Supplements and Cannabis in Breast Cancer Care: An Integrative Medicine Approach

Announcer:
You’re listening to Project Oncology on ReachMD. On this episode, Dr. Heather Greenlee will share key highlights from her session at the 2024 San Antonio Breast Cancer Symposium, which focused on the use of supplements and cannabis. Not only is Dr. Greenlee a Professor of Public Health Sciences and Clinical Research Divisions at Fred Hutchinson Cancer Center, but she’s also an Associate Professor of Hematology and Oncology at the University of Washington School of Medicine. Here’s Dr. Greenlee now.

Dr. Greenlee:
As some background, I’m the Medical Director of our Integrative Medicine Program here at the Fred Hutchinson Cancer Center, and within that, we provide integrative medicine consults to patients where we gather information from them about what their goals are as they’re progressing through their cancer journey, and for a lot of patients, that’s the use of dietary supplements. But in order for us to help them, we need to understand why they’re using them and what they’re hoping to achieve, and then we review them for safety and efficacy and then make some suggestions. So one of the first things to do is to address any deficiencies that patients might have that actually can be easily managed by the medical team. This is vitamin D, magnesium, potassium, electrolytes, and B12, and those can be assessed using standard labs. But beyond that, we take a very conservative approach. And so we spend time with our patients understanding what goals, and then most often, we actually seek a nonpharmacologic approach to helping them meet their goals.

Now, there are some clinical practice guidelines out there on the use of integrative therapies following a cancer diagnosis, and these are put forward by ASCO in conjunction with the Society for Integrative Oncology, and really, one of the only supplements that’s been shown to have data supporting its use right now in clinical trials is American ginseng for fatigue. And so in breast cancer patients, fatigue is something that a lot of them struggle with, and there’s a large trial run out of the cooperative networks showing that American ginseng can be useful for fatigue, but it’s really important to make sure that it’s a preparation of ginseng, that is the ground root from American ginseng, and that doesn’t have any alcohol in the extraction that can have estrogenic effects. Other than that, there really aren’t a lot of other supplements that we strongly recommend.

And this is not what a lot of patients want to hear. A lot of patients come in with a long list of dietary supplements. They want to hear what are all the things that they should be taking because they think of that as being a proactive way to be involved in their health, but what we end up doing is that we listen to them, understand what their health goals are, and then we offer a lot of other nonpharmacologic approaches. So we spend a lot of time talking about nutrition, physical activity, weight management, managing stress, managing fatigue, and managing sleep. We use a lot of mind/body medicine. We offer a lot of acupuncture. We do a lot of counseling around lifestyle behaviors, and so even though the conversation starts with dietary supplements, we shift it to focus on lifestyle medicine and other ways to support themselves following a cancer diagnosis.

That said, the American Society of Clinical Oncology, ASCO, came out with guidelines in March of 2024 on the use of cannabis, and so the only thing that they can recommend coming after a yearlong process to assess the current state of the science is that there is weak evidence right now for the use of cannabis with refractory chemotherapy-induced nausea and vomiting. Patients are using it for a lot of other reasons. They’re using it for sleep, pain, and anxiety, and there’s a growing body of literature to support those indications, but it’s certainly not definitive yet. So that said, there’s some concerns that we have with the use of cannabis. Cannabis is a complex plant. There’s a lot of different compounds in there. So THC is the psychoactive component. There are a lot of other components that are not psychoactive that do have some medicinal or potential medicinal benefits, but those really need to be better understood. But there are definitely some side effects that come out of cannabis use that people need to be understanding of. So even though patients do use it a lot for nausea and vomiting, there’s a syndrome called cannabinoid hyperemesis syndrome that comes along with using cannabis that actually can increase vomiting, and so people need to be really understanding to keep a watch out for that. A lot of patients don’t like the psychoactive components of cannabis, and we also have found that even though some people use cannabis to address anxiety or they think they’re using it to address anxiety, the use of cannabis can actually exacerbate other mood disorders, and so there’s a lot of areas for concern.

Announcer:
That was Dr. Heather Greenlee discussing the use of supplements and cannabis, which she spoke about at the 2024 San Antonio Breast Cancer Symposium. To access this and other episodes in our series, visit Project Oncology on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!