A Prospective Cohort Study of Patients with Non-Small Cell Lung Cancer and Multiple Myeloma to Assess the Benefits and Harms Related to Cannabis Use During Treatment

随着大多数美国人支持医用大麻合法化，要求他们的病人数量增加。 临床医生对医用大麻的了解也大大增加。然而，许多临床医生认为， 对医用大麻的功效、副作用和滥用潜力了解不足。一 一项全国性的肿瘤学家调查报告说，只有30%的人感到有足够的信息来提出建议 关于医用大麻的使用，尽管80%的人定期进行关于医用大麻的对话， 和病人一起。华盛顿州的一项研究发现，21%的癌症患者曾使用大麻 在过去的一个月里。尽管许多患者普遍认为大麻等草药疗法是 由于大麻本身是安全的，越来越多的证据表明，对大麻需要更加谨慎，因为它可能具有潜在的 直接的副作用，并可能导致大麻等草药和药物之间的相互作用。因此， 关于癌症患者在癌症活动期间使用大麻的知识存在重大差距 这项前瞻性队列研究旨在解决这些问题。本研究旨在评估 肺癌和多发性骨髓瘤患者使用大麻的流行率和模式 在积极治疗期间，以及询问有关大麻使用的通信模式， 治疗医疗队。为了减少癌症类型之间存在的复杂变量， 治疗，我们将研究两个独特的癌症人群-非小细胞肺癌（NSCLC）和多 骨髓瘤（MM），每个队列分别研究。这些患者提供了一个同质的人群， 癌症患者通常有标准化的治疗方案。癌症患者目前接受 在接受手术之前（新辅助）或之后（辅助）接受铂类化疗， PD-1抑制剂（一种免疫检查点抑制剂（ICI），例如，纳武单抗）。新诊断的MM患者 推荐接受来那度胺、硼替佐米和地塞米松（RVd）诱导治疗， 6个月后进行自体干细胞移植（ASCT）。这两个群体提供了独特的 研究大麻使用对实体瘤和血液癌的影响的机会， 化疗对于NSCLC队列，我们还将评估大麻对免疫治疗疗效的影响。 对于MM队列，我们将评估ASCT期间大麻的影响。同时，我们将调查肿瘤学 医疗保健提供者关于他们对大麻使用的看法，教育和实践模式， 患者数据收集将包括有关所有药物的信息，包括处方药、 为了评估潜在药物相互作用的发生率， 大麻我们假设接受癌症治疗的患者中有相当一部分使用 大麻（~20%），大麻相关的好处和危害基于癌症的不同模式 类型和治疗以及患者人口统计学（包括社会经济因素）。

With the majority of Americans supporting legalization of medical cannabis, the number of patients asking their clinicians about medical cannabis has also significantly increased. Many clinicians, however, feel that they have inadequate knowledge about the efficacy, side effects, and abuse potential of medical cannabis. One national survey of oncologists reported that only 30% felt sufficiently informed to make recommendations regarding medical cannabis use, even though 80% regularly conducted conversations about medical cannabis with patients. A study from Washington State found 21% of patients with cancer surveyed had used cannabis in the past month. Despite the common belief among many patients that herbal therapies such as cannabis are inherently safe, the evidence is growing that greater caution is needed with cannabis as it may have potential direct side effects and may lead to interactions between herbs such as cannabis and medications. Thus, an important knowledge gap exists regarding the use of cannabis by patients with cancer during active cancer treatment, and this prospective cohort study is proposed to address these questions. This study aims to assess the prevalence and patterns of cannabis use among patients with cancers of the lung and multiple myeloma during active treatment as well as inquire about the communication patterns regarding cannabis use with their treating medical team. In order to reduce the complex variables that exist between the types of cancers and treatments, we will study two unique cancer populations – non-small cell lung cancer (NSCLC) and multiple myeloma (MM), with each cohort studied separately. These patients provide a homogenous population of patients with cancer that have generally standardized treatment regimens. Cancer patients currently receive platinum-based chemotherapy either before (neoadjuvant) or after (adjuvant) receiving surgery together with a PD-1 inhibitor (a type of immune checkpoint inhibitor (ICI), ex. nivolumab). Newly diagnosed MM patients are recommended to receive induction therapy with lenalidomide, bortezomib, and dexamethasone (RVd) for three to six months followed by an autologous stem cell transplant (ASCT). These two cohorts provide unique opportunities to study the impact of cannabis use in both a solid tumor and hematologic cancer during chemotherapy. For the NSCLC cohort, we will also assess the effect of cannabis on immunotherapy efficacy. For the MM cohort, we will assess the effects of cannabis during ASCT. Concurrently, we will survey oncology healthcare providers about their perceptions, education, and practice patterns regarding cannabis use by patients. Data collection will include information about all the medications including prescription, over-the- counter, herbs, and supplements in order to assess for the prevalence of potential medication interactions with cannabis. We hypothesize that a substantial proportion of patients receiving cancer treatment are using cannabis (~20%) and that there are different patterns of cannabis related benefits and harms based on cancer type and treatment as well as patient demographics including socioeconomic factors.