Cannabis and Cannabinoid Use and Perceptions in Patients with Plasma Cell Disorders: A National Healthtree Foundation for Multiple Myeloma Survey

Cannabis/cannabinoid use continues to increase among cancer patients, with studies supporting its efficacy for cancer- and treatment-related symptoms. Despite this, lack of high-quality data and regulatory challenges have caused hesitancy among providers to recommend its use. We previously demonstrated a negative risk of chronic opioid use on survival in myeloma patients (Sweiss et al, ASH abstract 2022). Given this, we aimed to improve our understanding of patient-reported efficacy and safety of cannabis, with emphasis on its role as an alternative analgesic. Using the HealthTree Cure Hub, we prospectively administered a 23-question survey to patients with plasma cell disorders.Among 348 respondents, average age was 63.8 ± 12.4 years. Most were female (n=195, 58%). 259 (91%) were White and 22 (9%) were Black. 166 (48%) reported using cannabis during treatment for their MM, with 78 (47%) describing use as regular (weekly for ≥ 1 month). Prior cannabis use predicted for continued use during treatment for MM (p<0.001). Most reported using both THC- and CBD-containing products (60%). The most common formulations were edibles (76%), smoking/vaping (48%), tincture/oil (34%), and topical agents (31%). 124 (77%) obtained cannabis illegally or reported growing their own (n=33, 20%). Indications for use were pain (71%), sleep (73%), depression (32%), anxiety (29%), and stress reduction. A high prevalence of side effects was reported including dry mouth (50%), brain fog (50%), and dizziness (14%). Concern over high cost (27%) and side effects/drug interactions/dosing (51%) were identified as barriers experienced during cannabis use, while “fear of addiction” (4%) was rare.195 (57%) patients reported never having a discussion with their oncologist about cannabis. Among those who did, it was ultimately initiated by the patient (89%). Most perceived that the oncologist was “somewhat” (40%) or “not at all” (27%) able to discuss the risks/benefits (Fig A). Only 22 (15%) reported that the oncologist made a referral to a specialist. When used for pain, cannabis was indicated to be “mostly/completely effective” (50%) or “somewhat effective” (28%). 52 (32%) were able to avoid taking opioids all together, while 28 (17%) were able to reduce the dose of opioids (Fig B).We observed a high frequency of cannabis use in patients with plasma cell disorders undergoing treatment, including autologous transplant. Most expressed benefit despite side effects and an association with prevention or reduction in opioid use. A high number of respondents believed that the provider's role in recommending cannabis, having knowledge on the topic, or making referrals was minimal. Prospective studies evaluating the efficacy and safety of cannabis products in MM is of high priority.