Brooke Worster

Stigma associated with cannabis use remains a significant barrier not only to patient access but also to the participation and interest of underrepresented populations in clinical trials. This perspective explores how participant recruitment may be affected by stigma, and how strategies to reduce this can enhance trial recruitment and increase treatment access. Drawing on current research being conducted, including research on cannabis disclosure stigma and its impact on cancer patients, as well as relevant literature through 2026, this paper proposes a framework that advocates for culturally responsive recruitment strategies to address these barriers and increase the diversity and success of clinical trials.

Cannabis use for symptom management among patients with cancer has increased in recent years, with many reporting benefits for pain, anxiety, sleep, nausea, and appetite, as well as other symptoms. However, rigorous prospective data on the potential benefits and harms of cannabis use in this population are lacking. This commentary describes a US National Cancer Institute–led initiative addressing this research gap by supporting 5 prospective observational studies evaluating the benefits and harms of cannabis use among a large heterogeneous sample of patients with cancer undergoing active systemic treatment. We provide an overview of each study, including cancer type, treatment modalities, inclusion and exclusion criteria, data collection methods, and patient-reported and cancer-related outcomes.

Background: Malnutrition and food insecurity are common challenges among patients with cancer. Nutrition interventions can support patient nutrition needs and quality of life during cancer treatment, though measures to assess impact of interventions are lacking. In prior work, our team developed a Nutrition Experience Survey to assess patient-important domains related to impact of nutrition interventions during cancer treatment, from which a 9-item food-related and nutrition-related quality-of-life (FN-QoL) measure emerged. In this work, we report results from administering the overall Nutrition Experience Survey, including the FN-QoL measure, to a sample of patients with cancer and present initial validity testing of the FN-QoL measure. Methods: This is a cross-sectional survey study in which we administered the Nutrition Experience Survey to a convenience sample of English-speaking patients with cancer in Philadelphia, Pennsylvania. Survey responses were summarised with descriptive statistics. Validity and internal consistency of the FN-QoL measure were evaluated with bivariate correlation matrices and Cronbach’s alpha followed by a multiple linear regression analysis. Results: 117 individuals completed the survey: mean age 62 (21–90), 49.6% white, 58.3% women. Cronbach’s alpha confirmed adequate internal consistency (0.856) for the FN-QoL. The bivariate correlation matrix indicated that the FN-QoL was correlated with items as expected (eg, poorer subject health ratings, r =−0.48, pr =0.38, p<0.05). Multiple linear regression found that receipt of medically tailored meals and treatment-related symptoms were related to FN-QoL when adjusting for all other variables. Conclusion: Results suggest validity and potential utility of the FN-QoL measure to assess impact of food and nutrition interventions on quality of life among patients with cancer. Future work should assess applicability of this tool across populations who do not have cancer and sensitivity of this measure to change over time related to receipt of nutrition interventions.

Objective: Effective, non-pharmacological approaches to pain management for people with advanced cancer that can enhance quality of life while minimizing adverse effects are urgently needed. While music therapy has been demonstrated to be effective in reducing pain and improving pain-related outcomes across various patient populations, it has not been specifically examined in addressing chronic pain among people with advanced cancer. This study aims to enhance understanding of how people with advanced cancer experience music therapy for pain management. Methods: As part of a mixed methods intervention trial, we conducted semi-structured interviews with a subsample of 25 outpatients with advanced cancer (Stage 3 & 4) and chronic pain who had participated in 6 music therapy sessions designed to address psychosocial factors known to exacerbate the experience of chronic pain. We analyzed the interview transcripts using theoretical thematic analysis. Results: The findings suggest that engagement in music therapy enhanced psychosocial well-being, contributed to better pain management, and helped build early therapeutic rapport. Participants emphasized that co-creating and engaging in active music making enhanced their self-efficacy as they learned to use music to improve emotional regulation skills, increase physical functioning, relax, and decrease their medication use. Conclusion: Music therapy’s role in pain management goes beyond distraction and relaxation to include stress reduction, emotional expression, enhanced self-efficacy, and therapeutic connection and support through shared musical experiences. Incorporating board-certified music therapists into psycho-oncology care teams can help enable patients to effectively harness music as a daily tool for symptom management.

