Background: Head and neck cancer (HNC) comprises over 5,000 new cases in Canada each year. Due to the critical role of head and neck anatomy in function, body image, and socialization, patients treated have potentially unique survivorship needs. The prospect for swallowing, speaking, as well as aesthetic disfigurement often brings about it quality of life (QOL) issues including stress, anxiety, and depression. Marijuana is the most widely used illicit substance in Canada and will likely only increase after it’s impending legalization in Canada. Cannabis sativa has a unique ability to facilitate relaxation and relieve anxiety as well as improving pain, but no study has currently look at QOL issues in relation to the use of this illicit drug in newly diagnosed HNC patients.
Objective: To examine the difference in QOL issues between marijuana users and non-users who have newly diagnosed HNC.
Methods: Patients were enrolled consecutively and prospectively at the time of HNC diagnosis from January 2011 to January 2015. All patients were diagnosed and treated at a tertiary care cancer center. Patient who are current marijuana users were identified from the database. These patients were then case matched to non-marijuana users in a 1-to-1 scheme based on age, gender, and tumor subsite. Patient demographic and quality of life data were all collected prospectively. We utilized the EQ5D and the Edmonton Symptom Assessment System (ESAS) questionnaires as QOL life measures. . All QOL instruments were administered prospectively and at the time of patient accrual.
Results: Seventy-four patients were included in each group. Within the group of marijuana users, the mean age was 62 years with a mean follow-up of 24.2 months. There was no statistical significance difference (p>0.05) in age, gender, tumor subsite, and clinical TNM staging between the marijuana user and non-user group. On univariate analysis there was no statistical significant difference in the mobility (p=0.587), self-care (p=0.133), and usual activities (p=0.226) domains of the EQ5D. Marijuana users had significantly lower scores in the Anxiety/Depression (p<0.0001) and the Pain/Discomfort (p=0.044) domains. Wilcox Rank Test confirmed the results with improvement in Pain/Discomfort (z=-2.602, p=0.04) and Anxiety/Depression (z=-6.707, p<0.0001). There was no statistical significant difference on univariate analysis in the pain (p=0.101) and nausea (p=0.232) on the ESAS questionnaire. However, marijuana users however had less pain (p=0.04), were less tired (p=0.001), had lower scores of depression (p<0.0001), were less anxious (p<0.0001), had more appetite (p=0.025), were less drowsy (p<0.0001) as well as had a better sense of general well-being (p=0.003). A Wilcox-Rank test confirmed a statistically significant improvement in ESAS: anxiety (z=-10.04, p<0.0001), pain (z=-2.473, p=0.01), tiredness (z=-4.95, p<0.0001), depression (z=-5.901, p<0.0001), drowsiness (z=-5.454, p<0.0001), appetite (z=-4.021, p<0.0001), and well-being (z=-4.588, p<0.0001) domains.
Conclusions: Our case-matched study based on a prospective database shows that there may be significant QOL benefit, including decreased anxiety, pain, depression, as well as increased appetite and generalized well-being to marijuana usage in newly diagnosed HNC patients. Future long-term studies will be required to quantify the potential benefit of marijuana in HNC survivorship.