 (57)465 (49)426 (50)417 (55)596 (54)243 (50)
 Male765 (48)286 (43)477 (51)420 (50)345 (45)519 (46)244 (50)
Race, No. (%)<.01.55.36
 Asian10 (1)9 (1)1 (0)5 (1)5 (1)9 (1)1 (0)
 Black/African American65 (4)34 (5)31 (3)33 (4)32 (4)45 (4)20 (4)
 White1499 (93)604 (92)888 (94)795 (94)704 (92)1042 (93)452 (93)
 American Indian, Alaska Native, Native Hawaiian, Pacific Islander, more than one race, or prefer not to answer31 (2)11 (2)20 (2)12 (1)19 (2)17 (2)13 (3)
 Missing3 (0)1 (0)2 (0)1 (0)2 (0)2 (0)1 (0)
Race (dichotomized), No. (%).10.40.90
 Non-White106 (7)54 (8)52 (6)50 (6)56 (7)71 (6)34 (7)
 White1499 (93)604 (92)888 (94)795 (94)704 (92)1042 (93)452 (93)
 Missing3 (0)1 (0)2 (0)1 (0)2 (0)2 (0)1 (0)
Ethnicity, No. (%).11.25.38
 Non-Hispanic/non-Latino1504 (94)609 (92)889 (94)796 (94)708 (93)1050 (94)450 (92)
 Hispanic/Latino102 (6)50 (8)51 (5)50 (6)52 (7)64 (6)36 (7)
 Missing2 (0)0 (0)2 (0)0 (0)2 (0)1 (0)1 (0)
Marital status, No. (%).04<.01<.01
 Not married450 (28)171 (26)273 (29)212 (25)238 (31)294 (26)154 (32)
 Married1134 (71)483 (73)650 (69)625 (74)509 (67)809 (73)321 (66)
 Missing24 (1)5 (1)19 (2)9 (1)15 (2)12 (1)12 (2)
Living alone, No. (%).91.10.12
 Live with other people1165 (72)481 (73)679 (72)621 (73)544 (71)817 (73)343 (70)
 Live alone156 (10)63 (10)91 (10)89 (11)67 (9)113 (10)43 (9)
 Missing287 (18)115 (17)172 (18)136 (16)151 (20)185 (17)101 (21)
Education, No. (%).49<.01<.01
 ≤High school403 (25)157 (24)244 (26)194 (23)209 (27)261 (23)139 (29)
 ≥Some college920 (57)388 (59)527 (56)517 (61)403 (53)671 (60)247 (51)
 Missing285 (18)114 (17)171 (18)135 (16)150 (20)183 (16)101 (21)
Employment, No. (%).18.11.11
 Not employed735 (46)318 (48)411 (44)402 (48)333 (44)516 (46)217 (45)
 Employed588 (37)227 (34)360 (38)309 (37)279 (37)416 (37)169 (35)
 Missing285 (18)114 (17)171 (18)135 (16)150 (20)183 (16)101 (21)
Sleep disorder, No. (%).80.22.33
 Past 30 d25 (2)9 (1)16 (2)12 (1)13 (2)17 (2)8 (2)
 Former384 (24)154 (23)228 (24)188 (22)196 (26)255 (23)128 (26)
 Never1199 (75)496 (75)698 (74)646 (76)553 (73)843 (76)351 (72)
Pain, No. (%).56<.01.04
 Past 30 d96 (6)35 (5)61 (6)45 (5)51 (7)62 (6)33 (7)
 Former837 (52)350 (53)483 (51)416 (49)421 (55)562 (50)272 (56)
 Never675 (42)274 (42)398 (42)385 (46)290 (38)491 (44)182 (37)
Binge drinking,b No. (%)225 (14)56 (8)169 (18)<.00195 (11)130 (17)<.001128 (11)96 (20)<.001
Combustible tobacco use, No. (%)<.001<.001<.001
 Past 30 d155 (10)33 (5)120 (13)50 (6)105 (14)78 (7)77 (16)
 Former717 (45)224 (34)492 (52)361 (43)356 (47)477 (43)236 (48)
 Never733 (46)400 (61)329 (35)433 (51)300 (39)557 (50)174 (36)
 Missing3 (0)2 (0)1 (0)2 (0)1 (0)3 (0)0 (0)
Cancer region, No. (%).70.13.22
 Breast242 (15)110 (17)131 (14)124 (15)118 (15)172 (15)69 (14)
 Central nervous system22 (1)10 (2)11 (1)10 (1)12 (2)15 (1)7 (1)
 Connective/soft tissue44 (3)21 (3)23 (2)21 (2)23 (3)28 (3)16 (3)
 Digestive197 (12)72 (11)125 (13)99 (12)98 (13)130 (12)66 (14)
 Female genital87 (5)38 (6)47 (5)50 (6)37 (5)67 (6)20 (4)
 Head and neck82 (5)30 (5)52 (6)48 (6)34 (4)61 (5)21 (4)
 Hematologic236 (15)95 (14)140 (15)116 (14)120 (16)166 (15)70 (14)
 Lymphoma91 (6)31 (5)60 (6)45 (5)46 (6)65 (6)24 (5)
 Male genital134 (8)51 (8)83 (9)78 (9)56 (7)99 (9)35 (7)
 Musculoskeletal13 (1)7 (1)6 (1)5 (1)8 (1)7 (1)6 (1)
 Skin146 (9)62 (9)83 (9)92 (11)54 (7)105 (9)40 (8)
 Thoracic168 (10)71 (11)97 (10)79 (9)89 (12)107 (10)60 (12)
 Thyroid and other endocrine44 (3)20 (3)24 (3)29 (3)15 (2)33 (3)11 (2)
 Urinary system95 (6)37 (6)57 (6)46 (5)49 (6)56 (5)39 (8)
 Other7 (0)4 (1)3 (0)4 (0)3 (0)4 (0)3 (1)
Time since diagnosis, mean (SD), y2.9 (0.8)2.9 (0.8)2.8 (0.8).232.9 (0.8)2.9 (0.8).712.9 (0.8)2.8 (0.8).25
Physical interference due to pain,c mean (SD)2.1 (1.2)2.1 (1.2)2.1 (1.2).861.9 (1.1)2.3 (1.3)<.0012.0 (1.2)2.4 (1.3)<.001
General health,d mean (SD)3.6 (1.0)3.6 (1.0)3.6 (1.0).293.7 (.9)3.5 (1.0)<.0013.6 (1.0)3.4 (1.1)<.01
Social interference due to health,e mean (SD)2.1 (1.4)2.0 (1.4)2.2 (1.5)<.011.9 (1.3)2.4 (1.5)<.0012.0 (1.3)2.5 (1.6)<.001
a

Percentages may not sum to 100 because of rounding. T tests and χ2 tests were used to assess whether demographic, clinical, behavioral, and quality-of-life characteristics differed based on cannabis use groups.

b

Binge drinking was defined as drinking ≥4 drinks with alcohol in 1 day for women and ≥5 drinks with alcohol in 1 day for men [13].

c

For pain interference, higher scores greater interference from pain.

d

For general health, higher scores indicate better health.

e

For social interference due to health, higher scores indicate greater interference due to health.

Table 1.
Open in new tab

Demographic, clinical, behavioral, and quality-of-life characteristics and associations with cannabis use among patients with cancer throughout the cancer care trajectorya

