Using a discrete choice experiment to estimate individual preferences to medicate cancer-related symptoms with cannabis

In October 2018, Canada legalized non-medical cannabis, increasing accessibility nationwide. Although a separate medical cannabis framework exists, many individuals with cancer may now obtain cannabis through non-medical channels rather than through the medical system. This shift raises questions about how legalization has influenced patients’ attitudes and preferences regarding the use of cannabis to manage cancer-related symptoms and treatment side effects. We aimed to determine individuals’ preferences for using cannabis as a complementary therapy in cancer survivorship. Members of a Canadian research panel completed a discrete choice experiment (DCE) to assess preferences for medicinal cannabis. Respondents completed 12 choice sets, each consisting of two health states described by seven attributes identified from previous qualitative work, as well as an opt-out option. The seven attributes were cannabis effectiveness, ability to perform everyday activities, chance of unwanted side effects, opinions of family and friends about cannabis, doctor’s opinion of cannabis, access to cannabis, and out-of-pocket cost. Each attribute had three or four levels. DCE responses were analyzed using an error-component mixed logit regression model to estimate the relative attribute importance and willingness-to-pay. The dataset included 1,089 respondents who completed at least one choice set. Of these, 61.5% (n = 670) reported no experience with cancer, and 35.5% (n = 387) had some experience with cannabis. Analysis of the DCE responses demonstrated that respondents preferred the effective management of cancer symptoms and the ability to perform everyday activities. Respondents expressed disutility for unwanted side effects resulting from cannabis use. To our knowledge, this is the first study to elicit general population preferences for medicinal cannabis in the context of cancer survivorship. Insights from these preferences may inform policy and priority-setting to support equitable access to medical cannabis for symptom management improved quality of life among individuals with cancer.