Marijuana Utilization in Cancer Patients: A Comprehensive Analysis of National Health and Nutrition Examination Survey Data from 2005-2014

Abstract

Cannabis can improve symptoms of nausea and anorexia and may even serve as an alternative to narcotic pain medication in cancer patients. Data on substance use, including marijuana utilization, in cancer patients is limited. We used a population-based dataset to examine the utilization of marijuana and other substance use among cancer patients. We hypothesized that the use of marijuana among cancer patients would be greater than non-cancer patients and that it would increase in more recent years. Publicly available population-based datasets from the National Health and Nutrition Examination Survey (NHANES) were compiled for respondents aged 20-60 for years 2005 to 2014, based on availability of data for two variables of interest - cancer diagnosis and marijuana utilization. Propensity scores were calculated for each subject based on age, sex, race, education, and self-reported health status, then cases (respondents with a cancer diagnosis) were matched 1:2 to controls (respondents with no cancer diagnosis). Behavioral characteristics (current [within past 30 days] and recent [within past 12 months] marijuana use; smoking; binge alcohol; illicit drugs; and prescription narcotics) were compared between cancer patients and propensity score matched controls. Univariable logistic regressions and two-proportion Z-tests were performed; two tailed P < 0.05 was considered significant. Of 19,604 respondents, 826 cancer patients were matched to 1,652 controls. Among cancer patients, 40.3% currently used marijuana compared with 38.0% of non-cancer patients. Cancer patients were more likely to smoke cigarettes (odds ratio [OR] = 1.26, 95% CI = 1.07-1.49; P = 0.007), and take prescription narcotics (OR = 2.36, 95% CI = 1.79-3.12; P < 0.0001), with a trend toward being more likely to currently use marijuana (OR = 1.35, 95% CI = 0.99-1.84; P = 0.056). There was no difference in binge alcohol or illicit substance use among respondents. Cancer patients using marijuana in the last 12 months were more likely to take prescribed narcotics (OR = 1.90, 95% CI = 1.28-2.82; P = 0.0015). Among cancer patients, current marijuana utilization increased significantly over 10 years (Z = 2.20; P = 0.028) but prescription narcotic use did not (Z = 1.78, P = 0.08). From 2005-2014, the proportion of cancer patients currently using marijuana increased by 20.8%, compared with 4.6% among non-cancer patients. In this population-based dataset, 40% of cancer patients reported current marijuana use, and utilization of marijuana increased significantly over the last 10 years among these patients. Cancer patients using marijuana in the last year were more likely to take prescription narcotics. This work provides insight into the evolving role of cannabis use among cancer patients and as a potential adjunct to narcotic pain medication.