VariableOverall sample (N = 1608)Cannabis use before diagnosis
Cannabis use after diagnosis
Current cannabis use
No (n = 659)Yes (n = 942)PNo (n = 846)Yes (n = 762)PNo (n = 1115)Yes (n = 487)P
Age at cancer diagnosis, mean (SD), y60 (13)62 (13)59 (12)<.00163 (12)57 (13)<.00162 (13)57 (13)<.001
Sex, No. (%)<.01.09.21
 Female843 (52)373 (57)465 (49)426 (50)417 (55)596 (54)243 (50)
 Male765 (48)286 (43)477 (51)420 (50)345 (45)519 (46)244 (50)
Race, No. (%)<.01.55.36
 Asian10 (1)9 (1)1 (0)5 (1)5 (1)9 (1)1 (0)
 Black/African American65 (4)34 (5)31 (3)33 (4)32 (4)45 (4)20 (4)
 White1499 (93)604 (92)888 (94)795 (94)704 (92)1042 (93)452 (93)
 American Indian, Alaska Native, Native Hawaiian, Pacific Islander, more than one race, or prefer not to answer31 (2)11 (2)20 (2)12 (1)19 (2)17 (2)13 (3)
 Missing3 (0)1 (0)2 (0)1 (0)2 (0)2 (0)1 (0)
Race (dichotomized), No. (%).10.40.90
 Non-White106 (7)54 (8)52 (6)50 (6)56 (7)71 (6)34 (7)
 White1499 (93)604 (92)888 (94)795 (94)704 (92)1042 (93)452 (93)
 Missing3 (0)1 (0)2 (0)1 (0)2 (0)2 (0)1 (0)
Ethnicity, No. (%).11.25.38
 Non-Hispanic/non-Latino1504 (94)609 (92)889 (94)796 (94)708 (93)1050 (94)450 (92)
 Hispanic/Latino102 (6)50 (8)51 (5)50 (6)52 (7)64 (6)36 (7)
 Missing2 (0)0 (0)2 (0)0 (0)2 (0)1 (0)1 (0)
Marital status, No. (%).04<.01<.01
 Not married450 (28)171 (26)273 (29)212 (25)238 (31)294 (26)154 (32)
 Married1134 (71)483 (73)650 (69)625 (74)509 (67)809 (73)321 (66)
 Missing24 (1)5 (1)19 (2)9 (1)15 (2)12 (1)12 (2)
Living alone, No. (%).91.10.12
 Live with other people1165 (72)481 (73)679 (72)621 (73)544 (71)817 (73)343 (70)
 Live alone156 (10)63 (10)91 (10)89 (11)67 (9)113 (10)43 (9)
 Missing287 (18)115 (17)172 (18)136 (16)151 (20)185 (17)101 (21)
Education, No. (%).49<.01<.01
 ≤High school403 (25)157 (24)244 (26)194 (23)209 (27)261 (23)139 (29)
 ≥Some college920 (57)388 (59)527 (56)517 (61)403 (53)671 (60)247 (51)
 Missing285 (18)114 (17)171 (18)135 (16)150 (20)183 (16)101 (21)
Employment, No. (%).18.11.11
 Not employed735 (46)318 (48)411 (44)402 (48)333 (44)516 (46)217 (45)
 Employed588 (37)227 (34)360 (38)309 (37)279 (37)416 (37)169 (35)
 Missing285 (18)114 (17)171 (18)135 (16)150 (20)183 (16)101 (21)
Sleep disorder, No. (%).80.22.33
 Past 30 d25 (2)9 (1)16 (2)12 (1)13 (2)17 (2)8 (2)
 Former384 (24)154 (23)228 (24)188 (22)196 (26)255 (23)128 (26)
 Never1199 (75)496 (75)698 (74)646 (76)553 (73)843 (76)351 (72)
Pain, No. (%).56<.01.04
 Past 30 d96 (6)35 (5)61 (6)45 (5)51 (7)62 (6)33 (7)
 Former837 (52)350 (53)483 (51)416 (49)421 (55)562 (50)272 (56)
 Never675 (42)274 (42)398 (42)385 (46)290 (38)491 (44)182 (37)
Binge drinking,b No. (%)225 (14)56 (8)169 (18)<.00195 (11)130 (17)<.001128 (11)96 (20)<.001
Combustible tobacco use, No. (%)<.001<.001<.001
 Past 30 d155 (10)33 (5)120 (13)50 (6)105 (14)78 (7)77 (16)
 Former717 (45)224 (34)492 (52)361 (43)356 (47)477 (43)236 (48)
 Never733 (46)400 (61)329 (35)433 (51)300 (39)557 (50)174 (36)
 Missing3 (0)2 (0)1 (0)2 (0)1 (0)3 (0)0 (0)
Cancer region, No. (%).70.13.22
 Breast242 (15)110 (17)131 (14)124 (15)118 (15)172 (15)69 (14)
 Central nervous system22 (1)10 (2)11 (1)10 (1)12 (2)15 (1)7 (1)
 Connective/soft tissue44 (3)21 (3)23 (2)21 (2)23 (3)28 (3)16 (3)
 Digestive197 (12)72 (11)125 (13)99 (12)98 (13)130 (12)66 (14)
 Female genital87 (5)38 (6)47 (5)50 (6)37 (5)67 (6)20 (4)
 Head and neck82 (5)30 (5)52 (6)48 (6)34 (4)61 (5)21 (4)
 Hematologic236 (15)95 (14)140 (15)116 (14)120 (16)166 (15)70 (14)
 Lymphoma91 (6)31 (5)60 (6)45 (5)46 (6)65 (6)24 (5)
 Male genital134 (8)51 (8)83 (9)78 (9)56 (7)99 (9)35 (7)
 Musculoskeletal13 (1)7 (1)6 (1)5 (1)8 (1)7 (1)6 (1)
 Skin146 (9)62 (9)83 (9)92 (11)54 (7)105 (9)40 (8)
 Thoracic168 (10)71 (11)97 (10)79 (9)89 (12)107 (10)60 (12)
 Thyroid and other endocrine44 (3)20 (3)24 (3)29 (3)15 (2)33 (3)11 (2)
 Urinary system95 (6)37 (6)57 (6)46 (5)49 (6)56 (5)39 (8)
 Other7 (0)4 (1)3 (0)4 (0)3 (0)4 (0)3 (1)
Time since diagnosis, mean (SD), y2.9 (0.8)2.9 (0.8)2.8 (0.8).232.9 (0.8)2.9 (0.8).712.9 (0.8)2.8 (0.8).25
Physical interference due to pain,c mean (SD)2.1 (1.2)2.1 (1.2)2.1 (1.2).861.9 (1.1)2.3 (1.3)<.0012.0 (1.2)2.4 (1.3)<.001
General health,d mean (SD)3.6 (1.0)3.6 (1.0)3.6 (1.0).293.7 (.9)3.5 (1.0)<.0013.6 (1.0)3.4 (1.1)<.01
Social interference due to health,e mean (SD)2.1 (1.4)2.0 (1.4)2.2 (1.5)<.011.9 (1.3)2.4 (1.5)<.0012.0 (1.3)2.5 (1.6)<.001
VariableOverall sample (N = 1608)Cannabis use before diagnosis
Cannabis use after diagnosis
Current cannabis use
No (n = 659)Yes (n = 942)PNo (n = 846)Yes (n = 762)PNo (n = 1115)Yes (n = 487)P
Age at cancer diagnosis, mean (SD), y60 (13)62 (13)59 (12)<.00163 (12)57 (13)<.00162 (13)57 (13)<.001
Sex, No. (%)<.01.09.21
 Female843 (52)373 (57)465 (49)426 (50)417 (55)596 (54)243 (50)
 Male765 (48)286 (43)477 (51)420 (50)345 (45)519 (46)244 (50)
Race, No. (%)<.01.55.36
 Asian10 (1)9 (1)1 (0)5 (1)5 (1)9 (1)1 (0)
 Black/African American65 (4)34 (5)31 (3)33 (4)32 (4)45 (4)20 (4)
 White1499 (93)604 (92)888 (94)795 (94)704 (92)1042 (93)452 (93)
 American Indian, Alaska Native, Native Hawaiian, Pacific Islander, more than one race, or prefer not to answer31 (2)11 (2)20 (2)12 (1)19 (2)17 (2)13 (3)
 Missing3 (0)1 (0)2 (0)1 (0)2 (0)2 (0)1 (0)
Race (dichotomized), No. (%).10.40.90
 Non-White106 (7)54 (8)52 (6)50 (6)56 (7)71 (6)34 (7)
 White1499 (93)604 (92)888 (94)795 (94)704 (92)1042 (93)452 (93)
 Missing3 (0)1 (0)2 (0)1 (0)2 (0)2 (0)1 (0)
Ethnicity, No. (%).11.25.38
 Non-Hispanic/non-Latino1504 (94)609 (92)889 (94)796 (94)708 (93)1050 (94)450 (92)
 Hispanic/Latino102 (6)50 (8)51 (5)50 (6)52 (7)64 (6)36 (7)
 Missing2 (0)0 (0)2 (0)0 (0)2 (0)1 (0)1 (0)
Marital status, No. (%).04<.01<.01
 Not married450 (28)171 (26)273 (29)212 (25)238 (31)294 (26)154 (32)
 Married1134 (71)483 (73)650 (69)625 (74)509 (67)809 (73)321 (66)
 Missing24 (1)5 (1)19 (2)9 (1)15 (2)12 (1)12 (2)
Living alone, No. (%).91.10.12
 Live with other people1165 (72)481 (73)679 (72)621 (73)544 (71)817 (73)343 (70)
 Live alone156 (10)63 (10)91 (10)89 (11)67 (9)113 (10)43 (9)
 Missing287 (18)115 (17)172 (18)136 (16)151 (20)185 (17)101 (21)
Education, No. (%).49<.01<.01
 ≤High school403 (25)157 (24)244 (26)194 (23)209 (27)261 (23)139 (29)
 ≥Some college920 (57)388 (59)527 (56)517 (61)403 (53)671 (60)247 (51)
 Missing285 (18)114 (17)171 (18)135 (16)150 (20)183 (16)101 (21)
Employment, No. (%).18.11.11
 Not employed735 (46)318 (48)411 (44)402 (48)333 (44)516 (46)217 (45)
 Employed588 (37)227 (34)360 (38)309 (37)279 (37)416 (37)169 (35)
 Missing285 (18)114 (17)171 (18)135 (16)150 (20)183 (16)101 (21)
Sleep disorder, No. (%).80.22.33
 Past 30 d25 (2)9 (1)16 (2)12 (1)13 (2)17 (2)8 (2)
 Former384 (24)154 (23)228 (24)188 (22)196 (26)255 (23)128 (26)
 Never1199 (75)496 (75)698 (74)646 (76)553 (73)843 (76)351 (72)
Pain, No. (%).56<.01.04
 Past 30 d96 (6)35 (5)61 (6)45 (5)51 (7)62 (6)33 (7)
 Former837 (52)350 (53)483 (51)416 (49)421 (55)562 (50)272 (56)
 Never675 (42)274 (42)398 (42)385 (46)290 (38)491 (44)182 (37)
Binge drinking,b No. (%)225 (14)56 (8)169 (18)<.00195 (11)130 (17)<.001128 (11)96 (20)<.001
Combustible tobacco use, No. (%)<.001<.001<.001
 Past 30 d155 (10)33 (5)120 (13)50 (6)105 (14)78 (7)77 (16)
 Former717 (45)224 (34)492 (52)361 (43)356 (47)477 (43)236 (48)
 Never733 (46)400 (61)329 (35)433 (51)300 (39)557 (50)174 (36)
 Missing3 (0)2 (0)1 (0)2 (0)1 (0)3 (0)0 (0)
Cancer region, No. (%).70.13.22
 Breast242 (15)110 (17)131 (14)124 (15)118 (15)172 (15)69 (14)
 Central nervous system22 (1)10 (2)11 (1)10 (1)12 (2)15 (1)7 (1)
 Connective/soft tissue44 (3)21 (3)23 (2)21 (2)23 (3)28 (3)16 (3)
 Digestive197 (12)72 (11)125 (13)99 (12)98 (13)130 (12)66 (14)
 Female genital87 (5)38 (6)47 (5)50 (6)37 (5)67 (6)20 (4)
 Head and neck82 (5)30 (5)52 (6)48 (6)34 (4)61 (5)21 (4)
 Hematologic236 (15)95 (14)140 (15)116 (14)120 (16)166 (15)70 (14)
 Lymphoma91 (6)31 (5)60 (6)45 (5)46 (6)65 (6)24 (5)
 Male genital134 (8)51 (8)83 (9)78 (9)56 (7)99 (9)35 (7)
 Musculoskeletal13 (1)7 (1)6 (1)5 (1)8 (1)7 (1)6 (1)
 Skin146 (9)62 (9)83 (9)92 (11)54 (7)105 (9)40 (8)
 Thoracic168 (10)71 (11)97 (10)79 (9)89 (12)107 (10)60 (12)
 Thyroid and other endocrine44 (3)20 (3)24 (3)29 (3)15 (2)33 (3)11 (2)
 Urinary system95 (6)37 (6)57 (6)46 (5)49 (6)56 (5)39 (8)
 Other7 (0)4 (1)3 (0)4 (0)3 (0)4 (0)3 (1)
Time since diagnosis, mean (SD), y2.9 (0.8)2.9 (0.8)2.8 (0.8).232.9 (0.8)2.9 (0.8).712.9 (0.8)2.8 (0.8).25
Physical interference due to pain,c mean (SD)2.1 (1.2)2.1 (1.2)2.1 (1.2).861.9 (1.1)2.3 (1.3)<.0012.0 (1.2)2.4 (1.3)<.001
General health,d mean (SD)3.6 (1.0)3.6 (1.0)3.6 (1.0).293.7 (.9)3.5 (1.0)<.0013.6 (1.0)3.4 (1.1)<.01
Social interference due to health,e mean (SD)2.1 (1.4)2.0 (1.4)2.2 (1.5)<.011.9 (1.3)2.4 (1.5)<.0012.0 (1.3)2.5 (1.6)<.001
a

