Improvements in the diagnosis and treatment of cancers in recent years have led to a marked increase in patients' physical survival rates. While doctors can treat the physical disease, what is not well understood is how best to address the psychological needs of patients with cancer.
In addition to the physical pain associated with cancer, many patients also experience psychologically harmful symptoms of anxiety, depression, anger, and denial. Social isolation, in addition to hopelessness, helplessness and loss of independence, has also been associated with significant psychological suffering in patients coping with advanced-stage cancer.
A recently published book chapter "Use of the Classic Hallucinogen Psilocybin for Treatment of Existential Distress Associated with Cancer," reviews the potential of a novel psychoactive drug, psilocybin, in alleviating the psychological and spiritual distress that often accompanies a life-threatening cancer diagnosis.
The chapter, published in Psychological Aspects of Cancer: A Guide to Emotional and Psychological Consequences of Cancer, Their Causes, and Their Management, was co-written by Anthony P. Bossis, PhD, Clinical Assistant Professor of Psychiatry and Oral and Maxillofacial Pathology, Radiology, and Medicine at the New York University College of Dentistry (NYUCD) and Langone Medical Center.
The hallucinogen treatment model with psilocybin has been shown to induce a mystical or spiritual experience and is a unique therapeutic approach to reduce the anxiety of terminal cancer patients.
"Mystical or peak consciousness states in cancer patients have been associated with a number of benefits including improved psychological, spiritual, and existential well-being," said Dr. Bossis.
Psilocybin (a serotonergic psychoactive agent) is a naturally occurring active component of many species of mushrooms, and is rapidly metabolized to psilocin, a highly potent activator of serotonin receptors. In addition to receiving the psilocybin compound, patients enrolled in the study also receive psychological preparation prior to the psilocybin dosing followed by a brief series of integrative psychotherapeutic sessions.
The chapter includes a clinical case vignette of a patient in the ongoing Psilocybin Cancer Anxiety Study at the Bluestone Center for Clinical Research. Participants undergo two drug administration sessions in which psilocybin is administered on one occasion and a placebo on the other.
"The primary objective of this phase I, double-blind, controlled pilot study is to assess the efficacy of psilocybin administration on psychosocial distress, with the specific primary outcome variable being anxiety associated with advanced and/or recurrent cancer," said Bossis. "Secondary outcome measures will look at the effect of psilocybin on symptoms of pain perception, depression, existential/psychospiritual distress, attitudes toward illness, quality of life, and spiritual/mystical states of consciousness," said Bossis.
The clinical vignette describes a patient who, over the course of three years, experienced extreme fatigue, pain, overall body aches, discomfort and psychological distress due to cancer and intensive biweekly chemotherapy. The patient became increasingly anxious and depressed and was enrolled in two study sessions; in one he received psilocybin and the other placebo. Despite continuing the arduous chemotherapy schedule, suffering from illness, and undergoing additional surgical procedures, the patient continued to report a marked improvement in attitude, coping, and mood 18 weeks after his session and stated, "my quality of life is dramatically improved," the patient said.
Stephen Ross, MD, Assistant Professor of Psychiatry and Child and Adolescent Psychiatry at the NYU School of Medicine and Clinical Assistant Professor of Psychiatry and Oral and Maxillofacial Pathology, Radiology, and Medicine at the NYUCD is the principal investigator for the study; Dr. Bossis and Jeffrey Guss, MD, Clinical Assistant Professor of Psychiatry are co-principal investigators.
The co-authors of the chapter were: Charles S. Grob, MD, Professor of Psychiatry and Biobehavioral Sciences at Harbor-UCLA Medical Center and Roland R. Griffiths, PhD, Professor of Psychiatry and Behavioral Science and Neuroscience at Johns Hopkins University.
The Psilocybin Cancer Anxiety Study was also recently highlighted in a News article, "Opening Doors of Perception: Psychedelic Drugs and End-of-Life Care" in the Journal of the National Cancer Institute.
"The emotional, spiritual and existential distress that can often accompany a diagnosis of cancer often goes unidentified and untreated in cancer patients. Patients who have benefited from psilocybin clinical research have reported less anxiety, improved quality of life, enhanced psychological and spiritual well-being, and a greater acceptance of the life-changes brought on by cancer. It is a welcome development that this promising and novel clinical research model utilizing psilocybin has begun to gain clinical and academic attention," Bossis notes.
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