Olivia Newton-John’s Stage 4 Cancer Cannabis Management
— The singer and actress updates fans on her battle, but can marijuana help?
by Michele R. Berman, MD, and Mark S. Boguski, MD, PhD August 22, 2019
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?
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.
The singer and actress updates fans on her battle, but can marijuana help?
CBD Oil and Breast Cancer
If you’re being treated for breast cancer, you’ve probably had some side effects like pain, fatigue, nausea, discomfort, and anxiety. Maybe you’ve heard other people with the disease talk about using CBD products to ease these symptoms — or you’ve run across CBD at your local gas station or drug store. But what exactly is CBD? How does it work? And can it really help people who have breast cancer?
Defining the Terms
First, let’s break down the terms, which can be confusing.
- Cannabis is a type of flowering plant that has more than 500 chemicals. Hemp and marijuana are both forms of cannabis.
- Tetrahydrocannabinol (THC) might be the best-known chemical, known as a cannabinoid, in the cannabis plant. Its psychoactive ingredients create intoxication, or a “high.”
- Cannabidiol (CBD) is another well-known chemical in cannabis. Even though it’s also technically considered psychoactive, CBD is not intoxicating because it affects the brain differently than THC. CBD that’s extracted from hemp is federally legal, but it’s not legal in every state. CBD can also be extracted from marijuana.
- Hemp is any cannabis plant that contains mostly CBD and has a maximum of 0.3% THC. The 2018 Farm Bill made it legal to grow industrial hemp in the United States.
- Marijuana is any cannabis plant that has more than 0.3% THC, an amount that causes a high. It contains various amounts of CBD. Marijuana is not federally legal, and its legality varies from state to state.
How CBD Can Help
Your body has a natural endocannabinoid system, “a complex network of receptors on cells that regulates your daily body functions, such as inflammation, mood, and sleep,” says Marisa C. Weiss, MD, chief medical officer and founder of Breastcancer.org and director of breast radiation oncology at Lankenau Medical Center in Wynnewood, PA.
CBD works by interacting with this system, which means it can help reduce side effects of breast cancer treatment like pain, anxiety, insomnia, nausea, and vomiting.
That said, it’s important to note that there is no evidence that CBD can treat or cure breast cancer itself.
“As a doctor, I make the distinction between complementary and alternative medicine,” says Andrea Mathias Schmucki, MD, a patient advocate for the Living Beyond Breast Cancer Hear My Voice advocacy program and a former family physician. She is herself being treated for metastatic breast cancer, or cancer that’s spread to other parts of her body. “I look at CBD as complementary, using it in addition to, rather than as an alternative to, traditional treatment.”
Before she had a double mastectomy, reconstruction surgery, chemotherapy, and radiation for breast cancer in 2015, Mathias Schmucki says, she wouldn’t have put much stock in something like CBD (though she would have supported her patients’ choice to use it). But ibuprofen wasn’t relieving the itchy, scratchy, painful sensations she was having. She was so uncomfortable, “I was open to anything.” She knew that she didn’t need or want the mind-altering effects THC can create, so she decided to try CBD oil.
She bought some at her local pharmacy and took it by mouth every day for a month, noticing that it seemed to help on some days. But she wasn’t convinced that the changes were due to the CBD oil, so she didn’t get more when it ran out. Within 3 weeks, the horrible discomfort was back. She researched CBD in-depth and found a reputable company. Now, she’s a believer. “It has made a significant improvement in my daily quality of life,” she says.
How CBD Is Used
Weiss notes that there are all kinds of CBD products beyond oil, such as edibles, capsules, tinctures, creams and oils for skin, and sprays that you can use under your tongue.
Mathias Schmucki still takes CBD oil orally. She also uses a topical CBD oil for the skin on her radiation-treated side to help with the dryness and discomfort, plus a CBD extract in a coconut-oil-based suspension as a personal lubricant for intercourse. “A lot of women with breast cancer experience sexual side effects because one of the mainstays of treatment is anti-estrogen,” she explains.
Side Effects and Risks
According to Weiss, some people who use CBD have reported side effects including:
- Drowsiness and fatigue
- Dry mouth
- Less appetite
Mathias Schmucki notes that there aren’t a lot of studies on the potential risks of CBD oil, so it’s not clear exactly what they might be. However, “CBD is usually well-tolerated,” Weiss says.
Weiss offers these cautions:
- Don’t use cannabis products if you’ve had a heart attack within the past 6 months or if you have severe heart disease.
- Some medications can have a negative interaction with cannabis products, such as warfarin (Coumadin, Jantoven). Give your doctor and pharmacist a complete list of all the medications and supplements you’re taking so they can keep an eye out for interactions.
- Watch out for product ingredients that you might be allergic to, like coconut oil.
- It’s best to steer clear of cannabis products altogether if you’ve had serious side effects from using them before, like uncontrolled vomiting.
- Be aware that many CBD products may contain trace amounts of THC that can show up on a drug test. Check your employer’s medical cannabis policy before you use CBD.