Percentages may not sum to 100 because of rounding. T tests and χ2 tests were used to assess whether demographic, clinical, behavioral, and quality-of-life characteristics differed based on cannabis use groups.

b

Binge drinking was defined as drinking ≥4 drinks with alcohol in 1 day for women and ≥5 drinks with alcohol in 1 day for men [13].

c

For pain interference, higher scores greater interference from pain.

d

For general health, higher scores indicate better health.

e

For social interference due to health, higher scores indicate greater interference due to health.

Cannabis use

Most (59%) patients with cancer reported using cannabis before their cancer diagnosis. Fewer than half (47%) reported using cannabis after their diagnosis. Current cannabis use was reported in less than one-third of the sample (30%). When grouped based on patients’ longitudinal patterns of cannabis use, fewer than one-third (29%) reported never using cannabis, fewer than one-quarter of the sample (23%) reported only using cannabis before their cancer diagnosis, 12% reported only using cannabis after their diagnosis, and more than one-third (35%) reported using cannabis before and after their diagnosis.

Univariable correlates of cannabis use

Table 1 presents demographic, clinical, behavioral, and QOL factors associated with cannabis use at periods in the cancer care trajectory. Patients who reported using cannabis at each period were younger (mean age range = 59-62) compared to patients who reported never using cannabis (mean age = 64; P < .001). Men were more likely than women to report using cannabis before diagnosis (P < .01), but no sex differences were observed at other periods (P ≥ .09). Patients with cancer who were married and had some college education reported lower rates of cannabis use after cancer diagnosis and at the study survey than patients who were not married and who had less educational attainment, respectively (P < .01). Race, cancer type, and clinician-reported sleep disorders were not associated with cannabis use. Patients with current or previous clinician-reported pain as a comorbidity were more likely than patients who never had a pain comorbidity to use cannabis after diagnosis (P < .01) and at the time of the study survey (P = .04). Patients who self-reported binge drinking within the past month and patients who were former or current smokers were more likely to report cannabis use before diagnosis, after diagnosis, and at the time of the study survey than patients who did not report binge drinking or tobacco use, respectively (P < .001). Greater interference with physical functioning due to pain and worse general health were positively associated with cannabis use after diagnosis and at the time of the study survey (P < .01). Greater interference with social functioning due to health problems was positively associated with cannabis use before cancer diagnosis, after diagnosis, and at the time of the study survey (P < .01).

Table 2 presents correlates among timing patterns of cannabis use. Similar patterns of cannabis use were observed as described earlier, but 2 notable patterns of cannabis use indicated that sex and race may be associated with the timing of cannabis use among patients with cancer. Men were more likely to use cannabis only before their cancer diagnosis, and women were more likely to use cannabis only after their diagnosis (P ≤ .001). Also, White patients were more likely to use cannabis only before their cancer diagnosis than patients of other races (P = .03).

Table 2.
Open in new tab

Demographic, clinical, behavioral, and quality-of-life characteristics among patients with cancer, by patterns of cannabis usea

