Singer/actress Olivia Newton-John, 70, was recently seen on “60 Minutes Australia,” where she updated viewers on how she is doing with her stage 4 breast cancer.
The Grease star was originally diagnosed with breast cancer in 1992, after finding a small, painful lump. She underwent a partial mastectomy and breast reconstruction, followed by chemotherapy. She also used complementary treatments, such as herbal supplements, acupuncture, meditation, and visualization.
“I researched a lot and felt satisfied with my course of treatment. It was sort of an East meets West approach. I meditated every day, did yoga, and homeopathy, ate well — I boosted my inner strength as much as I could. When bad thoughts came in, I pushed them right out.”
In 2013, she was again diagnosed with breast cancer, this time after discovering a lump in her shoulder. She had kept this relapse quiet until recently.
In May 2017, Newton-John postponed some shows, saying that she was suffering with a “long-running issue with sciatica.” Turns out, this was not the cause of her back pain. Her publicity team posted a statement on Facebook, which said:
“The back pain that initially caused her to postpone the first half of her concert tour, has turned out to be breast cancer that has metastasized to the sacrum. In addition to natural wellness therapies, Olivia will complete a short course of photon [sic] radiation therapy and is confident she will be back later in the year, better than ever, to celebrate her shows.”
“‘I decided on my direction of therapies after consultation with my doctors and natural therapists and the medical team at my Olivia Newton-John Cancer Wellness and Research Centre [which she founded in 1995] in Melbourne, Australia,’ says Olivia Newton-John.”
In addition to hormone suppression therapy (via estrogen receptor blockade), Newton-John has continued to use complementary treatments including herbs, marijuana, and mindfulness/meditation therapy.
The tumor in her sacrum caused a sacral fracture, leaving her in severe pain, described as “months and months of excruciating, sleep-depriving, crying out loud pain.” Unable to walk, she “willed herself” to walk, progressing from a wheelchair, to a walker, cane, and finally to be able to walk unassisted.
Originally treated for pain with morphine, Newton-John was able to wean herself off the morphine by using marijuana, primarily cannabis oil. She claims it also is helping her with anxiety and sleep. Her husband, John Easterling, grows many of the herbs and marijuana in a greenhouse in the backyard of their California home. Olivia says: “I really believe the cannabis has made a huge difference. If I don’t take the drops, I can feel the pain, so I know it’s working.”
Newton-John refuses to focus on how much time she could have left, feeling that concentrating on a specific time could be a self-fulfilling prophecy. “So, for me, psychologically, it’s better not to have any idea of what they expect or what the last person that has what you have lived, so I don’t, I don’t tune in.”
Newton-John is organizing a auction of some of her memorabilia (including her famous Grease leather jacket and pants) to raise money for the Olivia Newton-John Cancer Wellness & Research Centre. Besides caring for cancer patients, the institute has been involved in about 200 clinical trials.
Is there a role for marijuana in the management of cancer patients?
Marijuana, also known as cannabis, has been used for medicinal purposes for at least 3,000 years. It was introduced into Western medicine in 1839 by W.B. O’Shaughnessy, who learned of its medicinal properties while working in India for the British East India Company. Its use was promoted for reported analgesic, sedative, anti-inflammatory, antispasmodic, and anticonvulsant effects.
The cannabis plant produces resin containing psychoactive compounds called cannabinoids, in addition to other compounds found in plants, such as terpenes and flavonoids. In the U.S., it is a controlled substance and is classified as a Schedule I agent (a drug with a high potential for abuse, and no currently accepted medical use).
Cannabinoids, also known as phytocannabinoids, are chemicals in cannabis that cause drug-like effects in the body, including the central nervous system and the immune system. The main psychoactive cannabinoid in Cannabis is delta-9-THC. Another active cannabinoid is cannabidiol (CBD), which may relieve pain and lower inflammation without causing the high of delta-9-THC.
There are two potential roles for cannabis in cancer management: as a primary treatment or as an adjuvant therapy aimed at ameliorating symptoms of cancer or the side effects of medical invention. Unfortunately, cannabis’ status as a Schedule I drug has severely limited scientific inquiry into the potential benefits (and side effects) of cannabis in regard to cancer, especially as a primary treatment.
There are a few studies done in mice, rats, and in vitro human cancer cell lines, that suggest that cannabinoids may have a protective effect against the development of certain types of tumors. Cannabinoids may cause antitumor effects by various mechanisms, including induction of cell death, inhibition of cell growth, and inhibition of tumor angiogenesis invasion and metastasis.
