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，询问他们的患者数量 临床医生对医用大麻的担忧也大幅增加。然而，许多临床医生认为，他们 对医用大麻的功效、副作用和滥用潜力了解不足。一 对肿瘤学家的全国性调查报告称，只有30%的人认为自己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 和病人在一起。华盛顿州的一项研究发现，接受调查的癌症患者中有21%使用过大麻 在过去一个月里。尽管许多患者普遍认为大麻等草药疗法 大麻本质上是安全的，越来越多的证据表明，需要更加谨慎地对待大麻，因为它可能有潜在的 直接副作用，并可能导致大麻等草药与药物之间的相互作用。因此，一个 关于癌症患者在癌症活动期使用大麻的重要知识缺口 这项前瞻性队列研究是为了解决这些问题而提出的。这项研究旨在评估 肺癌和多发性骨髓瘤患者中大麻的流行率和使用模式 在积极治疗期间，并询问与大麻使用有关的沟通模式 救治医疗队。为了减少癌症类型和癌症之间存在的复杂变量 治疗方面，我们将研究两种独特的癌症群体--非小细胞肺癌(NSCLC)和多发性 骨髓瘤(MM)，每个队列分别进行研究。这些患者提供了一个同质的人群 癌症患者一般都有标准化的治疗方案。癌症患者目前接受 以铂为基础的化疗在(新辅助)或(辅助)手术前和术后进行。 PD-1抑制剂(一种免疫检查点抑制物(ICI)，例如。Nivolumab)。新诊断的多发性骨髓瘤患者 推荐接受来那度胺、硼替佐米和地塞米松(Rvd)的诱导治疗，疗程三年。 至六个月后进行自体干细胞移植(ASCT)。这两个群体提供了独特的 研究使用大麻对实体肿瘤和血液病的影响的机会 化疗。对于非小细胞肺癌患者，我们还将评估大麻对免疫治疗效果的影响。 对于MM组，我们将在ASCT期间评估大麻的影响。同时，我们将对肿瘤学进行调查 卫生保健提供者了解他们对大麻使用的认知、教育和实践模式 病人。数据收集将包括所有药物的信息，包括处方、非处方药 计数器、草药和补充剂，以评估潜在的药物相互作用的流行率 大麻。我们假设相当大比例的接受癌症治疗的患者正在使用 大麻(~20%)，根据癌症，与大麻相关的益处和危害有不同的模式 类型和治疗以及患者人口统计，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.