Rural and Urban Cancer Patients Use Cannabis at Similar Rates, Pennsylvania Survey Finds

Cannabis has quietly become one of the most widely used symptom-management tools among people living with cancer in the United States, yet most of the evidence about who uses it, why, and with what perceived effect has come from large urban cancer centers. A new survey conducted at Penn State Cancer Institute now offers a rare window into a mixed rural, suburban, and urban patient population, and its central finding is striking: where patients live appears to matter far less than clinicians and policymakers might have assumed. Among 186 adults with a cancer diagnosis who had been in active treatment within the previous year, 26.1 percent reported using cannabis since their diagnosis, and the difference between rural and urban or suburban respondents was not statistically significant.

The study, published as an open-access research article in Supportive Care in Cancer, was designed specifically to address a gap in the literature. Rural cancer patients are frequently underrepresented in clinical research, in part because they face longer travel times, fewer medical providers, and barriers such as limited internet access that complicate participation in electronic surveys. The Penn State team, whose catchment area includes 19 Appalachian counties and a rural patient base exceeding 12 percent, deliberately chose an in-person, paper-based survey administered during oncology visits between June 2023 and June 2024. Participants completed an anonymous questionnaire covering cannabis use, reasons for and against use, perceived benefits and risks, sourcing, and demographic and clinical characteristics, with the instrument adapted from a previously developed survey and reviewed by nurses, physician assistants, clerks, and a patient advocate before deployment.

The demographic and clinical profile of the sample reflects the population it aimed to capture. Respondents had a mean age of 62.1 years, 58.9 percent were female, and 89.9 percent were white. Nearly half, 49.5 percent, lived in rural areas, while 41.4 percent described their residence as suburban and 5.4 percent as urban. More than half reported late-stage cancers, breast cancer was the most common diagnosis at 27.8 percent, followed by lung cancer at 15.0 percent and melanoma or skin cancer at 12.2 percent, and 67.9 percent had received chemotherapy. Notably, rural patients were more likely to have Tricare coverage and less likely to rely on Medicare than their urban and suburban counterparts, hinting at the socioeconomic texture underlying the comparison.

On the core question of prevalence, 26.1 percent of respondents reported cannabis use since diagnosis, with a 95 percent confidence interval of 20.0 to 33.2 percent. Within that figure, 20.1 percent reported current use and 23.9 percent reported use during cancer treatment. Rural patients reported slightly higher rates than urban and suburban patients, roughly 30 percent versus 23 percent, but the difference did not reach statistical significance, and in a multivariable logistic regression controlling for age, race, gender, and other sociodemographic factors, area of residence was not significantly associated with use since diagnosis. The only significant predictor was age itself, with older patients substantially less likely to report use. This aligns with prior national analyses and cancer-center cohorts that also found no rural-urban divide, even though some general-population studies have reported higher cannabis prevalence in urban settings.

How patients used cannabis proved as informative as how many did. Smoking was the most common route, accounting for 52.2 percent of users, and delta-9 THC was the most frequently reported primary component at 45.6 percent, followed by CBD at 26.1 percent and delta-8 THC at 19.6 percent, with 28.3 percent of users unsure what their products contained. A majority of users, 71.4 percent, obtained cannabis from state-regulated dispensaries, but urban and suburban patients were significantly more likely to do so than rural patients. Nearly 45 percent of users consumed cannabis almost every day or multiple times a day, and 30.1 percent reported using cannabis instead of opioids to manage pain, while 32.0 percent said it helped them decrease or stop other medications, a substitution pattern with potentially significant implications for opioid prescribing in oncology.

The symptom data form the most eye-catching part of the study. Among users who answered follow-up items, majorities reported improvement in seven of eleven assessed cancer-related symptoms: insomnia improved for 89.7 percent, appetite for 85.7 percent, mood for 83.7 percent, joint pain or stiffness for 83.3 percent, stress, anxiety, or depression for 81.6 percent, cancer-related pain for 80.7 percent, and digestive symptoms for 67.9 percent. The least improved symptoms were sweating and hot flashes at 27.8 percent, sexual interest at 41.7 percent, and fatigue at 48.5 percent, with fatigue also the symptom most often reported to have worsened. Crucially, these perceived benefits did not differ by area of residence, and the leading reasons for use were sleep, mood and mental health, cancer pain, and joint pain rather than the nausea and vomiting that dominate much of the clinical trial literature.

