Patient-reported experiences with cannabidiol (CBD) after cancer diagnosis.
Authors: Salz Talya , Mao Jun J. , Raghunathan Nirupa Jaya , Jinna Sankeerth , Brens Jessica , Korenstein Deborah , Furberg Helena , Chino Fumiko 
Published: June 2024

e24077 Background: Cannabis is used by almost a third of patients with cancer. However, the use of CBD, a cannabis product with minimal psychoactive effects, is unknown. Although there is some evidence of symptom mitigation (e.g. anxiety, pain, insomnia) in various populations, the harms and benefits of CBD are not well established, particularly in cancer. We sought to evaluate patterns of CBD use among patients with cancer and describe patient-reported use and experiences. Methods: Patients with 9 different cancers treated at an academic, comprehensive cancer center between March and August 2021 completed an anonymous survey eliciting experiences with, and attitudes toward, CBD use. Proportions for each survey item were reported with missing responses excluded from the denominator. Chi-squared tests compared sociodemographic and clinical characteristics between CBD users and non-users. Results: Among 1258 respondents (52% female, 81% white, median age 63), 18% percent (N = 226) used CBD after cancer diagnosis. Among the 12% (N = 150) of patients who used CBD during treatment, the most common modes of use were ingestion of tincture (45%, N = 99) and eating in food (41%, N = 90). More than half (54%, N = 81) used CBD a few times a week or more. Patients who were younger, had gastrointestinal or brain cancer, or who used CBD prior to diagnosis were more likely to use CBD after diagnosis (p < 0.05 for all). Most patients who used CBD after diagnosis did so to relieve symptoms (92%, N = 204), most commonly pain (56%, N = 125), difficulty sleeping (48%, N = 107); stress, anxiety, or depression (36%, N = 80); and neuropathy (18%, N = 40). Among respondents who used CBD to improve these symptoms, most reported improvement, with the highest reported benefit for stress, anxiety, and depression (74%), sleep issues and pain (71% each) and neuropathy (60%); 21-38% reported no change in symptoms, and 0-3% reported that any symptom worsened after CBD use. Of the 47% (N = 104) who used CBD at any time since diagnosis but stopped, the most commonly reported reasons were that that it did not help (30%, N = 31) and that the cost was too high (25%, N = 26). Among 50 patients who considered CBD but opted against it, the most common reported reasons were uncertainty about safety and effectiveness (28%, N = 14) and belief that CBD would not help (28%, N = 14). Conclusions: In a large sample of patients with cancer, about a fifth used CBD after diagnosis. Patients used CBD mostly for symptom relief, with many reporting benefit for key patient concerns of stress, sleep, and neuropathy. About half who used CBD however stopped, often due to either ineffectiveness or cost. Patients who decided against using CBD also cited uncertainty about effectiveness and safety. Because CBD is widely available and frequently used by patients, research to determine benefits and harms of CBD is critically needed to inform decisions about CBD use during cancer care.