New research demonstrates that medicinal cannabis may help patients with advanced pancreatic cancer manage distressing symptoms such as pain, insomnia and appetite loss, with a favourable safety profile and high patient satisfaction.

Study Overview

A pilot randomised waitlist-controlled trial known as CanPan involved 32 patients with newly diagnosed locally advanced or metastatic pancreatic adenocarcinoma. The research was conducted through a partnership between investigators and the Minnesota Medical Cannabis Program, and was published in JCO Oncology Practice whilst being presented at the 2026 ASCO Gastrointestinal Cancers Symposium.

Patients in the study had a median age of 71 years, with 53% being women and 91% identifying as White. All participants experienced at least one burdensome symptom at study commencement. The trial randomly assigned participants in a 1:1 ratio to receive either early cannabis intervention (weeks 0–8) or delayed access (weeks 9–16).

The intervention consisted of medical cannabis programme certification, personalised education with dosing guidance, and provision of cannabis products at no cost. Patients in the early access group typically collected their cannabis products approximately 3 days after commencing chemotherapy, following a median of 5 days from enrolment to chemotherapy initiation.

Baseline Symptom Burden

At the study's commencement, participants reported significant symptom burdens:

• 85% experienced moderate-to-severe insomnia
• 77% suffered from moderate-to-severe pain
• 69% had moderate-to-severe appetite loss
• 46% reported moderate-to-severe anxiety
• 31% were already using opioid medications (mean baseline oral morphine equivalent of 7 mg)

Additionally, quality of life assessments indicated mild limitations in both physical and mental health domains.

Cannabis Use Patterns

Participants predominantly used oral cannabis formulations, with tablets being the most common choice. The median daily dose at 4 weeks was 10 mg of tetrahydrocannabinol (THC) and 5 mg of cannabidiol (CBD). By 8 weeks, the median daily THC use was 7.3 mg.

Participants made a median of two visits to dispensaries during the study period, with a median one-way distance of 11 miles from their homes. They used six different dispensary locations across the study. The estimated out-of-pocket cost (had participants been required to pay) averaged $807 USD over the 8-week period, with a range of $199–$3,079 USD.

Key Findings

After 8 weeks, patients who received early cannabis access showed numerically higher improvement rates compared to those in the waitlist group:

• Pain improvement: 44% versus 20% (P = 0.35)
• Appetite improvement: 56% versus 30% (P = 0.37)
• Insomnia improvement: 67% versus 30% (P = 0.18)
• Most severe baseline symptom improvement: 89% versus 50% (P = 0.14)

Importantly, the early access group experienced a numerically greater decrease in opioid use (mean change of –3 mg versus +17 mg oral morphine equivalent), though this was not statistically significant (P = 0.22).

Safety Profile

The early access group reported lower rates of worsening potential side effects compared to the waitlist group:

• Dry mouth: 11% versus 20% (P = 0.99)
• Dizziness: 11% versus 20% (P = 0.99)
• Concentration problems: 22% versus 50% (P = 0.35)

Researchers attributed the favourable safety profile to the education participants received emphasising a "start low, go slow" approach to dosing.

Only one adverse event (fatigue and confusion) was reported in the early arm and designated as possibly related to cannabis use. After discussion with clinical staff, the participant chose to discontinue cannabis. Both study arms showed steady increases in neuropathy severity over time, consistent with the neurotoxic effects of chemotherapy.

Patient Acceptability

Of the 10 early arm participants who completed study experience surveys:

• 100% would recommend using cannabis to other patients with similar needs
• 100% reported that study activities (enrolment, obtaining cannabis, completing weekly surveys) were easy
• 90% reported that using cannabis was easy, practical, helped their symptoms and wellbeing without negative health impacts

Participant feedback for improving future trials included clearer dosing instructions and further streamlining of electronic patient-reported outcomes and cannabis pickup logistics.

Study Feasibility

The study successfully met all three prespecified feasibility metrics:

• 74% enrollment rate among eligible patients (goal ≥20%)
• 81% compliance with random assignment through week 8 (goal ≥60%)
• 75% completion rate for weekly patient-reported outcomes (goal ≥50%)

These findings demonstrate that randomised interventional cannabis trials can be successfully conducted through partnerships with state cannabis programmes, overcoming significant regulatory barriers that have historically limited such research in the United States.

Limitations and Context

It's important to note several limitations of this preliminary research:

• The trial was small with only 32 participants
• The 8-week primary study period was relatively brief, precluding conclusions about longer-term benefits or safety
• Participants were predominantly from urban, White populations in Minnesota
• Results may not be generalisable across different state cannabis programmes and regulations
• The study was not powered for definitive efficacy testing—differences between groups were not statistically significant
• Only 59% of participants had complete symptom data available at both baseline and 8 weeks for efficacy analysis
• Blinding was not possible given the study design
• As a pilot study, the findings require validation in larger, multicentre trials

The study was supported by philanthropic funding to the HealthPartners Cancer Research Centre, with cannabis products provided by Vireo Health (GreenGoods, Minnesota).

Researcher Perspective

The study's lead author, Dr Dylan Zylla from HealthPartners Institute Cancer Research Centre in Minneapolis, emphasised that this research design offers a model for collaboration between investigators and state cannabis programmes to overcome regulatory barriers.

"Early access to medical cannabis was associated with improvement in certain symptoms, particularly insomnia, with minimal harms," Dr Zylla noted. The research team concluded that these encouraging preliminary results regarding efficacy and safety support further exploration into cannabis for managing cancer-related symptoms.

This trial builds upon Dr Zylla's broader research programme examining cannabis in oncology, which has included analysis of over 1,000 patients with cancer enrolled in Minnesota's medical cannabis programme since 2015. Previous work by the research team found that roughly 30–40% of patients reported clinically meaningful improvement in symptoms, with adverse effects being uncommon (10.5%) and generally mild.

Current Approaches Insufficient

The researchers noted that current symptom management approaches for pancreatic cancer remain insufficient. More than 80% of patients continue to report moderate-to-severe symptom burden over time despite supportive care interventions. Additionally, treatment for one symptom can worsen another—for instance, opioids used for pain may worsen somnolence, constipation and itching, and have been associated with tumour growth and decreased survival in some studies.

Regulatory Innovation

The successful completion of this trial represents an important advancement in cannabis research methodology. Cannabis is classified as a Schedule I drug in the United States, making interventional trials difficult to conduct. By partnering with a state-run medical cannabis programme and using standard-of-care cannabis products that participants could individually titrate to achieve personalised symptom control, researchers were able to conduct a real-world interventional trial whilst overcoming otherwise insurmountable regulatory barriers.

The trial design was fully remote with no additional in-person study-specific visits after the initial consent visit, minimising participant burden whilst allowing ongoing cancer care to continue uninterrupted.

Original paper link: https://doi.org/10.1200/OP-25-01165

Important Regulatory Information for Australian Readers

In Australia, medicinal cannabis is a prescription-only medicine regulated by the Therapeutic Goods Administration (TGA). It is available through the Special Access Scheme or Authorised Prescriber pathways for patients with conditions where conventional treatments have proven inadequate.

The TGA's regulatory framework differs substantially from state-based programmes in the United States. Australian patients interested in accessing medicinal cannabis must consult with their healthcare provider to discuss whether it may be appropriate for their individual circumstances. Only healthcare practitioners can determine eligibility and prescribe medicinal cannabis products approved for use in Australia.

This article is for educational purposes only and should not replace professional medical advice. The research discussed was conducted in the United States under Minnesota's medical cannabis programme. Always consult with a qualified healthcare practitioner before making decisions about treatment options.