Attitudes toward cannabis were overwhelmingly favorable across the board. Fully 92.9 percent of respondents, including many who had never used it, believed there are benefits to cannabis use, most often citing pain management, relief of stress, anxiety, or depression, and control of treatment side effects. 83.1 percent were at least somewhat open to using cannabis, and 55.5 percent considered it safe for cancer patients, with only 2.8 percent calling it unsafe. Yet 76.7 percent also acknowledged risks, concentrated in the legal and social realm: negative career effects, inability to drive, legal consequences, and negative reactions from family or friends. The sample was split almost evenly on addictiveness, with 33.6 percent viewing cannabis as addictive and 34.6 percent as non-addictive, and 49.2 percent said they would be likely to participate in cannabis-related research, particularly involving edible preparations.

A few statistically significant differences between residence groups did emerge, and they are clinically meaningful. Urban and suburban patients were more likely to believe cannabis helps with nausea or vomiting, and, strikingly, were far more likely to avoid cannabis out of concern about interactions with their medications, 23.9 percent versus 4.8 percent among rural non-users. Rural respondents, by contrast, showed a borderline greater belief that cannabis increases cancer risk. The authors interpret these divergences as pointing to different educational needs: rural patients may need more information about sourcing and drug interactions, while urban patients may need reassurance grounded in evidence about other perceived risks. The lower dispensary use among rural patients, likely reflecting travel distance and access barriers, reinforces the point that availability, not attitude, may be the binding constraint outside metropolitan areas.

The findings sit against a backdrop of sharply limited clinical evidence. Observational studies like this one consistently report symptom improvement, but randomized trials and meta-analyses have been far less convincing: a 2025 systematic review of 98 studies found reductions in pain and anxiety in pre-post analyses but more limited evidence for appetite, chemotherapy-induced nausea and vomiting, and insomnia, while a 2023 umbrella review found moderate-certainty evidence that cannabinoids may improve sleep but also increase adverse events. The American Society of Clinical Oncology’s 2024 guideline offers only a weak recommendation to consider cannabis-based medicines for refractory CINV, with insufficient evidence for other symptoms. A key caveat is that most trials evaluated standardized pharmaceutical cannabinoids such as dronabinol or nabiximols rather than the whole-plant and inhaled products that most patients, including more than half of the users in this survey, actually consume.

The study’s implications are nonetheless clear. Nearly half of patients wanted to receive information about cannabis from their physicians, yet the most common reason for non-use was simply that no provider had recommended it, exposing a communication gap that recent research suggests is widespread, with conversations often patient-initiated and provider knowledge inconsistent. The authors call for clinician-led counseling on products, sourcing, benefits, risks, and drug interactions, particularly for practices serving mixed rural-urban catchments, and for rigorous, regimen-concordant trials that test the formulations patients actually use, with clinically meaningful endpoints such as opioid-sparing effects. With 26 percent of this sample using cannabis, 93 percent perceiving benefits, and age, not geography, the strongest predictor of use, the message for oncology is that cannabis is already embedded in patient self-management everywhere, and the evidence base needs to catch up in the clinic and the countryside alike.

Subject of Research: Cannabis use and perceptions among rural and urban cancer patients and survivors

Article Title: Cannabis use and perceptions among rural and urban cancer patients and survivors from a Pennsylvania cancer center

Article References: Ireland, J., Holben, L., Thompson, C. L., Zhu, J., Polimera, H. V., & Truica, C. I. (2026). Cannabis use and perceptions among rural and urban cancer patients and survivors from a Pennsylvania cancer center. Supportive Care in Cancer, 34(11), Article 1074. https://doi.org/10.1007/s00520-026-11061-7

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11061-7

Keywords: cannabis, cancer patients, symptom management, rural health, urban health, oncology, patient survey, THC, CBD, opioid substitution, palliative care, Pennsylvania