The burden of cannabis use disorder (CUD) in the context of its prevalence and subsequent cardiopulmonary outcomes among cancer patients with severe sepsis is unclear.

To address this knowledge gap, especially due to rising patterns of cannabis use and its emerging pharmacological role in cancer.

By applying relevant International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification codes to the National Inpatient Sample database between 2016-2020, we identified CUD(+) and CUD(-) arms among adult cancer admissions with severe sepsis. Comparing the two cohorts, we examined baseline demographic characteristics, epidemiological trends, major adverse cardiac and cerebrovascular events, respiratory failure, hospital cost, and length of stay. We used the Pearson χ² d test for categorical variables and the Mann-Whitney U test for continuous, non-normally distributed variables. Multivariable regression analysis was used to control for potential confounders. A P value ≤ 0.05 was considered for statistical significance.

We identified a total of 743520 cancer patients admitted with severe sepsis, of which 4945 had CUD. Demographically, the CUD(+) cohort was more likely to be younger (median age = 58 vs 69, P < 0.001), male (67.9% vs 57.2%, P < 0.001), black (23.7% vs 14.4%, P < 0.001), Medicaid enrollees (35.2% vs 10.7%, P < 0.001), in whom higher rates of substance use and depression were observed. CUD(+) patients also exhibited a higher prevalence of chronic pulmonary disease but lower rates of cardiovascular comorbidities. There was no significant difference in major adverse cardiac and cerebrovascular events between CUD(+) and CUD(-) cohorts on multivariable regression analysis. However, the CUD(+) cohort had lower all-cause mortality (adjusted odds ratio = 0.83, 95% confidence interval: 0.7-0.97, P < 0.001) and respiratory failure (adjusted odds ratio = 0.8, 95% confidence interval: 0.69-0.92, P = 0.002). Both groups had similar median length of stay, though CUD(+) patients were more likely to have higher hospital cost compared to CUD(-) patients (median = 94574 dollars vs 86615 dollars, P < 0.001).

CUD(+) cancer patients with severe sepsis, who tended to be younger, black, males with higher rates of substance use and depression had paradoxically significantly lower odds of all-cause in-hospital mortality and respiratory failure. Future research should aim to better elucidate the underlying mechanisms for these observations.

• Cannabis/marijuana
• Sepsis
• Cardiovascular outcomes
• Major adverse cardiac and cerebrovascular events
• Pulmonological complications
• Cancer

• pain
• symptoms and symptom management

• Humans
• Medical Marijuana/therapeutic use
• Male
• Cross-Sectional Studies
• Female
• Middle Aged
• Cancer Pain/drug therapy
• Aged
• Pain, Intractable/drug therapy
• Pain, Intractable/etiology
• Pain Management/methods
• Adult
• Neoplasms/complications

• ipilimumab
• marijuana
• nivolumab
• pembrolizumab

• T32 ES007060-31A1 NIEHS NIH HHS

• Cancer
• Supportive care
• Symptoms and symptom management

• Humans
• Young Adult
• Cannabis
• Medical Marijuana/therapeutic use
• Surveys and Questionnaires
• Pain/complications
• Anxiety
• Neoplasms/epidemiology
• Neoplasms/complications

• cannabinoid receptors
• cannabis
• endocannabinoid system
• immune checkpoint inhibitor
• tumor microenvironment

• KLI 887 Austrian Science Fund FWF
• P 33325 Austrian Science Fund FWF
• Austrian Science Fund

• Cancer patients
• Cannabis use
• Depression
• National Health and Nutrition Examination Survey
• Patient’s Health Questionnaire-9

• Cancer
• Cannabis
• Cross-sectional studies
• Health communication
• Palliative care

• Humans
• Male
• Cannabis
• Testicular Neoplasms
• Lung Neoplasms
• Anxiety
• Anxiety Disorders

• P30 CA008748 NCI NIH HHS
• P30 CA008748) NIH HHS

• medical cannabis
• outpatient palliative care
• pain management
• shared decision making
• symptom management

