Clinically Guided Cannabis Use Helps Mitigate Symptoms Experienced by Patients With Cancer

Brooke Worster, MD, MS, FACP

The clinically guided use of cannabinoids to alleviate symptoms of cancer also improved quality of life (QOL) and reduced emergency department (ED) visits which in turn reduced cost impacts, according to Blake Zenger, MBA, and Brooke Worster, MD, MS, FACP. A health care cost model for estimating the cost impacts of using evidence-based, clinically guided cannabinoids to mitigate symptoms of cancer as well as chronic pain, sleep disorders, and anxiety was created by EO Care and reviewed by Milliman, who concluded the model’s estimations were reasonable.¹

“When we talk to palliative care providers or oncologists so many of them have not received training or guidance about how to use cannabis in their treatment of patients with cancer and other conditions. In terms of pushing the field forward, [guidance with cannabis] is a gap that exists right now in what the providers have in their toolbox for treating people with cancer,” Zenger said in an interview with OncLive^®. Worster added that “This is the gap and drawing attention to that and being able to close that gap is going to be helpful.”

In the interview, Worster and Zenger highlighted how personalized guidance is crucial for patients with cancer who want to use cannabis to alleviate symptoms resulting from treatment. The two provided further insights on the health care cost impacts model in an additional interview.

Zenger is a strategic advisor to EO Care and former CIO of Equity Healthcare. Worster is an associate professor of medicine, division director of Supportive Oncology, chief medical officer at EO Care, and director of the Cannabis Medicine, Science and Business Master’s Program, Institute of Emerging Health Professions, all at Jefferson Health in Philadelphia, Pennsylvania.

OncLive: The Milliman report on the model noted that decreased health care costs included an avoidance in ED visits for patients. How was this reduction possible?

Worster: If you reduce the symptom burden that patients with cancer are often faced with, you keep them out of the ED. If you can proactively reduce a patient’s nausea and vomiting so that they can stay hydrated after getting chemotherapy, they’re not going to go to the ED. [Similarly], if you can reduce a patient’s pain, they’re not going to show up with uncontrolled pain in the ED. Cannabis is one of the tools in the toolkit to do that; not every patient [will] never go to an ED if they’re using cannabis. It’s not like that—it’s the art of medicine, it’s more nuanced. This adds something more [where] I have another tool that I can think of to keep a patient’s pain [under] control to keep them out of the ED.

Zenger: For the model, we took a typical population and said, ‘Here’s how many ER visits there are based on the literature’ and [found] the number of ED visits that could be prevented from that based on numbers from the literature. We then calculated what the cost of those ED visits would be and put that into the savings model.

What other patient-reported outcomes are important to note with EO Care?

Worster: We asked patients, ‘What’s important in your life [and] what things are important that you want to be able to do that you can’t?’ Not to sound too simplistic, but they’re all important. If a patient says to me, ‘I want to be able to play with my grandchild when they come to visit, and I can’t because my pain is so bad’ and [using cannabis] improves [symptoms] for that patient, that’s incredibly important.

Buckets of patient-reported outcomes that are important are [aspects such as] functional status or activities of daily living—I can get up, I can bathe myself, I can dress myself, for example. Others are more emotional—I want to feel less anxious and feel a bit more present when I’m engaging in conversations. Some [outcomes] are QOL, like playing with a grandchild. [When we] bucket [outcomes] that way, we are seeing that it’s a roughly equal split in terms of what patients are hoping for [with] those types of buckets—functional, QOL, and emotional/mental health buckets. We’re seeing fairly equitable improvements in all those buckets over time.

Zenger: Patients are being asked going into their relationship with EO Care to respond to those buckets with their score or how they would rate it. That’s [also done and factored in] later in the process to see what the outcome is.

EO’s cannabinoid-based treatments have improved patients’ conditions relative to those of non-cancer populations. How can these treatments/processes be replicated across the US?

Worster: I don’t think there’s any magic to it—it’s that very personalized, specific guidance if and when patients are interested in using cannabis for specific symptoms. Understanding what symptom we are looking to treat, what the status of it is now, what [the patients are] hoping for, and what other medications and complications are involved in this factor [into decision-making]. Then, giving patients the guidance in a very specific form as to how to incorporate cannabis into their treatment regimen is what EO does, and it’s not limited to patients with cancer by any means.

Patients with cancer are a very important population because of the severity of their symptoms, but it’s the same algorithm [for] when you look at it for an older adult who is suffering from arthritis that’s preventing them from doing a meaningful activity of daily life. That’s how you’re going to improve their outcomes, [with] that very specific personalized guidance.

What is important to highlight for colleagues on this model and cannabis as a therapy to alleviate symptoms for patients with cancer?

Worster: It’s the awareness that this exists, that there is an ability for patients to receive personalized quality guidance to avoid and minimize risks on a large-scale. Because if we say, ‘I get it, the science isn’t there,’ and wait, we’re going to continue to see more troubling adverse effects because patients have access to cannabis, and they want to use it. We need to meet people where they are in a real-world space.

Zenger: For patients who through a friend or their doctor decide that they would like to try cannabis in the mitigation of their symptoms when being treated for cancer, options are to go to a dispensary; but when you walk into a dispensary, you have no idea what the qualifications are of the people behind the counter. They’re giving you advice on based on their experience, which is probably [not relevant] when it comes to treating patients with cancer. [EO] is trying to change that and have there be a set of clinically guided doctor managed methods for treating patients with cancer.

Reference

1. Independent review of EO Care’s model for quantifying theoretical healthcare cost impacts in the United States. Milliman Report. Published May 2024. Accessed July 30, 2024. https://www.milliman.com/-/media/milliman/pdfs/2024-articles/5-10-24_independent-review-of-eo-cares-model.ashx