Psychedelic Research May Support Unprecedented End-of-Life Care for Patients With Cancer

Despite significant advances in cancer therapeutics over the past few years, little progress has been made in developing successful strategies to mitigate common, oftendebilitating treatment complications such as neuropathy and fatigue. These conditions, along with chronic pain and anxiety, contribute to suffering and clinical depression, which are not easily eliminated with conventional pharmacotherapeutics alone.

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Investigations of unconventional therapies have been slow, particularly those involving cannabinoids and psychedelics (eg, psilocybin, lysergic acid diethylamide, 3,4-methylenedioxymethamphetamine, and ketamine) because of federal regulations, social stigmas, and other medical and societal concerns. Although cannabis (medical and/or recreational) has been legalized or decriminalized in more than 46 states and territories, highqualityevidence to support its efficacy to relieve anxiety, anorexia, insomnia, pain, or other symptoms caused by cancer or cancer-related treatments is sparse. In contrast, several small, controlled trials have demonstrated safety and preliminary efficacy of psilocybin treatments for anxiety and depression in patients with cancer. Psilocybin and other psychedelics hold promise in treating anxiety, depression, substance abuse and addiction, posttraumatic stress disorder, obsessive compulsive disorder, headaches, and chronic pain disorders.

Initiatives at federal and state levels have helped facilitate psychedelics research by forming special research advisory councils that help provide appropriate funding for legalization, decriminalization, or use at state-regulated centers, as well as streamlining processes for investigators to obtain licenses to conduct studies of psychedelic compounds. Additionally, the FDA’s designation of psilocybin as a “breakthrough therapy” in 2018 for treatment-resistant depression and for major depressive disorder in 2019 supports expedited development and review, for which there exists an elevated level of interest among the medical community that cares for affected patients.

However, these substances are not without risks, including blood pressure and heart rate elevations, fear, anxiety, hallucinations, and psychedelicperceptual disturbances. Individuals with a history of psychosis, bipolar disorder, schizophrenia, schizoaffective disorder, and other comorbidities may not be appropriate candidates. Potential drug-drug interactions are also a concern, particularly with other medications used for psychiatric or mood disorders and drugs that might affect psilocybin metabolism.

Additionally, the current therapeutic model for psilocybin treatment includes assisted psychotherapy sessions that help prepare patients before treatment, support patients during treatment sessions, and provide counseling posttreatment to support the integration of experiences during the treatment session. As such, therapeutic planning and delivery are medically complex, requiring specialized practitioners and settings. However, dosing regimens appear to be limited and infrequent and produce durable responses. Thus, psilocybin treatment may be feasible and accessible for a broad number of patients, including those who do not live within proximity of research or treatment centers.

Although the resurgence of interest and clinical trials investigating psychedelics within the past decade or so may not be on the radar for most oncology pharmacists, it is important, on behalf of our patients, to become aware of recent and future developments in these therapies. Our patients with cancer who may be experiencing anxiety, depression, emotional distress, or end-of-life issues have few options available to them to manage these symptoms, so opportunities to explore treatment options for these symptoms are invaluable. We can also serve as advocates and resources for patients and providers who may be interested in learning more about clinical trials investigating these drugs and potential treatment options available to patients with cancer.

About The Author

Lisa E. Davis, PharmD, FCCP, BCPS, BCOP, is the editor-in-chief of Pharmacy Times Oncology Edition. Davis holds positions as a clinical pharmacist in early-phase clinical trial and breast cancer programs at the University of Arizona (Arizona) Cancer Center and a clinical professor of pharmacy practice and science at the Arizona R. Ken Coit College of Pharmacy. Davis also sits on the Hematology/Oncology Pharmacy Association Board of Directors and is a member of the Cancer Prevention and Control Program and scientific review committee at the Arizona Cancer Center.