CharacteristicNever used cannabis (n = 469)Cannabis only before diagnosis (n = 374)Cannabis only after diagnosis (n = 190)Cannabis before and after diagnosis (n = 568)P
Age at cancer diagnosis, mean (SD), y64 (13)62 (11)59 (14)59 (13)<.001
Sex, No. (%)<.001
 Female250 (53)175 (47)123 (65)290 (51)
 Male219 (47)199 (53)67 (35)278 (49)
Race, No. (%).03
 Asian5 (1)0 (0)4 (2)1 (0)
 Black/African American25 (5)8 (2)9 (5)23 (4)
 White432 (92)360 (96)172 (91)528 (93)
 American Indian, Alaska Native, Native Hawaiian, Pacific Islander, more than one race, or prefer not to answer7 (1)5 (1)4 (2)15 (3)
 Missing0 (0)1 (0)1 (1)1 (0)
Race (dichotomized), No. (%).09
 Non-White37 (8)13 (3)17 (9)39 (7)
 White432 (92)360 (96)172 (91)528 (93)
 Missing0 (0)1 (0)1 (1)1 (0)
Ethnicity, No. (%).06
 Non-Hispanic/non-Latino440 (94)353 (94)169 (89)536 (94)
 Hispanic/Latino29 (6)21 (6)21 (11)30 (5)
 Missing0 (0)0 (0)0 (0)2 (0)
Marital status, No. (%).02
 Not married120 (26)90 (24)51 (27)183 (32)
 Married347 (74)277 (74)136 (72)373 (66)
 Missing2 (0)7 (2)3 (2)12 (2)
Living alone, No. (%).50
 Live with other people348 (74)271 (72)133 (70)408 (72)
 Live alone46 (10)42 (11)17 (9)49 (9)
 Missing75 (16)61 (16)40 (21)111 (20)
Education, No. (%).07
 ≤High school104 (22)89 (24)53 (28)155 (27)
 ≥Some college290 (62)225 (60)98 (52)302 (53)
 Missing75 (16)60 (16)39 (21)111 (20)
Employment, No. (%).13
 Not employed237 (51)162 (43)81 (43)249 (44)
 Employed157 (33)152 (41)70 (37)208 (37)
 Missing75 (16)60 (16)39 (21)111 (20)
Sleep disorder, No. (%).36
 Past 30 d5 (1)7 (2)4 (2)9 (2)
 Former99 (21)88 (24)55 (29)140 (25)
 Never365 (78)279 (75)131 (69)419 (74)
Pain, No. (%).04
 Past 30 d24 (5)21 (6)11 (6)40 (7)
 Former235 (50)179 (48)115 (61)304 (54)
 Never210 (45)174 (47)64 (34)224 (39)
Binge drinking,b No. (%)43 (9)52 (14)13 (7)117 (21)<.001
Combustible tobacco use, No. (%)<.001
 Past 30 d21 (4)28 (7)12 (6)92 (16)
 Former155 (33)206 (55)69 (36)286 (50)
 Never291 (62)140 (37)109 (57)189 (33)
 Missing2 (0)0 (0)0 (0)1 (0)
Cancer region, No. (%).04
 Breast77 (16)46 (12)33 (17)85 (15)
 Central nervous system5 (1)5 (1)5 (3)6 (1)
 Connective/soft tissue14 (3)7 (2)7 (4)16 (3)
 Digestive52 (11)47 (13)20 (11)78 (14)
 Female genital29 (6)21 (6)9 (5)26 (5)
 Head and neck26 (6)22 (6)4 (2)30 (5)
 Hematologic60 (13)56 (15)35 (18)84 (15)
 Lymphoma16 (3)29 (8)15 (8)31 (5)
 Male genital39 (8)39 (10)12 (6)44 (8)
 Musculoskeletal4 (1)1 (0)3 (2)5 (1)
 Skin54 (12)37 (10)8 (4)46 (8)
 Thoracic43 (9)36 (10)28 (15)61 (11)
 Thyroid and other endocrine19 (4)10 (3)1 (1)14 (2)
 Urinary system27 (6)18 (5)10 (5)39 (7)
 Other4 (1)0 (0)0 (0)3 (1)
Time since diagnosis, mean (SD), y2.8 (0.8)2.9 (0.8)3.0 (0.8)2.8 (0.8).06
Physical interference due to pain,c mean (SD)2.0 (1.2)1.9 (1.1)2.5 (1.3)2.3 (1.3)<.001
General health,d mean (SD)3.7 (0.9)3.7 (0.9)3.4 (1.1)3.5 (1.0)<.01
Social interference due to health,e mean (SD)1.9 (1.3)1.9 (1.3)2.3 (1.4)2.4 (1.5)<.001
CharacteristicNever used cannabis (n = 469)Cannabis only before diagnosis (n = 374)Cannabis only after diagnosis (n = 190)Cannabis before and after diagnosis (n = 568)P
Age at cancer diagnosis, mean (SD), y64 (13)62 (11)59 (14)59 (13)<.001
Sex, No. (%)<.001
 Female250 (53)175 (47)123 (65)290 (51)
 Male219 (47)199 (53)67 (35)278 (49)
Race, No. (%).03
 Asian5 (1)0 (0)4 (2)1 (0)
 Black/African American25 (5)8 (2)9 (5)23 (4)
 White432 (92)360 (96)172 (91)528 (93)
 American Indian, Alaska Native, Native Hawaiian, Pacific Islander, more than one race, or prefer not to answer7 (1)5 (1)4 (2)15 (3)
 Missing0 (0)1 (0)1 (1)1 (0)
Race (dichotomized), No. (%).09
 Non-White37 (8)13 (3)17 (9)39 (7)
 White432 (92)360 (96)172 (91)528 (93)
 Missing0 (0)1 (0)1 (1)1 (0)
Ethnicity, No. (%).06
 Non-Hispanic/non-Latino440 (94)353 (94)169 (89)536 (94)
 Hispanic/Latino29 (6)21 (6)21 (11)30 (5)
 Missing0 (0)0 (0)0 (0)2 (0)
Marital status, No. (%).02
 Not married120 (26)90 (24)51 (27)183 (32)
 Married347 (74)277 (74)136 (72)373 (66)
 Missing2 (0)7 (2)3 (2)12 (2)
Living alone, No. (%).50
 Live with other people348 (74)271 (72)133 (70)408 (72)
 Live alone46 (10)42 (11)17 (9)49 (9)
 Missing75 (16)61 (16)40 (21)111 (20)
Education, No. (%).07
 ≤High school104 (22)89 (24)53 (28)155 (27)
 ≥Some college290 (62)225 (60)98 (52)302 (53)
 Missing75 (16)60 (16)39 (21)111 (20)
Employment, No. (%).13
 Not employed237 (51)162 (43)81 (43)249 (44)
 Employed157 (33)152 (41)70 (37)208 (37)
 Missing75 (16)60 (16)39 (21)111 (20)
Sleep disorder, No. (%).36
 Past 30 d5 (1)7 (2)4 (2)9 (2)
 Former99 (21)88 (24)55 (29)140 (25)
 Never365 (78)279 (75)131 (69)419 (74)
Pain, No. (%).04
 Past 30 d24 (5)21 (6)11 (6)40 (7)
 Former235 (50)179 (48)115 (61)304 (54)
 Never210 (45)174 (47)64 (34)224 (39)
Binge drinking,b No. (%)43 (9)52 (14)13 (7)117 (21)<.001
Combustible tobacco use, No. (%)<.001
 Past 30 d21 (4)28 (7)12 (6)92 (16)
 Former155 (33)206 (55)69 (36)286 (50)
 Never291 (62)140 (37)109 (57)189 (33)
 Missing2 (0)0 (0)0 (0)1 (0)
Cancer region, No. (%).04
 Breast77 (16)46 (12)33 (17)85 (15)
 Central nervous system5 (1)5 (1)5 (3)6 (1)
 Connective/soft tissue14 (3)7 (2)7 (4)16 (3)
 Digestive52 (11)47 (13)20 (11)78 (14)
 Female genital29 (6)21 (6)9 (5)26 (5)
 Head and neck26 (6)22 (6)4 (2)30 (5)
 Hematologic60 (13)56 (15)35 (18)84 (15)
 Lymphoma16 (3)29 (8)15 (8)31 (5)
 Male genital39 (8)39 (10)12 (6)44 (8)
 Musculoskeletal4 (1)1 (0)3 (2)5 (1)
 Skin54 (12)37 (10)8 (4)46 (8)
 Thoracic43 (9)36 (10)28 (15)61 (11)
 Thyroid and other endocrine19 (4)10 (3)1 (1)14 (2)
 Urinary system27 (6)18 (5)10 (5)39 (7)
 Other4 (1)0 (0)0 (0)3 (1)
Time since diagnosis, mean (SD), y2.8 (0.8)2.9 (0.8)3.0 (0.8)2.8 (0.8).06
Physical interference due to pain,c mean (SD)2.0 (1.2)1.9 (1.1)2.5 (1.3)2.3 (1.3)<.001
General health,d mean (SD)3.7 (0.9)3.7 (0.9)3.4 (1.1)3.5 (1.0)<.01
Social interference due to health,e mean (SD)1.9 (1.3)1.9 (1.3)2.3 (1.4)2.4 (1.5)<.001
a

Percentages may not sum to 100 due to rounding. T tests and χ2 tests were used to assess whether demographic, clinical, behavioral, and quality-of-life characteristics differed based on patterns of cannabis use.

b

Binge drinking was defined as drinking ≥4 drinks with alcohol in 1 day for women and ≥5 drinks with alcohol in 1 day for men [13].

c

For pain interference, higher scores mean greater interference from pain.

d

For general health, higher scores indicate better health.

e

For social interference due to health, higher scores indicate greater interference due to health.

Table 2.
Open in new tab

Demographic, clinical, behavioral, and quality-of-life characteristics among patients with cancer, by patterns of cannabis usea

