Abstract P5-09-02: Symptom profile of breast cancer patients seeking medical cannabis in Pennsylvania’s new medical marijuana program
Authors: Hibbs Julianne , Weiss Marisa , Ali Zonera , Shevade Aarti , Leitenberger Adam , Bowman-Jenkins Melissa , Gilman Paul 
Published: March 2020

Abstract
Background: Little is known about the role of medical cannabis in the care of breast cancer patients. Cancer is 1 of 17 medical conditions in the 2018 launch of Pennsylvania’s Medical Marijuana Program (PA MMP), requiring physician qualification followed by an evaluation by an HCP (usually a pharmacist) at a medical marijuana dispensary. To help reduce this knowledge gap, we analyzed the symptoms for which breast cancer patients sought medical cannabis.
Methods: One breast oncologist at Lankenau Medical Center, a community academic hospital, performed all patient certifications after taking the following steps: history and physical examination; review of all medications, including the Prescription Monitoring Program database, for drug-drug-interactions; and informed consent. The dispensary and cannabis products utilized were chosen by the patient. EMR and PA MMD records of all patients certified in the first 10 months of the PA MMP were analyzed. There was no access to the dispensaries’ database.
Results: Of the 54 cancer patients certified, 31 had breast cancer: 22 had non-metastatic disease and 9 had metastatic disease. Median age was 64 (range, 26 - 86).
Of the 22 women with non-metastatic disease, 16 (73%) sought cannabis for pain, of whom 4/16 (25%) had chemotherapy-induced peripheral neuropathy (CIPN), 3/16 (19%) had exacerbation of pre-existing muscle/joint pain from hormonal therapy. 11/22 (50%) had insomnia and 10/22 (45%) had anxiety—of whom 8 had both. 1 of 22 had nausea. 3 recreational users wanted to shift to medical grade products.
The 9 patients with metastatic breast cancer sought medical cannabis for: cancer pain (8/9, 89%), anxiety (8/9, 89%); insomnia (3/9, 33%), anorexia (3/9, 33%), and nausea (3/9, 33%).
Patients had an average of 3 symptoms. About half of patients with pain expressed a fear of opioid use and wanted to avoid, stop, or reduce its use. All patients sought a medical solution for symptom relief; only 2 also admitted a desire to get high.
The qualifying physician mainly recommended a CBD-dominant sublingual preparation. Topical products applied to focal areas of pain were also commonly suggested. Except for immediate relief of acute pain, smoking and vaping were strongly discouraged to avoid lung toxicity, especially during radiation and chemotherapy. As the PA MMP physician-facing patient-certification database does not interface with the dispensaries’ database, the product type, dose, source, and method of delivery purchased by each patient are unknown.
Conclusion: Women with non-metastatic and metastatic breast cancer sought medical cannabis for symptomatic management of pain (73-89%, resp), anxiety (45-89%, resp), insomnia (50-33%, resp), nausea (4% and 33%, resp), and anorexia (0 and 33%). Patients reported an average of 3 symptoms. Pain was rarely experienced alone. Insomnia and anxiety were frequently combined. Other benefits of medical cannabis included the use of safer products (eg with less fungus and pesticides than recreational sources) and a shift to safer methods of delivery (eg. sublingual preparations vs. smoking or vaping). Fear of opioids motivated patients to avoid, reduce or stop opioids. For optimal continuity of care, the physician and dispensary databases must be integrated.
Citation Format: Julianne Hibbs, Marisa Weiss, Zonera Ali, Aarti Shevade, Adam Leitenberger, Melissa Bowman-Jenkins, Paul Gilman. Symptom profile of breast cancer patients seeking medical cannabis in Pennsylvania’s new medical marijuana program [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-09-02.