Lighting up – Cancer, cannabis, and the importance of deeply understanding the patient treatment experience

Jun 3

By Rich Durante, Managing Director, Pharmaceuticals & Medicines | June 3, 2021

“You have cancer.”

Those three words begin a cycle of physical and emotional turmoil for almost 2 million patients each year.

Two years ago, that was my sister. She was diagnosed with non-Hodgkin’s lymphoma (NHL). Like any cancer diagnosis, this brought my entire family up short. While a diagnosis of NHL is typically a bit less traumatic because the probability of treatment success is relatively high, my sister was an exception. She was diagnosed with a high-risk variant called B-cell NHL or “double-hit” lymphoma which has a significantly worse prognosis and requires extremely aggressive chemotherapy.

Most of us have some connection to cancer – either personal or through family members or friends. Because of this, we know that cancer treatment is never easy. The side effects of chemotherapy can be debilitating and painful. There is the stress surrounding whether the treatment will work and added anxiety around the disruption of a normal life. My sister went into the hospital for 4 days every third week to receive her chemo. She couldn’t work. She was physically and mentally exhausted for days following each chemo administration. Like any cancer patient, it took a significant toll on both her physical and emotional well-being.

Identifying gaps in care is vital for optimizing the patient journey

There is no doubt that being a cancer patient can be rough. The question my family kept asking and that many patients and their families no doubt ask is ‘what can be done to make this experience easier?’ We as medical professionals, marketers, and researchers with an interest in cancer treatment strive to understand how we can make this journey more manageable. And while there are numerous ways in which medical advances prolong the lives of these patients, we do not really understand all the potential gaps in their care, and the ways in which the medical community could better support these patients, but sometimes fails at doing.

Take the combination of cancer symptoms and the side effects associated with many cancer treatments – pain, cachexia, nausea / vomiting, and others. Adequately managing these symptoms often requires a multi-faceted arsenal of medical and non-medical approaches. Some physicians embrace this treatment approach with open arms; others are more circumspect of the non-medical side of the equation.

Which brings us to cannabis.

Limited data is an obstacle to effective patient care

To bring more clarity to the role that cannabis is playing in the cancer patient experience, we surveyed over 400 cancer patients in the US, Canada, and the UK using the Maru research platform and our in-house sample panel. Of the 200 US cancer patients surveyed, only 8% reported past-month cannabis use as part of their treatment protocol and 9% reported past-month use of CBD oil.

While medical marijuana and other forms of cannabis have gained acceptance as treatment for a variety of conditions ranging from Alzheimer’s to multiple sclerosis, it seems underutilized as a cancer symptom treatment. When one reviews the available research, it is clear that there is limited data available to understand the benefits and risks of cannabis for the treatment of cancer symptoms. While there is some research on the benefits for pain management, these studies have typically been focused on other conditions. Some larger studies, for instance, have found a benefit for cannabis in managing neuropathic pain – a type of pain sometimes experienced by cancer patients – but the focus of these studies was generally in other therapeutic areas and not focused on cancer so their impact on the cancer patient experience has been inconsequential.

There have, however, been studies indicating that of those using cannabis to treat cancer symptoms, a significant percentage of patients reported experiencing meaningful benefits. Recent research conducted in Washington state (where both medicinal and recreational use of cannabis is legal) found that of the patients who reported use of cannabis in the past month, almost all were using it for some treatment-related benefit, and 90% reported a moderate-to-major benefit.

To a researcher, insights professional or marketer who has an interest in cancer treatment, the conflict between low inclusion in treatment programs and a high reported benefit is an interesting question. What is the impact on the patient treatment experience, and what is the opportunity? With such limited clarity around the holistic patient experience, how can stakeholders make effective decisions to optimize the patient experience?

Cancer treatment is an emotional experience requiring a different approach to understanding.

At the Maru Group we leverage advanced Customer Experience (CX) software and deep research expertise to help our pharma clients develop a more complete, holistic understanding of the experience of being a patient – including not just the behavioral aspect but the emotional experience as well.

We do this in several ways. For example, in conducting research with patients, we use System 1 methods for tapping into how emotions influence their experiences and their decisions. In past research with chronic pain patients, we leveraged our Emotional Signature task (which utilizes visual semiotics) to develop a deeper understanding of the emotional conflicts patients experience from using highly effective, yet addictive, medications (e.g., oxycodone) to manage their pain.

By building communities of patients and caregivers for the purpose of engaging with them consistently over time, we can address a broad range of questions related to the experience of living with cancer and other diseases. The questions we address using these communities help our clients understand the emotional experience of the patient’s diagnosis, the day-to-day experience of going through chemotherapy, the ways in which their lives are altered and disrupted by their disease, and the ways in which they interact with the physicians, nurses, and other healthcare professionals that guide and support them through this journey.

Are physicians preventing the best treatment due to a dearth of data?

Beyond understanding the extent of usage, the question of why more patients aren’t using cannabis as part of their treatment protocol becomes particularly relevant. Our data suggest that physicians could be a barrier. The Maru research we referenced earlier suggests that the interest is there among some of these patients – we found that 12% of the patients in our research who had never used cannabis expressed an interest in having cannabis as part of their treatment regimen. Furthermore, almost half (41%) of these patients reported having discussed cannabis as a treatment with their doctor. The fact that these patients have never integrated cannabis into their treatment protocol, despite interest and discussions with their physicians, suggests that the doctors themselves may be acting as a barrier to using cannabis as supportive therapy.

Why? One factor contributing to physician reluctance to recommend cannabis is the data-driven nature of most medical practices. There are only two cannabinoid-based agents that have been approved in the US - Marinol (dronabinol) and Cesamet (nabilone) - and these medications are indicated only as antiemetics, not for pain or other side effects that cannabis may help control. The lack of rigorous research on cannabis as a therapy and the resulting lack of approvals is contributing to physicians’ reluctance to recommend cannabis.

A second barrier is physicians’ perceptions of cannabis. Past research suggests that many physicians do not believe that cannabis confers any medical benefits and over half believe there are significant health risks. More recent research suggests that perceptions of cannabis’s efficacy have become more positive – a 2018 study indicates that approximately one-third of oncologists believed that cannabis was as or more effective than standard pain medications, and 65% considered it equally or more effective for the treatment of cachexia. Yet this research also indicates that oncologists are not confident in their knowledge of cannabis – only 30% of all oncologists felt that they had sufficient knowledge to make a recommendation to their patients to try cannabis.

Rely on better insights to engineer the best patient experiences

We have established that there is a disconnect between support from the medical community for recommending cannabis for cancer treatment and patient-reported benefit to their treatment experience. It also seems that the reason this gap exists is a lack of data informing the medical community on this and other potential opportunities to improve the experience. By better understanding the patient experience could other benefits be revealed? For instance, what if more knowledge about the impact of treatment-related pain on a cancer patient’s life led to a less hazardous approach to pain management than opiates? The cannabis scenario is just one potential example where a deeper understanding of the patient experience may generate insights that pharma companies can take advantage of to inform their product and market strategies and influence medical practitioners.

Which brings us back to my sister and her experience as a cancer patient – fortunately, there is a happy ending to her story (at least so far). However, understanding her experience and those of other patients is critical for understanding ways in which the medical community can better support them as they confront the physical and emotional challenges that come with the disease.

By working with Maru to build and maintain a patient / caregiver community, your team has an agile, flexible source of insights on what it is like to be a patient, how the patient experience changes over time, and steps that can be taken to better support them. Furthermore, by leveraging our unique methodologic tools, you can understand both the physical and emotional experience of being a patient at a deeper level.

Monica Low