CharacteristicNever used cannabis (n = 469)Cannabis only before diagnosis (n = 374)Cannabis only after diagnosis (n = 190)Cannabis before and after diagnosis (n = 568)P
Age at cancer diagnosis, mean (SD), y64 (13)62 (11)59 (14)59 (13)<.001
Sex, No. (%)<.001
 Female250 (53)175 (47)123 (65)290 (51)
 Male219 (47)199 (53)67 (35)278 (49)
Race, No. (%).03
 Asian5 (1)0 (0)4 (2)1 (0)
 Black/African American25 (5)8 (2)9 (5)23 (4)
 White432 (92)360 (96)172 (91)528 (93)
 American Indian, Alaska Native, Native Hawaiian, Pacific Islander, more than one race, or prefer not to answer7 (1)5 (1)4 (2)15 (3)
 Missing0 (0)1 (0)1 (1)1 (0)
Race (dichotomized), No. (%).09
 Non-White37 (8)13 (3)17 (9)39 (7)
 White432 (92)360 (96)172 (91)528 (93)
 Missing0 (0)1 (0)1 (1)1 (0)
Ethnicity, No. (%).06
 Non-Hispanic/non-Latino440 (94)353 (94)169 (89)536 (94)
 Hispanic/Latino29 (6)21 (6)21 (11)30 (5)
 Missing0 (0)0 (0)0 (0)2 (0)
Marital status, No. (%).02
 Not married120 (26)90 (24)51 (27)183 (32)
 Married347 (74)277 (74)136 (72)373 (66)
 Missing2 (0)7 (2)3 (2)12 (2)
Living alone, No. (%).50
 Live with other people348 (74)271 (72)133 (70)408 (72)
 Live alone46 (10)42 (11)17 (9)49 (9)
 Missing75 (16)61 (16)40 (21)111 (20)
Education, No. (%).07
 ≤High school104 (22)89 (24)53 (28)155 (27)
 ≥Some college290 (62)225 (60)98 (52)302 (53)
 Missing75 (16)60 (16)39 (21)111 (20)
Employment, No. (%).13
 Not employed237 (51)162 (43)81 (43)249 (44)
 Employed157 (33)152 (41)70 (37)208 (37)
 Missing75 (16)60 (16)39 (21)111 (20)
Sleep disorder, No. (%).36
 Past 30 d5 (1)7 (2)4 (2)9 (2)
 Former99 (21)88 (24)55 (29)140 (25)
 Never365 (78)279 (75)131 (69)419 (74)
Pain, No. (%).04
 Past 30 d24 (5)21 (6)11 (6)40 (7)
 Former235 (50)179 (48)115 (61)304 (54)
 Never210 (45)174 (47)64 (34)224 (39)
Binge drinking,b No. (%)43 (9)52 (14)13 (7)117 (21)<.001
Combustible tobacco use, No. (%)<.001
 Past 30 d21 (4)28 (7)12 (6)92 (16)
 Former155 (33)206 (55)69 (36)286 (50)
 Never291 (62)140 (37)109 (57)189 (33)
 Missing2 (0)0 (0)0 (0)1 (0)
Cancer region, No. (%).04
 Breast77 (16)46 (12)33 (17)85 (15)
 Central nervous system5 (1)5 (1)5 (3)6 (1)
 Connective/soft tissue14 (3)7 (2)7 (4)16 (3)
 Digestive52 (11)47 (13)20 (11)78 (14)
 Female genital29 (6)21 (6)9 (5)26 (5)
 Head and neck26 (6)22 (6)4 (2)30 (5)
 Hematologic60 (13)56 (15)35 (18)84 (15)
 Lymphoma16 (3)29 (8)15 (8)31 (5)
 Male genital39 (8)39 (10)12 (6)44 (8)
 Musculoskeletal4 (1)1 (0)3 (2)5 (1)
 Skin54 (12)37 (10)8 (4)46 (8)
 Thoracic43 (9)36 (10)28 (15)61 (11)
 Thyroid and other endocrine19 (4)10 (3)1 (1)14 (2)
 Urinary system27 (6)18 (5)10 (5)39 (7)
 Other4 (1)0 (0)0 (0)3 (1)
Time since diagnosis, mean (SD), y2.8 (0.8)2.9 (0.8)3.0 (0.8)2.8 (0.8).06
Physical interference due to pain,c mean (SD)2.0 (1.2)1.9 (1.1)2.5 (1.3)2.3 (1.3)<.001
General health,d mean (SD)3.7 (0.9)3.7 (0.9)3.4 (1.1)3.5 (1.0)<.01
Social interference due to health,e mean (SD)1.9 (1.3)1.9 (1.3)2.3 (1.4)2.4 (1.5)<.001
CharacteristicNever used cannabis (n = 469)Cannabis only before diagnosis (n = 374)Cannabis only after diagnosis (n = 190)Cannabis before and after diagnosis (n = 568)P
Age at cancer diagnosis, mean (SD), y64 (13)62 (11)59 (14)59 (13)<.001
Sex, No. (%)<.001
 Female250 (53)175 (47)123 (65)290 (51)
 Male219 (47)199 (53)67 (35)278 (49)
Race, No. (%).03
 Asian5 (1)0 (0)4 (2)1 (0)
 Black/African American25 (5)8 (2)9 (5)23 (4)
 White432 (92)360 (96)172 (91)528 (93)
 American Indian, Alaska Native, Native Hawaiian, Pacific Islander, more than one race, or prefer not to answer7 (1)5 (1)4 (2)15 (3)
 Missing0 (0)1 (0)1 (1)1 (0)
Race (dichotomized), No. (%).09
 Non-White37 (8)13 (3)17 (9)39 (7)
 White432 (92)360 (96)172 (91)528 (93)
 Missing0 (0)1 (0)1 (1)1 (0)
Ethnicity, No. (%).06
 Non-Hispanic/non-Latino440 (94)353 (94)169 (89)536 (94)
 Hispanic/Latino29 (6)21 (6)21 (11)30 (5)
 Missing0 (0)0 (0)0 (0)2 (0)
Marital status, No. (%).02
 Not married120 (26)90 (24)51 (27)183 (32)
 Married347 (74)277 (74)136 (72)373 (66)
 Missing2 (0)7 (2)3 (2)12 (2)
Living alone, No. (%).50
 Live with other people348 (74)271 (72)133 (70)408 (72)
 Live alone46 (10)42 (11)17 (9)49 (9)
 Missing75 (16)61 (16)40 (21)111 (20)
Education, No. (%).07
 ≤High school104 (22)89 (24)53 (28)155 (27)
 ≥Some college290 (62)225 (60)98 (52)302 (53)
 Missing75 (16)60 (16)39 (21)111 (20)
Employment, No. (%).13
 Not employed237 (51)162 (43)81 (43)249 (44)
 Employed157 (33)152 (41)70 (37)208 (37)
 Missing75 (16)60 (16)39 (21)111 (20)
Sleep disorder, No. (%).36
 Past 30 d5 (1)7 (2)4 (2)9 (2)
 Former99 (21)88 (24)55 (29)140 (25)
 Never365 (78)279 (75)131 (69)419 (74)
Pain, No. (%).04
 Past 30 d24 (5)21 (6)11 (6)40 (7)
 Former235 (50)179 (48)115 (61)304 (54)
 Never210 (45)174 (47)64 (34)224 (39)
Binge drinking,b No. (%)43 (9)52 (14)13 (7)117 (21)<.001
Combustible tobacco use, No. (%)<.001
 Past 30 d21 (4)28 (7)12 (6)92 (16)
 Former155 (33)206 (55)69 (36)286 (50)
 Never291 (62)140 (37)109 (57)189 (33)
 Missing2 (0)0 (0)0 (0)1 (0)
Cancer region, No. (%).04
 Breast77 (16)46 (12)33 (17)85 (15)
 Central nervous system5 (1)5 (1)5 (3)6 (1)
 Connective/soft tissue14 (3)7 (2)7 (4)16 (3)
 Digestive52 (11)47 (13)20 (11)78 (14)
 Female genital29 (6)21 (6)9 (5)26 (5)
 Head and neck26 (6)22 (6)4 (2)30 (5)
 Hematologic60 (13)56 (15)35 (18)84 (15)
 Lymphoma16 (3)29 (8)15 (8)31 (5)
 Male genital39 (8)39 (10)12 (6)44 (8)
 Musculoskeletal4 (1)1 (0)3 (2)5 (1)
 Skin54 (12)37 (10)8 (4)46 (8)
 Thoracic43 (9)36 (10)28 (15)61 (11)
 Thyroid and other endocrine19 (4)10 (3)1 (1)14 (2)
 Urinary system27 (6)18 (5)10 (5)39 (7)
 Other4 (1)0 (0)0 (0)3 (1)
Time since diagnosis, mean (SD), y2.8 (0.8)2.9 (0.8)3.0 (0.8)2.8 (0.8).06
Physical interference due to pain,c mean (SD)2.0 (1.2)1.9 (1.1)2.5 (1.3)2.3 (1.3)<.001
General health,d mean (SD)3.7 (0.9)3.7 (0.9)3.4 (1.1)3.5 (1.0)<.01
Social interference due to health,e mean (SD)1.9 (1.3)1.9 (1.3)2.3 (1.4)2.4 (1.5)<.001
a

Percentages may not sum to 100 due to rounding. T tests and χ2 tests were used to assess whether demographic, clinical, behavioral, and quality-of-life characteristics differed based on patterns of cannabis use.

b

Binge drinking was defined as drinking ≥4 drinks with alcohol in 1 day for women and ≥5 drinks with alcohol in 1 day for men [13].

c

For pain interference, higher scores mean greater interference from pain.

d

For general health, higher scores indicate better health.

e

For social interference due to health, higher scores indicate greater interference due to health.

Table 3 presents the distributions of most frequently used cannabis forms and reasons for use among patients with cancer who reported cannabis use after diagnosis. By comparison, those who used cannabis only after diagnosis were more likely to take the drug by mouth, such as pills, tinctures, or under the tongue, and apply it topically, such as in a lotion, cream or patch; those who used cannabis both before and after diagnosis were more likely to smoke the drug, such as in a joint, bong, pipe, blunt, vape, or vaporize; use cannabis for mood changes, stress, anxiety, or depression; and use for digestive problems or for recreation or enjoyment (P < .001).

Table 3.
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Most common forms of cannabis and reasons for cannabis use among patients with cancer, by patterns of use after diagnosisa

Cannabis use after diagnosis (n = 762 )Cannabis only after diagnosis (n = 190)Cannabis before and after diagnosis (n = 568)P
Most common forms of cannabis, No. (%)<.001
 Smoking, such as in a joint, bong, pipe, or blunt204 (27)19 (10)183 (32)
 Eating it in food such as brownies, cakes, cookies, or candy154 (20)40 (21)113 (20)
 Drinking it in a liquid such as tea, cola, or alcohol9 (1)5 (3)4 (1)
 Taking by mouth, such as pills, tinctures, or under the tongue188 (25)76 (40)112 (20)
 Vaping or vaporizing108 (14)16 (8)92 (16)
 Dabbing, such as using waxes or shatter10 (1)1 (1)9 (2)
 Applying topically, such as in a lotion, cream, or patch53 (7)23 (12)29 (5)
 Other20 (3)6 (3)14 (2)
 Missing16 (2)4 (2)12 (2)
Reasons for use, No. (%)
 Pain414 (54)111 (58)301 (53).22
 Mood changes, stress, anxiety, or depression394 (52)69 (36)321 (57)<.001
 Neuropathy (numbness or tingling)149 (20)41 (22)107 (19).47
 Difficulty sleeping461 (60)105 (55)353 (62).11
 Difficulty concentrating73 (10)15 (8)56 (10).51
 Skin problems22 (3)5 (3)17 (3).99
 Sweating symptoms (eg, hot flashes, night sweats)43 (6)8 (4)35 (6).41
 Digestive problems (eg, nausea, vomiting, diarrhea, constipation)222 (29)37 (19)184 (32)<.001
 Lack of appetite224 (29)42 (22)180 (32).02
 Lack of energy or fatigue140 (18)37 (19)102 (18).72
 Lack of sexual interest of activity60 (8)11 (6)48 (8).30
 Used as a treatment or cure for cancer80 (10)22 (12)56 (10).59
 Used recreationally or enjoyment171 (22)3 (2)166 (29)<.001
 Used for other cancer symptom or cancer treatment side effects50 (7)12 (6)38 (7).99
 Other reason31 (4)11 (6)20 (4).25
Cannabis use after diagnosis (n = 762 )Cannabis only after diagnosis (n = 190)Cannabis before and after diagnosis (n = 568)P
Most common forms of cannabis, No. (%)<.001
 Smoking, such as in a joint, bong, pipe, or blunt204 (27)19 (10)183 (32)
 Eating it in food such as brownies, cakes, cookies, or candy154 (20)40 (21)113 (20)
 Drinking it in a liquid such as tea, cola, or alcohol9 (1)5 (3)4 (1)
 Taking by mouth, such as pills, tinctures, or under the tongue188 (25)76 (40)112 (20)
 Vaping or vaporizing108 (14)16 (8)92 (16)
 Dabbing, such as using waxes or shatter10 (1)1 (1)9 (2)
 Applying topically, such as in a lotion, cream, or patch53 (7)23 (12)29 (5)
 Other20 (3)6 (3)14 (2)
 Missing16 (2)4 (2)12 (2)
Reasons for use, No. (%)
 Pain414 (54)111 (58)301 (53).22
 Mood changes, stress, anxiety, or depression394 (52)69 (36)321 (57)<.001
 Neuropathy (numbness or tingling)149 (20)41 (22)107 (19).47
 Difficulty sleeping461 (60)105 (55)353 (62).11
 Difficulty concentrating73 (10)15 (8)56 (10).51
 Skin problems22 (3)5 (3)17 (3).99
 Sweating symptoms (eg, hot flashes, night sweats)43 (6)8 (4)35 (6).41
 Digestive problems (eg, nausea, vomiting, diarrhea, constipation)222 (29)37 (19)184 (32)<.001
 Lack of appetite224 (29)42 (22)180 (32).02
 Lack of energy or fatigue140 (18)37 (19)102 (18).72
 Lack of sexual interest of activity60 (8)11 (6)48 (8).30
 Used as a treatment or cure for cancer80 (10)22 (12)56 (10).59
 Used recreationally or enjoyment171 (22)3 (2)166 (29)<.001
 Used for other cancer symptom or cancer treatment side effects50 (7)12 (6)38 (7).99
 Other reason31 (4)11 (6)20 (4).25
a

χ2 tests were used to assess whether forms of use and reasons for use differed by patterns of cannabis use.