Talking to Your Doctor
Weiss and Mathias Schmucki agree that it’s critical to talk to your doctor before you use CBD, especially if you’re in active treatment for breast cancer. For one thing, you need to make sure it’s a safe option for you.
If you’re taking certain medications like blood thinners and thyroid and seizure medications, you’ll need periodic blood tests to make sure your levels are where they should be. If you’re on a medication like this and you’re going to use CBD products, Mathias Schmucki says, your doctor will need to monitor you to make sure your levels stay on track. “Everybody’s different, so you won’t really know how CBD will affect your body’s metabolism of other medications,” she says.
Your doctor may not be enthusiastic about you using CBD, but that doesn’t necessarily mean they’re resistant to the idea. “Remember that your doctor wants to help manage your symptoms and pain, so being open and honest about what you need is the best way to communicate,” Weiss advises.
If you’re having breast cancer treatment side effects or symptoms that aren’t being controlled, or if you think your doctor isn’t listening to your needs or doesn’t have the experience to give you advice on CBD products, get a second opinion, Weiss suggests. She recommends talking to an oncologist who is knowledgeable about cannabis products if your doctor can’t help.
“I tell my doctors that I’m not holding them responsible for my decision to use CBD, but I want them to know this is a choice I’m making,” Mathias Schmucki says. “I’m giving them information they need to provide the best care that they can.”
How to Buy CBD
What should you look for if you decide to give CBD products a try?
- Medical-grade CBD products. “Just because CBD products made from hemp are now widely available, you shouldn’t assume they’re safe, effective, or even legal where you live, since some state laws still consider hemp CBD illegal,” Weiss says. She recommends looking for medical-grade CBD products because they’re “probably a safer option.”
- Certificate of analysis. Weiss recommends asking for a certificate of analysis (COA) from the company or dispensary you use. A COA comes from a third-party laboratory and tells you the quantity of cannabinoids in the product so that you know exactly what you’re getting. Some COAs also show the levels of potential toxins like pesticides, arsenic, and heavy metals.
For Mathias Schmucki, finding a company that provided a COA with all this information was a must. She says there are several online companies that send it with every product. “The companies with the best reputations will often have very robust websites with educational resources,” she says, so look for these.
Mathias Schmucki says other options, like how the CBD is extracted or what the best delivery method is, are a matter of personal choice.
Keep this in mind, too: “Everyone reacts differently to cannabis products, so don’t feel discouraged if your symptoms aren’t reduced with the first product you try,” Weiss says. “You may need to test different products to find what’s best for you, including the delivery method and dosage.” She suggests starting low and slow, making changes as you go.
“There’s a lot of information out there, but I think you really have to be careful about where you get that information,” Mathias Schmucki says. She advises looking to see if your local medical center has an integrative oncology department that includes nontraditional therapy like CBD and can give you guidance. Other good resources include pharmacists trained in cannabis, experts at medical cannabis dispensaries, and pain management doctors, Weiss says.
Mathias Schmucki has also found that talking to other people who currently have or previously had breast cancer is invaluable. A private Facebook group called Fighting Breast Cancer with Cannabis has been helpful in her own journey.
The Future of CBD
“Research on medical cannabis products, including CBD oil, has been limited because federal laws in the United States have made it difficult to study,” Weiss says. But now that hemp production is legal, it can be studied, Mathias Schmucki notes. “Lifting federal regulations off of the growing and scientific study of cannabis plants will help over time in answering some of these questions about areas like safety, dosing, and contraindications,” she says.
“In the meantime, more research is being done to provide better answers,” Weiss says. For example, she’s the principal investigator on a research team at Lankenau Medical Center that’s testing CBD in cancer patients with chemotherapy-induced peripheral neuropathy (CIPN). This is the first and only FDA-approved CBD study for patients with CIPN, “a common and difficult side effect of the most commonly used chemotherapies, which can damage the nerves and lead to pain, discomfort, or numbness, most often in the hands and feet,” she explains.
Johns Hopkins Medicine: “Side Effects from Breast Cancer Treatment.”
Marisa C. Weiss, MD, chief medical officer and founder, Breastcancer.org; director of breast radiation oncology, Lankenau Medical Center, Wynnewood, PA.
National Center for Complementary and Integrative Health: “Cannabis (Marijuana) and Cannabinoids: What You Need to Know.”
PBS NewsHour: “Is CBD legal? Here’s what you need to know, according to science.”
Project CBD: “Is CBD Really Non-Psychoactive?”
U.S. Department of Agriculture: “Hemp and Farm Programs.”
Breastcancer.org: “Medical Cannabis.”
Andrea Mathias Schmucki, MD, patient advocate, Living Beyond Breast Cancer Hear My Voice advocacy program.
Citizen Truth: “What is a CBD Certificate of Authenticity (COA) (And How to Read It).”
CBD oil can’t treat or cure breast cancer, but it may ease side effects of treatment like pain, anxiety, insomnia, nausea, and vomiting. Here’s what to know about using CBD oil for breast cancer.