While significant advancements in cancer therapy have been achieved, cancerremains a major medical and public health problem (Markham et al., 2020). Malignancies ranked as the second leading cause of death worldwide in 2018, accounting for an estimatedof 9.6 million deaths (WHO, 2018).The burden of cancer in Thailand is similarly significant, with more than 170,000 cancer cases and 114,000 cancer deathsrecorded in 2018, comprising over36% of the prematuredeaths attributable to non-communicable disease (WHO, 2020).Cancers of the liver, lung, colon and rectum, breast, stomach, and gallbladder are the most common sites for malignancy in Thailand, each contributing from 1 to 5% of all total deaths.Incidence of cancer types differs among the country’s regionsdue to differences in cultural and lifestyle patterns (Virani et al., 2017). Liver and lung cancers, in particular,are expected to increase in the north and northeast of the country.The magnitude of the problem requires not only sufficient access to the curative sector but also the integration of public health into optimal efforts for cancer diagnosis and therapy. The main goal should be to prolong the patient’s life with the best possible quality of life (QOL) (“WHO | Cancer control. Knowledge into action,” n.d.).

Cannabis is a plant that has been studied and used to relieve side effects from existing cancer treatments. The primary group of active chemicalsin cannabis is cannabinoids with several of these compounds used as medicinal substances.The two most commonly used compounds are delta-9 tetrahydrocannabinol (THC) and Cannabidiol (CBD),with both chemicals acting through the endocannabinoid system (Lal et al., 2021). These cannabinoids have been used as a pain reliever, antiemetic drug in chemotherapy treatment, appetite stimulant, stress reliever, and sleep aid (Abrams and Guzman, 2015). The use of cannabis in cancer patients, however, can cause side effects such as dry mouth, nausea, vomiting, confusion. Special attention is needed for older adults with cardiovascular disease in whom palpitations, tachycardia, high blood pressure can occur, as well as people with mental illness (Whiting et al.,2015; Sexton et al., 2016).

In Thailand, medical cannabis (MC) remains a new concept with only limited research available. The Thai government authorized the use of cannabis for medical purposes in 2019. The rapid introduction of MC has led to misconceptions and controversies, such as 1) the belief that cannabis can cure all diseases, 2) the growth of illegal cannabis trading through online media, and 3) the pursuit of marijuana among ineligible patients (SuphanchaimatandPavasuthipaisit, 2018; SaengkhamandOngkasingh, 2020).

MC use among cancer patients can be considered a form of complementary and alternative medicine (CAM). Demographics associated with use of CAM among cancer patients around the world have shown some notable trends. For example, young women with cancer in Italy were more like to use CAM therapies, including dietary supplements and herbs (Bonacchi et al.,2014). Similarly, in Ghana, being young, married, female, and having a high level of education were all factors that led to increased CAM use following cancer diagnosis (Yarneyet al.,2013). These trends mimic trends in the broader population. For example, in Norway, CAM usage was higher in younger, female, and educated individuals (Kristoffersen et al.,2021).

Clinical characteristics are also important. Patients that have undergone treatment for a long duration of time or had less success in treatment were more like to have higher awareness about CAM, which can affect subsequent usage (Choi et al.,2021). An advanced stage of cancer has been shown to be strongly related to CAM use (Naja et al.,2015). Increased usage of CAM has been associated among rural elderly cancer and among those who have more than one comorbidity (Ayele et al., 2017). Besides demographics and clinical characteristics, social attitudes and previous experience can be an important factor in determining CAM usage. For example, social networks and encouragement from family can strongly influence choices to use CAM (Labidi et al.,2020). Expectations of CAM effectiveness or dissatisfaction with current treatment have also been shown to increase the use of CAM (Tangkiatkumjai et al.,2020; Bauml et al., 2015). However, health literacy regarding CAM is also important, with young men having lower levels of health literacy (Sharoni et al.,2019).

Overall, while cultural and societal differences affect attitudes towards CAM among cancer patients, some similar trends are observed globally, including generally being associated with females, younger age, higher income, more advanced stages of cancer, and previous experience with or knowledge about CAM. Considering cannabis use in particular, MC may be slightly different. For example, MC has been shown to be more common among males compared to females (Haug et al.,2017). Furthermore, there may be higher levels of stigma associated with MC use (Leos-Toro et al., 2018).

Therefore, given the importance of culture, demographics, and laws, as well as the relative novelty of MC in Thailand, there is a need to understand the role of these factors in affecting MC use among cancer patients in Thailand. Given the higher incidence of cancer in northern Thailand relative to the rest of the country, we were interested in studying demand of MC use among cancer patients in the region. This study aimed to identify factors associated with demand of MC use among cancer patients in northern Thailand.