Table 3.
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Most common forms of cannabis and reasons for cannabis use among patients with cancer, by patterns of use after diagnosisa

Cannabis use after diagnosis (n = 762 )Cannabis only after diagnosis (n = 190)Cannabis before and after diagnosis (n = 568)P
Most common forms of cannabis, No. (%)<.001
 Smoking, such as in a joint, bong, pipe, or blunt204 (27)19 (10)183 (32)
 Eating it in food such as brownies, cakes, cookies, or candy154 (20)40 (21)113 (20)
 Drinking it in a liquid such as tea, cola, or alcohol9 (1)5 (3)4 (1)
 Taking by mouth, such as pills, tinctures, or under the tongue188 (25)76 (40)112 (20)
 Vaping or vaporizing108 (14)16 (8)92 (16)
 Dabbing, such as using waxes or shatter10 (1)1 (1)9 (2)
 Applying topically, such as in a lotion, cream, or patch53 (7)23 (12)29 (5)
 Other20 (3)6 (3)14 (2)
 Missing16 (2)4 (2)12 (2)
Reasons for use, No. (%)
 Pain414 (54)111 (58)301 (53).22
 Mood changes, stress, anxiety, or depression394 (52)69 (36)321 (57)<.001
 Neuropathy (numbness or tingling)149 (20)41 (22)107 (19).47
 Difficulty sleeping461 (60)105 (55)353 (62).11
 Difficulty concentrating73 (10)15 (8)56 (10).51
 Skin problems22 (3)5 (3)17 (3).99
 Sweating symptoms (eg, hot flashes, night sweats)43 (6)8 (4)35 (6).41
 Digestive problems (eg, nausea, vomiting, diarrhea, constipation)222 (29)37 (19)184 (32)<.001
 Lack of appetite224 (29)42 (22)180 (32).02
 Lack of energy or fatigue140 (18)37 (19)102 (18).72
 Lack of sexual interest of activity60 (8)11 (6)48 (8).30
 Used as a treatment or cure for cancer80 (10)22 (12)56 (10).59
 Used recreationally or enjoyment171 (22)3 (2)166 (29)<.001
 Used for other cancer symptom or cancer treatment side effects50 (7)12 (6)38 (7).99
 Other reason31 (4)11 (6)20 (4).25
Cannabis use after diagnosis (n = 762 )Cannabis only after diagnosis (n = 190)Cannabis before and after diagnosis (n = 568)P
Most common forms of cannabis, No. (%)<.001
 Smoking, such as in a joint, bong, pipe, or blunt204 (27)19 (10)183 (32)
 Eating it in food such as brownies, cakes, cookies, or candy154 (20)40 (21)113 (20)
 Drinking it in a liquid such as tea, cola, or alcohol9 (1)5 (3)4 (1)
 Taking by mouth, such as pills, tinctures, or under the tongue188 (25)76 (40)112 (20)
 Vaping or vaporizing108 (14)16 (8)92 (16)
 Dabbing, such as using waxes or shatter10 (1)1 (1)9 (2)
 Applying topically, such as in a lotion, cream, or patch53 (7)23 (12)29 (5)
 Other20 (3)6 (3)14 (2)
 Missing16 (2)4 (2)12 (2)
Reasons for use, No. (%)
 Pain414 (54)111 (58)301 (53).22
 Mood changes, stress, anxiety, or depression394 (52)69 (36)321 (57)<.001
 Neuropathy (numbness or tingling)149 (20)41 (22)107 (19).47
 Difficulty sleeping461 (60)105 (55)353 (62).11
 Difficulty concentrating73 (10)15 (8)56 (10).51
 Skin problems22 (3)5 (3)17 (3).99
 Sweating symptoms (eg, hot flashes, night sweats)43 (6)8 (4)35 (6).41
 Digestive problems (eg, nausea, vomiting, diarrhea, constipation)222 (29)37 (19)184 (32)<.001
 Lack of appetite224 (29)42 (22)180 (32).02
 Lack of energy or fatigue140 (18)37 (19)102 (18).72
 Lack of sexual interest of activity60 (8)11 (6)48 (8).30
 Used as a treatment or cure for cancer80 (10)22 (12)56 (10).59
 Used recreationally or enjoyment171 (22)3 (2)166 (29)<.001
 Used for other cancer symptom or cancer treatment side effects50 (7)12 (6)38 (7).99
 Other reason31 (4)11 (6)20 (4).25
a

χ2 tests were used to assess whether forms of use and reasons for use differed by patterns of cannabis use.

Multivariable correlates of cannabis use

Table 4 presents the results of multivariable logistic regression models identifying correlates of cannabis use at specific time periods in the cancer care trajectory. Higher odds of reporting cannabis use before diagnosis were associated with younger age (odds ratio [OR] = 0.97, 95% confidence interval [CI] = 0.95 to 0.98), male sex (OR = 1.44, 95% CI = 1.13 to 1.84), White race (OR = 2.29, 95% CI = 1.41 to 3.74), self-reported binge drinking (OR = 1.93, 95% CI = 1.37 to 2.74), current smoking (OR = 3.55, 95% CI = 2.24 to 5.78), former smoking (OR = 3.11, 95% CI = 2.41 to 4.03), and greater social interference due to health problems (OR = 1.15, 95% CI = 1.04 to 1.28). Higher odds of reporting cannabis use after diagnosis were associated with younger age (OR = 0.97, 95% CI = 0.96 to 0.98), self-reported binge drinking (OR = 1.42, 95% CI = 1.04 to 1.94), current smoking (OR = 2.54, 95% CI = 1.66 to 3.92), former smoking (OR = 1.76, 95% CI = 1.37 to 2.26), greater physical interference due to pain (OR = 1.19, 95% CI = 1.06 to 1.34), and greater social interference due to health problems (OR = 1.15, 95% CI = 1.04 to 1.26). Finally, higher odds of reporting cannabis use at the time of the study survey were associated with younger age (OR = 0.98, 95% CI = 0.97 to 0.99), self-reported binge drinking (OR = 1.75, 95% CI = 1.27 to 2.41), current smoking (OR = 2.31, 95% CI = 1.51 to 3.53), former smoking (OR = 1.82, 95% CI = 1.38 to 2.40), greater physical interference due to pain (OR = 1.22, 95% CI = 1.08 to 1.39), and greater social interference due to health problems (OR = 1.17, 95% CI = 1.06 to 1.30).

Table 4.
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Results from 3 logistic regression models examining factors associated with cannabis use status

Cannabis used before diagnosisCannabis used after diagnosisCannabis used currently
Odds ratio (95% confidence interval)Odds ratio (95% confidence interval)Odds ratio (95% confidence interval)
Age at diagnosis0.97 (0.95 to 0.98)***0.97 (0.96 to 0.98)***0.98 (0.97 to 0.99)***
Male vs female1.44 (1.13 to 1.84)**0.90 (0.71 to 1.13)1.21 (0.94 to 1.56)
White vs other racial groups2.29 (1.41 to 3.74)**1.22 (0.76 to 1.98)1.25 (0.74 to 2.15)
≥Some college vs <some college1.15 (0.88 to 1.49)0.94 (0.73 to 1.22)0.88 (0.67 to 1.16)
Current pain vs no pain0.92 (0.54 to 1.58)0.77 (0.46 to 1.29)0.87 (0.49 to 1.49)
Former pain vs no pain0.94 (0.73 to 1.20)0.98 (0.77 to 1.25)0.96 (0.73 to 1.25)
Binge drinking vs no binge drinking1.93 (1.37 to 2.74)***1.42 (1.04 to 1.94)*1.75 (1.27 to 2.41)**
Current vs never tobacco use3.55 (2.24 to 5.78)***2.54 (1.66 to 3.92)***2.31 (1.51 to 3.53)***
Former vs never tobacco use3.11 (2.41 to 4.03)***1.76 (1.37 to 2.26)***1.82 (1.38 to 2.40)***
Physical interference due to pain0.91 (0.80 to 1.02)1.19 (1.06 to 1.34)**1.22 (1.08 to 1.39)**
General health1.03 (0.89 to 1.19)1.02 (0.89 to 1.17)1.09 (0.94 to 1.26)
Social interference due to health1.15 (1.04 to 1.28)**1.15 (1.04 to 1.26)**1.17 (1.06 to 1.30)**
Cannabis used before diagnosisCannabis used after diagnosisCannabis used currently
Odds ratio (95% confidence interval)Odds ratio (95% confidence interval)Odds ratio (95% confidence interval)
Age at diagnosis0.97 (0.95 to 0.98)***0.97 (0.96 to 0.98)***0.98 (0.97 to 0.99)***
Male vs female1.44 (1.13 to 1.84)**0.90 (0.71 to 1.13)1.21 (0.94 to 1.56)
White vs other racial groups2.29 (1.41 to 3.74)**1.22 (0.76 to 1.98)1.25 (0.74 to 2.15)
≥Some college vs <some college1.15 (0.88 to 1.49)0.94 (0.73 to 1.22)0.88 (0.67 to 1.16)
Current pain vs no pain0.92 (0.54 to 1.58)0.77 (0.46 to 1.29)0.87 (0.49 to 1.49)
Former pain vs no pain0.94 (0.73 to 1.20)0.98 (0.77 to 1.25)0.96 (0.73 to 1.25)
Binge drinking vs no binge drinking1.93 (1.37 to 2.74)***1.42 (1.04 to 1.94)*1.75 (1.27 to 2.41)**
Current vs never tobacco use3.55 (2.24 to 5.78)***2.54 (1.66 to 3.92)***2.31 (1.51 to 3.53)***
Former vs never tobacco use3.11 (2.41 to 4.03)***1.76 (1.37 to 2.26)***1.82 (1.38 to 2.40)***
Physical interference due to pain0.91 (0.80 to 1.02)1.19 (1.06 to 1.34)**1.22 (1.08 to 1.39)**
General health1.03 (0.89 to 1.19)1.02 (0.89 to 1.17)1.09 (0.94 to 1.26)
Social interference due to health1.15 (1.04 to 1.28)**1.15 (1.04 to 1.26)**1.17 (1.06 to 1.30)**
*

P < .05,

**

P < .01,

***

P < .001.

