Health-related quality of life shown to improve in those using medical cannabis

18th May 2023

Patients’ self-reported, health-related quality of life significantly improves in all domains following use of medical cannabis, research shows.

Use of medical cannabis significantly improves all domains on the 36-item Short Form Health Survey (SF-36), which looks at health-related quality-of-life, according to the findings of a recent study by Australian researchers.

A legal framework to allow prescription of medical cannabis in Australia has been available since 2016. Moreover, a 2022 systematic review found that cannabinoids are effective for several indications including epilepsy and chronic pain. The term ‘medical cannabis’ refers to a wide array of products, such as dried flowers and oils, that contain bioactive constituents in addition to tetrahydrocannabinol and cannabidiol.

However, the lack of randomised trial data means clinicians cannot know with any level of certainty whether a particular medical cannabis product would be efficacious. Nevertheless, one means through which clinicians can gain a better understanding of the impact of medical cannabis is through an assessment of health-related quality of life.

This was the subject of a recent study published in JAMA Network Open. Australian researchers assessed if use of medical cannabis led to improvements in health-related quality of life and if these benefits persisted over time. The team retrospectively reviewed the medical records of those prescribed medical cannabis across the country. The outcome of interest was the change in health-related quality of life based on changes from baseline in the SF-36. This questionnaire consists of eight domains that evaluate the impact of an intervention, such as medical cannabis, on several measures including physical and mental health, body pain and physical functioning.

Benefits to quality of life found

A total of 3,148 patients with mean age 55.9 years (53.6% female) had usable data for analysis and 15 follow-up consultations were examined for each patient.

Medical cannabis was used mainly for chronic non-cancer pain (68.6%), cancer pain (6%), insomnia (4.8%) and anxiety (4.2%). After commencing treatment, significant improvements occurred in all eight domains of the SF-36. After controlling for potential confounders, SF-36 domain scores increased from 6.6 to 18.31, (all with p <0.001). Moreover, these improvements largely persisted over time.

Despite the clear benefits to quality of life, the researchers noted a total of 2,919 self-reported adverse events, with at least two considered serious. They concluded that clinicians should exercise caution in the prescription of medical cannabis, avoiding where possible in those with known contra-indications.

Music interventions associated with improvement in mental and physical health-related QOL

31st March 2022

Music interventions produce improvements in mental and physical health-related QOL, although which intervention is best remains uncertain

The use of music interventions appear to be associated with clinically meaningful improvements in mental and a smaller improvement in physical health-related quality of life. However, the specific type of music intervention providing the greatest benefit remains unclear.

This was the conclusion from a meta-analysis of studies by researchers from the Institute of Music Physiology and Musicians’ Medicine, Hannover University of Music, Hannover, Germany.

The use of music interventions (MIs) such as listening to music, playing an instrument or singing, has been shown to positively impact on the global and social functioning of patients with mental health conditions such as schizophrenia.

 Furthermore, there is also reliable evidence for the positive effects of music and singing on wellbeing (related to the positive aspects of a person’s life) in adults without underlying mental health problems.

Other evidence from an umbrella review of performing arts as a health resource, concluded that positive health effects were associated with as little as 30 to 60 minutes of performing arts participation.

The CDC in the US defines health-related quality of life (HRQOL) as an individual’s or a group’s perceived physical and mental health over time. HRQOL can be assessed using dedicated questionnaires, including the 36-item Health Survey Short Form (SF-36) and related, reduced 12-item Health Survey Short Form (SF-12). Moreover, both the SF-36 and 12 have been used in studies of music interventions.

Although music interventions appear to give rise to improvements in both HRQOL and well-being, what remains unclear is the associations between different types of MIs and changes in HRQOL as measured using both the SF-36 and SF-12.

This was the purpose of the current study and the German team included randomised and non-randomised trials that investigated music making (singing, listening, playing music) interventions and which reported changes in SF-36 or SF-12, before and after the intervention.

The researchers focused on both the mental component summary (MCS) and the physical component summary (PCS) of the SF-36 or SF-12 since higher scores in each of these domains were indicative of better mental and physical HRQOL. The threshold mean difference in MCS scores was set as a mean difference of 3 or more.

Music interventions and MCS and PCS scores

The literature search identified 26 eligible studies with 779 participants (mean age = 60 years) and which comprised listening to music, music therapy, singing with one study exploring the effect of gospel music.

Overall, a music intervention was associated with a significant decrease in both MCS (total mean difference, TMD = 2.95, p < 0.01) and PCS scores (TMD = 1.09, p = 0.02) compared to pre-intervention values.

In subgroup analysis, in which MIs were added to usual treatment, there was a significant increase in MCS scores vs usual treatment alone (TMD = 3.72, 95% CI 0.40 – 7.05) but not for PCS. However, it was not possible to identify any important differences based on the type of musical intervention.

The authors concluded that while MIs led to a significant increase in mental HRQOL, the changes in PCS were equivocal. They added that given the variation in the effect of the different interventions such as singing, listening to music etc, it was not possible to provide any firm recommendations about the optimal intervention or dosage for use in specific clinical scenarios.

Citation
McCrary JM et al. Association of Music Interventions With Health-Related Quality of Life: A Systematic Review and Meta-analysis JAMA Netw Open 2022