Objective: To improve mechanistic understanding, this randomized controlled trial examined anxiety, mood, emotional support, and pain‐related self‐efficacy as mediators of music therapy for pain management in people with advanced cancer.Methods: People with advanced cancer who had chronic pain were randomized (1:1) to 6 weekly individual music therapy or social attention control sessions. We measured mediators and pain outcomes (pain interference and pain intensity) using self‐report measures at baseline, session 4, and post‐intervention. We included outcome expectancy/treatment credibility, music reward, adult playfulness, and baseline pain interference and pain intensity as moderators.Results: Participants (n = 92) had a mean age of 56 years. Most were female (71.7%), white (47.8%) or Black (39.1%), and had stage IV cancer (75%). Self‐efficacy was found to be a significant mediator of music therapy for pain intensity (indirect effect ab = 0.79, 95% CI 0.01–1.82) and pain interference (indirect effect ab = 1.16, 95% CI 0.02–2.51), while anxiety, mood, and emotional support were not. The mediating effect of pain‐related self‐efficacy was significantly moderated by baseline pain interference but not by the other moderators.Conclusions: The findings suggest that the impact of music therapy on chronic pain is mediated by self‐efficacy. This knowledge can help optimize music therapy interventions for chronic pain management for people with advanced cancer by capitalizing on teaching music‐based self‐management strategies.Trial Registration: ClinicalTrials.gov identifier: NCT03432247

Background: The legal climate for cannabis use has dramatically changed with an increasing number of states passing legislation legalizing access for medical and recreational use. Among cancer patients, cannabis is often used to ameliorate adverse effects of cancer treatment. Data are limited on the extent and type of use among cancer patients during treatment and the perceived benefits and harms. This multicenter survey was conducted to assess the use of cannabis among cancer patients residing in states with varied legal access to cannabis. Methods: A total of 12 NCI-Designated Cancer Centers, across states with varied cannabis-access legal status, conducted surveys with a core questionnaire to assess cannabis use among recently diagnosed cancer patients. Data were collected between September 2021 and August 2023 and pooled across 12 cancer centers. Frequencies and 95% confidence intervals for core survey measures were calculated, and weighted estimates are presented for the 10 sites that drew probability samples. Results: Overall reported cannabis use since cancer diagnosis among survey respondents was 32.9% (weighted), which varied slightly by state legalization status. The most common perceived benefits of use were for pain, sleep, stress and anxiety, and treatment side effects. Reported perceived risks were less common and included inability to drive, difficulty concentrating, lung damage, addiction, and impact on employment. A majority reported feeling comfortable speaking to health-care providers though, overall, only 21.5% reported having done so. Among those who used cannabis since diagnosis, the most common modes were eating in food, smoking, and pills or tinctures, and the most common reasons were for sleep disturbance, followed by pain and stress and anxiety with 60%-68% reporting improved symptoms with use. Conclusion: This geographically diverse survey demonstrates that patients use cannabis regardless of its legal status. Addressing knowledge gaps concerning benefits and harms of cannabis use during cancer treatment is critical to enhance patient-provider communication.

Background: Supportive oncology (SO) care reduces symptom severity, admissions, and costs in patients with advanced cancer. This study examines the impact of SO care on utilization and costs.Methods: Retrospective analysis of utilization and costs comparing patients enrolled in SO versus three comparison cohorts who did not receive SO. Using claims, the authors estimated differences in health care utilization and cost between the treatment group and comparison cohorts. The treatment group consisting of patients treated for cancer at an National Cancer Institute‐designated cancer center who received SO between January 2018 and December 2019 were compared to an asynchronous cohort that received cancer care before January 2018 (n = 60), a contemporaneous cohort with palliative care receiving SO care from other providers in the Southeastern Pennsylvania region during the program period (n = 86), and a contemporaneous cohort without palliative care consisting of patients at other cancer centers who were eligible for but did not receive SO care (n = 393).Results: At 30, 60, and 90 days post‐enrollment into SO, the treatment group had between 27% and 70% fewer inpatient admissions and between 16% and 54% fewer emergency department visits (p < .05) compared to non‐SO cohorts. At 90 days following enrollment in SO care, total medical costs were between 4.4% and 24.5% lower for the treatment group across all comparisons (p < .05).Conclusions: SO is associated with reduced admissions, emergency department visits, and total costs in advanced cancer patients. Developing innovative reimbursement models could be a cost‐effective approach to improve care of patients with advanced cancer.

There is growing interest in cannabis use for cancer pain. This commentary aims to discuss the evidence surrounding cannabis use for cancer pain in the context of the long‐racialized landscape of cannabis policies and the disparity in pain control among cancer patients holding minoritized racial identities. Much evidence surrounding both the benefits and harms of cannabis use in cancer patients, and all patients in general, is lacking. Although drawing on the research in cancer that is available, it is also important to illustrate the broader context about how cannabis’ deep roots in medical, political, and social history impact patient use and health care policies. There are lessons we can learn from the racialized disparities in opioid risk mitigation strategies, so they are not replicated in the settings of cannabis for cancer symptom management. Additionally, the authors intentionally use the term “cannabis” here rather than “marijuana.: In the early 1900s, the lay press and government popularized the use of the word “marijuana” instead of the more common “cannabis” to tie the drug to anti‐Mexican prejudice.