Psychedelic therapy could reduce anxiety, distress among patients with cancer
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Anxiety and depression that may follow a cancer diagnosis, especially as a patient approaches the end of life, can be incapacitating and difficult to assuage.
“As the head of our palliative care program, I see a lot of patients who have a great deal of existential distress and anxiety over the fact that they are confronting their own mortality,” Anna C. Beck, MD, director of supportive oncology and survivorship and the University Supportive and Palliative Care Program at The University of Utah School of Medicine, told Healio. “This comes to mind especially in terms of a cancer diagnosis, but it’s not unique to cancer. Anytime someone is confronted with a life-threatening illness, these sorts of things tend to bubble to the surface.”
To address the apprehension patients with cancer face as their disease progresses, Beck and colleagues at Huntsman Cancer Institute conducted a pilot study involving group psychotherapy combined with a therapeutic dose of psilocybin, the active ingredient in “magic mushrooms.” The goal is to facilitate group discussion and allow for a shift in thinking that brings about empowerment and peace of mind, Beck said.
Psychedelic drugs such as psilocybin and LSD underwent extensive study as potential agents in conventional medicine in the 1950s, ’60s and ’70s. Early findings suggested these drugs can relieve anxiety among individuals facing their mortality. Although psychedelics are now illegal, a resurgence of interest in their therapeutic use has led to increased research.
Beck spoke with Healio about the methodology of the study, the “smooth sailing” of its execution thus far, and the potential regulatory hurdles facing this unorthodox treatment approach.
Healio: How did you become interested in the use of psychedelics to alleviate the fear of mortality among individuals with cancer?
Beck: My background is as a breast and medical oncologist, but I’m also board-certified in palliative care and have been a hospice medical director for over 15 years. So, my interest is in taking care of patients who have had serious illness, especially cancer, as they approach the end of life.
It can be very hard to support people when they’re dealing with anxiety as they confront the end of life. Often, conventional medications do not help with this type of fear. Selective serotonin reuptake inhibitors and other antidepressants can help even out some of the emotional swings. However, psilocybin has more of a record of helping patients really “go there” with their fears and reach a new equilibrium. I can’t say it erases the fear of dying, but somehow it does help patient view death more as a natural part of life, with less fear and anxiety around it. That is often only accomplished with the higher doses of psilocybin. In our study, it’s important to emphasize that this is done in conjunction with psychotherapy.
Healio: How is the study being conducted?
Beck: Paul Thielking, MD, a psychiatrist and member of our team, designed the methodology of our research. Participants have three 2-hour preparatory sessions before taking psilocybin. During these sessions, they talk about their intentions and goals. They discuss what made them interested in being part of the study and what they hope to gain from their participation.
On psilocybin treatment day, they take a standardized higher dose — 25 mg. We make a bit of a ceremony around the process. As a group, they take the medicines in the infusion room, which we’ve modified to appear less clinical. They spend the day in the infusion room in reclining chairs with their individual therapists, but still as a group. After the treatment, they attend three 2-hour sessions during which they discuss and process their experiences on psilocybin and influence one another. There is a lot of interplay throughout the process.
Healio: What have been the results of your study so far?
Beck: It’s a pilot trial, so our initial intent is to see if it’s feasible. We haven’t analyzed all the data. However, it has been very much smooth sailing. We’ve had very robust interest in the trial among patients at Huntsman Cancer Institute, as well as from patients around the country. So, recruitment has not been difficult. We also have not had any significant or unexpected adverse outcomes. Just being part of this trial and witnessing the dosing sessions has been a very gratifying experience.
Healio: What are your goals for future research, and what legal or regulatory hurdles do you anticipate?
Beck: Ultimately, our intentions are the same as in any clinical trial — we want to show that it’s safe and feasible and can be effective and practical. The goal is to hopefully bring something to the table that will help patients who are struggling with existential distress associated with a life-threatening illness.
I wanted to note that although this is a study of psychedelics, it’s also a study specifically of psychedelic group therapy. Most of the previous studies with psilocybin have been one-on-one trials — a therapist with a patient. So, we are trying to show that a group environment confers additional therapeutic benefit. Group treatment is also much more practical — you can treat more patients without compromising efficacy.
In terms of obstacles, it is certainly harder when the drug you are testing is Schedule I and requires a special license. So, in that sense, it certainly is different than a lot of phase 1 cancer trials. Psilocybin has had a checkered past for how it was perceived and used back in the ’60s and ’70s, and ultimately it became illegal. Everything that’s happened lately with cannabis has made it more possible for something like psychedelics to be brought back into conventional medicine.
I give a talk to the medical students each year on end-of-life care for patients with cancer. This year, they asked me to do a few slides about our trial with psilocybin, and I got so many emails. So many of the students stopped by and said, “Can I be part of this?”
The patients seem to be very appreciative, too. I had one patient who, after his psilocybin dose, came up to me when he was leaving the hospital and was overcome with gratitude for the experience. I have been an oncologist for 30 years or so, and I have never seen that kind of gratitude when one of my patients received chemotherapy.
Healio: Is there anything else you’d like to mention?
Beck: As an oncologist who focuses on caring for patients at the end of life, I see this as a tool we have never had before. Also, the group aspect of this treatment is providing an additional layer of support and a uniqueness to this trial. And in terms of feasibility, we can’t comment on efficacy yet, because we haven’t analyzed those numbers fully, but as to the question, “Can we recruit?” Absolutely. We have had no problems and have not seen any significant untoward events so far.
For more information:
Anna C. Beck, MD, can be reached at The University of Utah Health, 82 1100 E. #403, Salt Lake City, UT 84102; email: anna.beck@hci.utah.edu.
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ClinicalTrials.gov. Study of psilocybin enhanced group psychotherapy in patients with cancer (HOPE). Available at: clinicaltrials.gov/ct2/show/NCT04522804. Accessed June 21, 2022.
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