Table 4.
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Results from 3 logistic regression models examining factors associated with cannabis use status

Cannabis used before diagnosisCannabis used after diagnosisCannabis used currently
Odds ratio (95% confidence interval)Odds ratio (95% confidence interval)Odds ratio (95% confidence interval)
Age at diagnosis0.97 (0.95 to 0.98)***0.97 (0.96 to 0.98)***0.98 (0.97 to 0.99)***
Male vs female1.44 (1.13 to 1.84)**0.90 (0.71 to 1.13)1.21 (0.94 to 1.56)
White vs other racial groups2.29 (1.41 to 3.74)**1.22 (0.76 to 1.98)1.25 (0.74 to 2.15)
≥Some college vs <some college1.15 (0.88 to 1.49)0.94 (0.73 to 1.22)0.88 (0.67 to 1.16)
Current pain vs no pain0.92 (0.54 to 1.58)0.77 (0.46 to 1.29)0.87 (0.49 to 1.49)
Former pain vs no pain0.94 (0.73 to 1.20)0.98 (0.77 to 1.25)0.96 (0.73 to 1.25)
Binge drinking vs no binge drinking1.93 (1.37 to 2.74)***1.42 (1.04 to 1.94)*1.75 (1.27 to 2.41)**
Current vs never tobacco use3.55 (2.24 to 5.78)***2.54 (1.66 to 3.92)***2.31 (1.51 to 3.53)***
Former vs never tobacco use3.11 (2.41 to 4.03)***1.76 (1.37 to 2.26)***1.82 (1.38 to 2.40)***
Physical interference due to pain0.91 (0.80 to 1.02)1.19 (1.06 to 1.34)**1.22 (1.08 to 1.39)**
General health1.03 (0.89 to 1.19)1.02 (0.89 to 1.17)1.09 (0.94 to 1.26)
Social interference due to health1.15 (1.04 to 1.28)**1.15 (1.04 to 1.26)**1.17 (1.06 to 1.30)**
Cannabis used before diagnosisCannabis used after diagnosisCannabis used currently
Odds ratio (95% confidence interval)Odds ratio (95% confidence interval)Odds ratio (95% confidence interval)
Age at diagnosis0.97 (0.95 to 0.98)***0.97 (0.96 to 0.98)***0.98 (0.97 to 0.99)***
Male vs female1.44 (1.13 to 1.84)**0.90 (0.71 to 1.13)1.21 (0.94 to 1.56)
White vs other racial groups2.29 (1.41 to 3.74)**1.22 (0.76 to 1.98)1.25 (0.74 to 2.15)
≥Some college vs <some college1.15 (0.88 to 1.49)0.94 (0.73 to 1.22)0.88 (0.67 to 1.16)
Current pain vs no pain0.92 (0.54 to 1.58)0.77 (0.46 to 1.29)0.87 (0.49 to 1.49)
Former pain vs no pain0.94 (0.73 to 1.20)0.98 (0.77 to 1.25)0.96 (0.73 to 1.25)
Binge drinking vs no binge drinking1.93 (1.37 to 2.74)***1.42 (1.04 to 1.94)*1.75 (1.27 to 2.41)**
Current vs never tobacco use3.55 (2.24 to 5.78)***2.54 (1.66 to 3.92)***2.31 (1.51 to 3.53)***
Former vs never tobacco use3.11 (2.41 to 4.03)***1.76 (1.37 to 2.26)***1.82 (1.38 to 2.40)***
Physical interference due to pain0.91 (0.80 to 1.02)1.19 (1.06 to 1.34)**1.22 (1.08 to 1.39)**
General health1.03 (0.89 to 1.19)1.02 (0.89 to 1.17)1.09 (0.94 to 1.26)
Social interference due to health1.15 (1.04 to 1.28)**1.15 (1.04 to 1.26)**1.17 (1.06 to 1.30)**
*

P < .05,

**

P < .01,

***

P < .001.

Table 5 presents results of multivariable multinomial logistic regression models identifying correlates of cannabis use only before diagnosis, only after diagnosis, and before and after diagnosis. Compared with patients with cancer who never used cannabis, those who only used cannabis before diagnosis were more likely to be younger (OR = 0.97, 95% CI = 0.96 to 0.99), White (OR = 3.14, 95% CI = 1.48 to 6.66), a current smoker (OR = 2.80, 95% CI = 1.44 to 5.47), or a former smoker (OR = 3.02, 95% CI = 2.16 to 4.21). Compared with never users, patients with cancer who used cannabis only after diagnosis were more likely to be younger (OR = 0.97, 95% CI = 0.95 to 0.99), female (OR = 1.54, 95% CI = 1.02 to 2.31), and reporting interference with physical functioning due to pain (OR = 1.32, 95% CI = 1.09 to 1.60). Compared with never users, patients who used cannabis before and after cancer diagnosis were more likely to be younger (OR = 0.95, 95% CI = 0.93 to 0.96), White (OR = 2.22, 95% CI = 1.22 to 4.01), binge drinkers (OR = 2.04, 95% CI = 1.35 to 3.08), current smokers (OR = 5.50, 95% CI = 3.03 to 10.00), former smokers (OR = 3.86, 95% CI = 2.79 to 5.34), and report interference with social functioning due to health problems (OR = 1.24, 95% CI = 1.09 to 1.41).

Table 5.
Open in new tab

Results from multinomial logistic regression models examining factors associated with patterns of cannabis use

Cannabis only before diagnosis vs neverCannabis only after diagnosis vs neverCannabis before and after diagnosis vs never
Odds ratio (95% confidence interval)Odds ratio (95% confidence interval)Odds ratio (95% confidence interval)
Age at diagnosis0.97 (0.96 to 0.99)***0.97 (0.95 to 0.99)**0.95 (0.93 to 0.96)***
Male vs female1.34 (0.98 to 1.84)0.65 (0.43 to 0.98)*1.24 (0.91 to 1.67)
White vs other racial groups3.14 (1.48 to 6.66)**1.31 (0.65 to 2.64)2.22 (1.22 to 4.01)**
≥Some college vs <some college1.09 (0.76 to 1.54)0.79 (0.52 to 1.21)1.06 (0.76 to 1.47)
Current pain vs no pain0.96 (0.48 to 1.92)0.74 (0.31 to 1.78)0.75 (0.39 to 1.46)
Former pain vs no pain0.94 (0.68 to 1.31)1.01 (0.67 to 1.53)0.93 (0.68 to 1.28)
Binge drinking vs no binge drinking1.36 (0.87 to 2.14)0.69 (0.35 to 1.34)2.04 (1.35 to 3.08)***
Current vs never tobacco use2.80 (1.44 to 5.47)**1.81 (0.79 to 4.12)5.50 (3.03 to 10.00)***
Former vs never tobacco use3.02 (2.16 to 4.21)***1.44 (0.95 to 2.21)3.86 (2.79 to 5.34)***
Physical interference due to pain0.90 (0.76 to 1.06)1.32 (1.09 to 1.60)**1.06 (0.91 to 1.24)
General health1.04 (0.86 to 1.26)1.01 (0.80 to 1.27)1.03 (0.86 to 1.23)
Social interference due to health1.10 (0.96 to 1.27)1.09 (0.92 to 1.28)1.24 (1.09 to 1.41)**
Cannabis only before diagnosis vs neverCannabis only after diagnosis vs neverCannabis before and after diagnosis vs never
Odds ratio (95% confidence interval)Odds ratio (95% confidence interval)Odds ratio (95% confidence interval)
Age at diagnosis0.97 (0.96 to 0.99)***0.97 (0.95 to 0.99)**0.95 (0.93 to 0.96)***
Male vs female1.34 (0.98 to 1.84)0.65 (0.43 to 0.98)*1.24 (0.91 to 1.67)
White vs other racial groups3.14 (1.48 to 6.66)**1.31 (0.65 to 2.64)2.22 (1.22 to 4.01)**
≥Some college vs <some college1.09 (0.76 to 1.54)0.79 (0.52 to 1.21)1.06 (0.76 to 1.47)
Current pain vs no pain0.96 (0.48 to 1.92)0.74 (0.31 to 1.78)0.75 (0.39 to 1.46)
Former pain vs no pain0.94 (0.68 to 1.31)1.01 (0.67 to 1.53)0.93 (0.68 to 1.28)
Binge drinking vs no binge drinking1.36 (0.87 to 2.14)0.69 (0.35 to 1.34)2.04 (1.35 to 3.08)***
Current vs never tobacco use2.80 (1.44 to 5.47)**1.81 (0.79 to 4.12)5.50 (3.03 to 10.00)***
Former vs never tobacco use3.02 (2.16 to 4.21)***1.44 (0.95 to 2.21)3.86 (2.79 to 5.34)***
Physical interference due to pain0.90 (0.76 to 1.06)1.32 (1.09 to 1.60)**1.06 (0.91 to 1.24)
General health1.04 (0.86 to 1.26)1.01 (0.80 to 1.27)1.03 (0.86 to 1.23)
Social interference due to health1.10 (0.96 to 1.27)1.09 (0.92 to 1.28)1.24 (1.09 to 1.41)**
*

P < .05,

**

P < .01,

***

P < .001.