No ongoing clinical trials of cannabis as a treatment for cancer in humans were identified in a PubMed search. The only published trial of any cannabinoid in patients with cancer is a small pilot study of intratumoral injection of delta-9-THC in patients with recurrent glioblastoma multiforme, which demonstrated no significant clinical benefit.
Although few relevant surveys of practice patterns exist, it appears that physicians caring for cancer patients in the U.S. who recommend medicinal cannabis do so predominantly for symptom management. The potential benefits of medicinal cannabis for people living with cancer include antiemetic effects, appetite stimulation, pain relief, and improved sleep.
Dronabinol, a synthetically produced delta-9-THC, was approved in the U.S. in 1986 as an antiemetic to be used in cancer chemotherapy. Nabilone, a synthetic derivative of delta-9-THC, was first approved in Canada in 1982 and is now also available in the U.S. Numerous clinical trials and meta-analyses have shown that dronabinol and nabilone are effective in the treatment of nausea and vomiting induced by chemotherapy. Both dronabinol and nabilone have been approved by the FDA for the treatment of nausea/vomiting associated with cancer chemotherapy in patients who have failed to respond to conventional antiemetic therapy. The American Society of Clinical Oncology antiemetic guidelines updated in 2017 recommends that the FDA-approved cannabinoids, dronabinol, or nabilone be used to treat nausea/vomiting that is resistant to standard antiemetic therapies.
The studies that look at cannabinoid’s effect on appetite on patients with cancer or HIV have had mixed results. A few studies showed no significant improvement in appetite or weight gain. However, a smaller, placebo-controlled trial of dronabinol in cancer patients demonstrated improved and enhanced chemosensory perception in the cannabinoid group — food tasted better, appetite increased, and the proportion of calories consumed as protein was greater than in the placebo recipients.
Another clinical trial that involved 139 patients with HIV or AIDS and weight loss found that, compared with placebo, oral dronabinol was associated with a statistically significant increase in appetite after 4 to 6 weeks of treatment. Patients receiving dronabinol tended to have weight stabilization, whereas patients receiving placebo continued to lose weight.
Pain management improves a patient’s quality of life throughout all stages of cancer. Cancer pain results from inflammation, invasion of bone or other pain-sensitive structures, or nerve injury.
A 2017 review looked at five studies evaluating the efficacy of cannabis in patients with cancer. “Four out of the five studies found that cannabis was significantly associated with a decrease in cancer-associated pain,” the authors wrote. Limitations to the studies included the small number of patients in some studies, variation in route of administration, and a lack of dosing guidelines. Further research is needed into this potentially important adjuvant treatment.
Anxiety and Sleep
In a small pilot study of analgesia involving 10 patients with cancer pain, secondary measures showed that 15 mg and 20 mg doses of the cannabinoid delta-9-THC were associated with anxiolytic effects. Another small placebo-controlled study of dronabinol in cancer patients with altered chemosensory perception also noted increased quality of sleep and relaxation in THC-treated patients.
Patients often experience mood elevation after exposure to cannabis, depending on their previous experience. In a five-patient case series of inhaled cannabis that examined analgesic effects in chronic pain, it was reported that patients who self-administered cannabis had improved mood, improved sense of well-being, and less anxiety.
Seventy-four patients with newly diagnosed head and neck cancer self-described as current cannabis users were matched to 74 nonusers in a Canadian study investigating quality of life. Cannabis users had significantly lower scores in the anxiety/depression and pain/discomfort scale. Cannabis users were also less tired, had more appetite, and better general well-being
Cannabis’ status as a Schedule I drug has limited studies on the potential benefits of cannabis for cancer patients as well as others with chronic illness. Even with the increasing number of states that have legalized medicinal or recreational marijuana, researchers may shy away from this research because of federal restrictions and inability to get federal grants to pay for such research.
Do you think it’s time for the federal government to revisit marijuana’s status?
For more information: National Cancer Institute
Clinical trials (all as adjuvant therapy): ClinicalTrials.gov
Michele R. Berman, MD, and Mark S. Boguski, MD, PhD, are a wife and husband team of physicians who have trained and taught at some of the top medical schools in the country, including Harvard, Johns Hopkins, and Washington University in St. Louis. Their mission is both a journalistic and educational one: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.
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