Cannabis, as a natural medicinal remedy, has long been used for palliative treatment to alleviate the side effects caused by diseases. Cannabis-based products isolated from plant extracts exhibit potent immunoregulatory properties, reducing chronic inflammatory processes and providing much needed pain relief. They are a proven effective solution for treatment-based side effects, easing the resulting symptoms of the disease. However, we discuss the fact that cannabis use may promote the progression of a range of malignancies, interfere with anti-cancer immunotherapy, or increase susceptibility to viral infections and transmission. Most cannabis preparations or isolated active components cause an overall potent immunosuppressive impact among users, posing a considerable hazard to patients with suppressed or compromised immune systems. In this review, current knowledge and perceptions of cannabis or cannabinoids and their impact on various immune-system components will be discussed as the “two sides of the same coin” or “double-edged sword”, referring to something that can have both favorable and unfavorable consequences. We propose that much is still unknown about adverse reactions to its use, and its integration with medical treatment should be conducted cautiously with consideration of the individual patient, effector cells, microenvironment, and the immune system.

(1) Background: In November 2017, medical cannabis was legalized in Poland. Until now, there have been no studies conducted to examine the perspectives of Polish physicians about their preferences regarding medical cannabis legal status and educational needs. (2) Methods: The survey was a self-developed online questionnaire with 57 participants. Participation was voluntary. The link was shared through a personal network of medical doctors, regional medical chambers, and with doctors attending palliative care courses organized by our research group. Results: Between June and October 2020, 173 HCPs from Poland completed the survey. More than half of the study participants never received any education on medical cannabis (60.1%); 71.1% declared their knowledge was insufficient to counsel patients about medical cannabis use. The majority claimed that they would like to be able to answer patient questions (92.4%); 93.1% declared a need to create clear guidelines for using cannabinoids in clinical practice. Furthermore, 71.7% believed that medicines containing cannabinoids and 52.0% that herbal cannabis should be reimbursed (3). Conclusion: Most medical doctors do not feel prepared for patient counseling. They could benefit from targeted educational interventions. We have also identified physicians’ preferences that might inspire the stakeholders involved who are critical for shaping policies regarding cannabis-based therapeutics.

• Poland
• cannabinoids
• education
• medical cannabis
• perspectives
• physicians
• survey

• cannabidiol
• cannabinoids
• cannabis
• marijuana
• proteomics
• tetrahydrocannabinol

• Alzheimer Disease/drug therapy
• Analgesics/therapeutic use
• Cannabinoid Receptor Agonists/therapeutic use
• Cannabinoids/genetics
• Cannabinoids/therapeutic use
• Cannabis/genetics
• Glaucoma/drug therapy
• Humans
• Multiple Sclerosis/drug therapy
• Parkinson Disease/drug therapy
• Proteome/drug effects
• Proteome/genetics
• Proteomics
• Schizophrenia/drug therapy

Cannabis sativa L. is a source of over 150 active compounds known as phytocannabinoids that are receiving renewed interest due to their diverse pharmacologic activities. Indeed, phytocannabinoids mimic the endogenous bioactive endocannabinoids effects through activation of CB1 and CB2 receptors widely described in the central nervous system and peripheral tissues. All phytocannabinoids have been studied for their protective actions towards different biological mechanisms, including inflammation, immune response, oxidative stress that, altogether, result in an inhibitory activity against the carcinogenesis. The role of the endocannabinoid system is not yet completely clear in cancer, but several studies indicate that cannabinoid receptors and endogenous ligands are overexpressed in different tumor tissues. Recently, in vitro and in vivo evidence support the effectiveness of phytocannabinoids against various cancer types, in terms of proliferation, metastasis, and angiogenesis, actions partially due to their ability to regulate signaling pathways critical for cell growth and survival. The aim of this review was to report the current knowledge about the action of phytocannabinoids from Cannabis sativa L. against cancer initiation and progression with a specific regard to brain, breast, colorectal, and lung cancer as well as their possible use in the therapies. We will also report the known molecular mechanisms responsible for such positive effects. Finally, we will describe the actual therapeutic options for Cannabis sativa L. and the ongoing clinical trials.

• Cannabis sativa L.
• cancer therapeutic agents
• inflammation
• phytocannabinoids