Treatment with cannabinoids for medical use could be useful to counter sleep disorders and other symptoms in people with cancer
In adults, insomnia is a disorder that affects between 33 and 50 per cent of the general population, but for some subgroups the prevalence is significantly higher: among cancer patients, for example, the percentage of those suffering from insomnia is three times higher, and the highest prevalence is found among breast cancer patients.
In many of these patients, insomnia is related to emotional stress, difficulties in the postoperative course and side effects of hormone treatment, e.g. hot flushes and night sweats. These negative effects are reflected in the quality of life, clinical situation and long-term prognosis.
The available treatment options, which include pharmacological treatments, cognitive-behavioural therapy, relaxation techniques, acupuncture and sleep hygiene measures, have so far yielded variable results in terms of effectiveness.
Possible treatments for insomnia that are currently being studied include medical cannabis.
In a recently published paper, a group of US experts discussed the state of research on cannabis as a treatment for insomnia, presenting the case of a breast cancer patient.
The case study
The patient is a 49-year-old woman with a history of invasive ductal carcinoma, which presented 12 years ago with a 2-centimetre mass in her left breast and two positive lymph nodes. The patient underwent a left mastectomy with axillary lymph node dissection and immediate reconstruction, and a right mastectomy with the aim of reducing the risk, but without finding any signs of breast cancer. She also received chemo- and radiotherapy treatment after surgery and started tamoxifen therapy, which was then discontinued due to intolerance and resumed with toremifene.
Three years ago, PET-CT scan found diffuse metastases involving the subcutaneous soft tissue of the left breast, bilateral lung nodules, mediastinal lymph nodes and the right cervical lymph node; bone lesions were also detected. The patient was treated with palbociclib and letrozole, goserelin and zoledronic acid; she currently continues to take palbociclib and letrozole and is in remission.
During treatment, the woman reported insomnia and headaches secondary to taking palbociclib, as well as chemotherapy-induced peripheral neuropathy, anxiety, constipation, fatigue and nausea.
To counteract anxiety, the patient reported using cannabidiol (CBD) oil, which was beneficial, and asked about medical cannabis to treat her other symptoms, in particular insomnia, poor overall sleep quality, and pain associated with frontal headaches, which occurred with multiple weekly episodes and were often accompanied by nausea.
After evaluating the benefits and risks, she started treatment with a regimen that involved taking 2.5 mg THC and 2.5 mg CBD in a 1:1 ratio at the beginning of the day, and 5 mg THC and 0.25 mg CBD tincture drops in the evening.
Used for five evenings a week, the treatment improved insomnia, headaches and anxiety, without causing any adverse effects.
A look at the present and the future
To date, only a few studies have evaluated the efficacy of cannabis considering sleep as the primary outcome, and data are even more limited in the cancer patient population.
In other populations, e.g. subjects with obstructive sleep apnoea syndrome and with fibromyalgia, trials indicated an improvement in sleep associated with nabilone compared to both placebo and amitriptyline. Other studies, which considered sleep as a secondary outcome, showed favourable results for cannabinoids in terms of reduction of sleep disturbances and general improvement of sleep quality.
“The case presented highlights the potential benefit that cannabis can have on insomnia, disease symptom management and overall quality of life in cancer patients. Since cannabis may also help counteract other symptoms of the disease, such as chemotherapy-induced nausea or peripheral neuropathic pain, it could be a therapeutic option to consider. In this case, for example, the patient also experienced a significant improvement in headaches and anxiety, as well as in overall sleep quality”, the authors comment. “Prospective, randomised trials are needed to consider insomnia as a primary outcome in cancer patients, and to evaluate its safety, tolerability, dosage and therapeutic efficacy compared to current treatments, as well as any effect on hormonal therapies, immunotherapy and survival”.
Reference
Jafri S, Hansen E, Fuenmayor R, Case AA. Medical cannabis for insomnia in a patient with advanced breast cancer. J Pain Symptom Manage. 2023;65(5):e497-e502.
