We observed no differences in reported coping strategies by cancer survivor status, which may be explained by the increased use of cannabis for non-medical purposes across the U.S. . The results of this study should be considered in light of the limitations of the study. First, due to the cross-sectional nature of the study, causation and temporality cannot be determined. Due to the anonymity of survey responses, there may be repeat responses, although data cleaning and reCAPTCHA methods in REDCap were used to avoid multiple responses. In addition, no monetary or other incentives were provided, thus reducing the likelihood of intentional repeated responses. Generalizability of study findings may be limited due to the electronic nature of the survey, which excludes cannabis users without internet access. Furthermore, due to the self-reported nature of the data, there is potential for recall bias and misclassification bias of COVID-19 and cannabis behaviors and symptoms.
Additionally, due to the urgent need for data collection early in the pandemic, the COVID-19 Cannabis Questionnaire was not validated within the target population prior to dissemination in the field. Medicinal cannabis use was based on self-report without medical record or prescription confirmation. Lastly, while differences in the age distribution between cancer survivors and non-cancer survivors were considered in our matching strategy, we describe bivariate associations between cannabis behaviors, COVID-19 symptoms, coping strategies by cancer status, and additional factors including race/ethnicity, gender, and socioeconomic status, which may explain the differences observed in the sample.Cannabinoids, active components of the plant Cannabis sativa, had been used for centuries in ancient medicine as therapeutic remedies for a variety of conditions, before becoming stigmatized due to their psychoactive effects . In the second half of the 19th century, phyto-cannabinoids have been re-evaluated after the discovery of the chemical structure and isolation of different substances, and the subsequent development of cannabinoid-based drugs that have been FDA approved mainly to treat chemotherapy-induced nausea, insomnia and appetite, epilepsy, spasticity, and pain management .
Then, the elucidation of the endocannabinoid system, from the initial type 1 and type 2 cannabinoid receptors and their endogenous ligands to the emerging complexity of a wider system made up of additional putative receptors, ligands and enzymes, altogether termed endocannabinoidome, has further boosted research into the therapeutic potential of phyto, endo and even syntho cannabinoids, cancer treatment included. Unfortunately, despite accumulated evidence pointing in the direction of the potential anti-carcinogenic effects of cannabinoids, there are still few data that corroborate those pre-clinical studies , but the fast-paced rhythm of research in this field bodes well for the long-awaited good news . In the current research topic, new important pieces of evidence regarding the role of cannabinoids in different types of cancer and their mechanisms of action are presented in four original manuscripts and six review articles. First, Singh et al. review literature data of cannabinoids’ anti-cancer effects and of their activity as cell proliferation inhibitors, signalling molecules, apoptosis inducers and cell motility deactivators in prostate cancer. The authors concluded that, although several pathways used by cannabinoids to provoke the death of cancer cells have indeed been identified, their mechanism of action remains as yet unclear . Of note, one of those key mechanisms involved in the development and progression of cancer is autophagy.
Lee et al. examine the molecular mechanism and role of this complex process in different types of cancer, and the role played by cannabinoids in its regulation. The ambivalent contribution of autophagy to tumour’s spread, inhibitory in early stages through anti-inflammatory and anti-necrosis action and supportive in more advanced stages by supplying energy to cancer cells, is an interesting starting point for innovative therapeutic exploitation. Several studies have demonstrated how cannabinoids, by inducing autophagy, can inhibit cancer cell proliferation in vitro and in some in vivo models through the activation of the p8/TRIB3 pathway; consistently, different cannabinoids in combination with radiotherapy have been found to reduce tumour growth by promoting autophagy; however, these promising data still lack a proper mechanistic understanding and require further investigation .