Table 5.
Open in new tab

Results from multinomial logistic regression models examining factors associated with patterns of cannabis use

Cannabis only before diagnosis vs neverCannabis only after diagnosis vs neverCannabis before and after diagnosis vs never
Odds ratio (95% confidence interval)Odds ratio (95% confidence interval)Odds ratio (95% confidence interval)
Age at diagnosis0.97 (0.96 to 0.99)***0.97 (0.95 to 0.99)**0.95 (0.93 to 0.96)***
Male vs female1.34 (0.98 to 1.84)0.65 (0.43 to 0.98)*1.24 (0.91 to 1.67)
White vs other racial groups3.14 (1.48 to 6.66)**1.31 (0.65 to 2.64)2.22 (1.22 to 4.01)**
≥Some college vs <some college1.09 (0.76 to 1.54)0.79 (0.52 to 1.21)1.06 (0.76 to 1.47)
Current pain vs no pain0.96 (0.48 to 1.92)0.74 (0.31 to 1.78)0.75 (0.39 to 1.46)
Former pain vs no pain0.94 (0.68 to 1.31)1.01 (0.67 to 1.53)0.93 (0.68 to 1.28)
Binge drinking vs no binge drinking1.36 (0.87 to 2.14)0.69 (0.35 to 1.34)2.04 (1.35 to 3.08)***
Current vs never tobacco use2.80 (1.44 to 5.47)**1.81 (0.79 to 4.12)5.50 (3.03 to 10.00)***
Former vs never tobacco use3.02 (2.16 to 4.21)***1.44 (0.95 to 2.21)3.86 (2.79 to 5.34)***
Physical interference due to pain0.90 (0.76 to 1.06)1.32 (1.09 to 1.60)**1.06 (0.91 to 1.24)
General health1.04 (0.86 to 1.26)1.01 (0.80 to 1.27)1.03 (0.86 to 1.23)
Social interference due to health1.10 (0.96 to 1.27)1.09 (0.92 to 1.28)1.24 (1.09 to 1.41)**
Cannabis only before diagnosis vs neverCannabis only after diagnosis vs neverCannabis before and after diagnosis vs never
Odds ratio (95% confidence interval)Odds ratio (95% confidence interval)Odds ratio (95% confidence interval)
Age at diagnosis0.97 (0.96 to 0.99)***0.97 (0.95 to 0.99)**0.95 (0.93 to 0.96)***
Male vs female1.34 (0.98 to 1.84)0.65 (0.43 to 0.98)*1.24 (0.91 to 1.67)
White vs other racial groups3.14 (1.48 to 6.66)**1.31 (0.65 to 2.64)2.22 (1.22 to 4.01)**
≥Some college vs <some college1.09 (0.76 to 1.54)0.79 (0.52 to 1.21)1.06 (0.76 to 1.47)
Current pain vs no pain0.96 (0.48 to 1.92)0.74 (0.31 to 1.78)0.75 (0.39 to 1.46)
Former pain vs no pain0.94 (0.68 to 1.31)1.01 (0.67 to 1.53)0.93 (0.68 to 1.28)
Binge drinking vs no binge drinking1.36 (0.87 to 2.14)0.69 (0.35 to 1.34)2.04 (1.35 to 3.08)***
Current vs never tobacco use2.80 (1.44 to 5.47)**1.81 (0.79 to 4.12)5.50 (3.03 to 10.00)***
Former vs never tobacco use3.02 (2.16 to 4.21)***1.44 (0.95 to 2.21)3.86 (2.79 to 5.34)***
Physical interference due to pain0.90 (0.76 to 1.06)1.32 (1.09 to 1.60)**1.06 (0.91 to 1.24)
General health1.04 (0.86 to 1.26)1.01 (0.80 to 1.27)1.03 (0.86 to 1.23)
Social interference due to health1.10 (0.96 to 1.27)1.09 (0.92 to 1.28)1.24 (1.09 to 1.41)**
*

P < .05,

**

P < .01,

***

P < .001.

Discussion

Self-reported rates of cannabis use among patients with cancer were 59% before diagnosis and 47% after diagnosis. Fewer than one-third of patients with cancer (30%) reported being current cannabis users. Consistent patterns emerged showing that cannabis use was more common among younger patients with cancer, those with greater interference with physical functioning due to pain, those with a history of tobacco use, and those who reported binge drinking in the prior month.

The rates of cannabis use we report are statistically significantly higher than published rates for patients with cancer in the range of 8% to 24% (1-6). Current use of cannabis (ie, within the prior month) in our study was 30%. Some of this difference can be attributed to further legalization of marijuana, both for recreational and medicinal purposes, throughout the United States and in the state of Florida. As of 2023, 38 states allowed medical use of cannabis, and 23 states allowed use of cannabis for nonmedical purposes (15). Use of cannabis for medical purposes has increased dramatically in Florida in the previous 6 years, with the number of patients registered to use medical marijuana expanding from 54 251 in 2017 (16) to 848 942 in 2023 (17). This explanation for the high rates of cannabis use we observed is underscored by more recent research examining current cannabis use among patients with cancer, such as 1 study reporting 31% of patients reporting ever using cannabis after their cancer diagnosis (18). This finding is similar to our reported rate of current cannabis use (30%); however, a higher rate (47%) reported using cannabis at any point after diagnosis. Thus, the potential for significant recent increases in the rates of cannabis use among patients with cancer should be further explored in future research.

Little research has examined correlates of cannabis use among patients with cancer. One recent study of patients in Denmark found that cannabis use was more common among patients with cancer using tobacco and reporting worse QOL (19). Another study in the United States found that younger patients and those with lower educational achievement were more likely to use cannabis (18). This finding is in line with our findings of higher rates of cannabis use among patients reporting worse physical and social functioning and using other substances (eg, tobacco, alcohol). Future studies in this area should examine whether cannabis use among patients with cancer is associated with changes in QOL or psychosocial outcomes.

Strengths of this study include a large sample of patients with cancer seen at an National Cancer Institute–Designated Cancer Center, the availability of QOL data from around the time of diagnosis, and the ability to identify patterns of cannabis use beyond current users vs nonusers. Limitations of this study include the potential for selection bias resulting from the requirement that patients have an e-mail address on file and limited racial and ethnic heterogeneity of the sample, although the sample demographics were approximately similar to that of the patients treated at this institution (20). Also, patients with cancer who used cannabis may have been more likely to participate in this survey study, and we only have limited data on nonresponders; thus, there is some risk for self-selection bias that may have influenced our results. The use of self-reported data regarding substance use may have introduced some social desirability bias, and the lack of formal validation of the cannabis survey measure limits the potential for comparisons across studies. Future investigators should consider objective measurement of current or recent cannabis use through biospecimen testing and use of validated self-report measures.

Our study suggests that rates of cannabis use among patients with cancer may be elevated compared with reports in the past few years. This study elucidates correlates of cannabis use, which may help clinicians identify patients likely to consider using cannabis and for whom such counseling may be warranted.

Data availability

To protect the privacy of individuals who participate in this study, individual-level data underlying this article, including protected health information, cannot be shared. Summary-level data may be requested by contacting the corresponding author Brian D. Gonzalez ([email protected]).

Author contributions

Brian D. Gonzalez, PhD (Conceptualization; Data curation; Formal analysis; Writing—original draft; Writing—review & editing), Xiaoyin Li, PhD (Data curation; Formal analysis; Writing—original draft; Writing—review & editing), Yessica C. Martinez, MPH (Investigation; Project administration), Heather S. L. Jim, PhD (Writing—original draft; Writing—review & editing), Laura B. Oswald, PhD (Writing—review & editing), Jessica Y. Islam, PhD (Writing—review & editing), Kea Turner, PhD (Writing—review & editing), Kathleen M. Egan, ScD (Conceptualization; Data curation; Funding acquisition; Investigation; Methodology; Project administration; Supervision; Writing—review & editing).

Funding

This study was supported in part by a grant from the National Cancer Institute (P30CA076292, PI: Cleveland). Additional support was provided by the following shared resources at the H. Lee Moffitt Cancer Center: Biostatistics and Bioinformatics Shared Resource; Collaborative Data Services Core; and Participant Research, Interventions, and Measurement.

Monograph sponsorship

This article appears as part of the monograph “Cannabis Use Among Cancer Survivors,” sponsored by the National Cancer Institute.

Conflicts of interest

B.D.G. received honoraria from Sure Med Compliance and Elly Health.

H.S.L.J. has consulted for SBR Bioscience and received grant funding from Kite Pharma. All the other authors declare no potential conflicts of interest.

Acknowledgments

Ethics approval and consent to participate: Total Cancer Care (MCC# 14690/Advarra IRB# Pro00014441).

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Author notes

Brian D. Gonzalez and Xiaoyin Li contributed equally to this work.

© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For permissions, please email: [email protected]
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