Landscape
04 Feb 2019

Psilocybin vs. cancer: psychedelic therapy in palliative care

by Roderick

Psilocybin is often associated with feelings of resolution, understanding and acceptance. It mediates the exploration of oneself and one’s place in the world. While many may use this molecule for recreational or spiritual purposes, it has been recently applied to those who are coming to the end of their lives. Specifically, for those dealing with terminal cancer, psilocybin therapy can provide the understanding and perspective that allows for a peaceful exit.

It has long been demonstrated that terminal cancer patients with higher levels of ‘existential and spiritual well-being’ tend to encounter better medical outcomes, a higher quality of life and an increased desire to make the best of their remaining time. Previous research on psilocybin therapy has demonstrated robust and enduring reductions in anxiety and depression, a burden common to cancer patients. A recent study by Malone et al. (2018) explored the experiences of four terminal cancer patients who underwent psilocybin therapy.

These researchers uncovered the notion that the effectiveness of psilocybin therapy relies on a few specific realizations. The “narratives extended beyond the cancer diagnosis itself, frequently revolving around themes of self-compassion and love, acceptance of death, and memories of past trauma.”

This investigation highlighted the personal nature of the experiences produced with psilocybin; the focus drifted from a diagnosis to love, acceptance and memories of past challenges overcome. Patients considering themselves to be more than terminally ill is paramount to maintaining humanization in those who are coming to the end of their lives.

These revelations are aside from any clinical reading or differential diagnosis—they are fundamental changes in thought processes. A recent study by Finlayson et al. (2018) explored the perception and understanding of disease in ovarian cancer patients experiencing recurrent diagnoses. The team discovered that “perceiving recurrent ovarian cancer as a chronic illness, and the perceived inability to make treatment decisions, led to enduring emotional distress.” Of note is the weight of ‘perception’ on the production of emotional distress, leading to subsequently poorer outcomes.

Griffiths et al. (2016) demonstrated that high-dose psilocybin “produced large decreases in … measures of depressed mood and anxiety, along with increases in quality of life, life meaning, and optimism, and decreases in death anxiety.” Even after six months, patients exhibited sustained changes, with significant decreases in depression and anxiety and an overall higher rating of well-being and life satisfaction. These lasting effects enable patients to use their remaining time in fruitful and impactful ways.

High doses of psilocybin were not subsequently found to be required for immediate, substantial and sustained positive outcomes. Ross et al. (2016) contributed evidence to support the single use of a ‘moderate dose’ of psilocybin alongside psychotherapy and support. They also observed significant improvements in anxiety, depression, demoralization, hopelessness and overall quality of life. These changes also persisted past the six month mark, with 60-80% of patients demonstrating clinically significant reductions in depression or anxiety.

The removal of dose sizet from the experience of desired outcome has made psilocybin an ever more appealing molecule for clinical and therapeutic applications. Studies that investigate the impact of dose in a rigorous environment are currently ongoing, however all recent evidence points towards a different consideration that is non-existent in trials excluding psychedelic compounds. This group of chemicals have the ability to induce ‘mystical experiences’ that are rarely found in the sterile confines of hospitals and palliative care facilities.

These ‘mystical experiences’ are the same as those attributed to miracles and divine revelations. Regardless of religious affiliation, low and moderate doses of psilocybin produced these occurrences to a similar extent as large doses. The most recent studies of psychedelic compounds indicate that the magnitude of these ‘mystical experiences’ is directly correlated to positive and lasting outcomes.

FundAMental is one of many groups that are emerging around the science, technology and individuals associated with psilocybin therapy. Essentially a cheerleader for crowdfunding research projects on psychedelic-assisted therapy, one of their primary targets is currently the advancement of the very approaches covered in the preceding paragraphs. The project, headed by Dr. Stephen Ross at NYU, is a larger study with a more diverse population that will be conducted to establish the generality and safety of psilocybin treatment.

These projects, and the understanding of how best to apply psilocybin in a clinical atmosphere, are coupled with the lack of any sustained deleterious physiological or psychological effects. This has opened the door towards understanding, applying and even legalizing psilocybin. While the latter slowly makes its way through bureaucracy and courts, bolstered by growing evidence of medical applications, the former are well underway. As all signs point to positives and risks are minimized and controlled, psilocybin therapy may one day be a standard course of action for those seeking acceptance and resolution.

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Malone, Tara C., et al. "Individual Experiences in Four Cancer Patients Following Psilocybin-Assisted Psychotherapy." Frontiers in pharmacology 9 (2018): 256.

Grob, Charles S., et al. "Pilot study of psilocybin treatment for anxiety in patients with advanced-stage cancer." Archives of general psychiatry 68.1 (2011): 71-78.

Lim, Chu Hsien, Brian Kangas, and Jack Bergman. "The Utility of Psilocybin in Managing Anxiety and Depression in Cancer Patients." Journal of Young Investigators 35.2 (2018).

Griffiths, Roland R., et al. "Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial." Journal of psychopharmacology 30.12 (2016): 1181-1197.

Ross, Stephen, et al. "Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial." Journal of psychopharmacology 30.12 (2016): 1165-1180.

Finlayson, Catherine Scott, et al. "The Experience of Being Aware of Disease Status in Women with Recurrent Ovarian Cancer: A Phenomenological Study." Journal of palliative medicine (2018).

http://www.fundamental.nyc/

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