Every year, hundreds of thousands of people in America develop depression and anxiety as a result of a cancer diagnosis. As of now, there isn’t much physicians can do to treat those conditions, says Dr. Anna Beck, an oncologist and the director of end-of-life care at Huntsman Cancer Institute.
“You can’t throw medications for anxiety or depression at this kind of existential distress,” Beck said. “You need something that’s really kind of out of the box.”
In the spirit of out-of-the-box thinking, Beck and a team of researchers at Huntsman are exploring an experimental treatment for the demoralization and anxiety that often accompany cancer: group psychedelic therapy.
They want to see whether group psychotherapy, combined with psilocybin, the active ingredient in magic mushrooms, can safely help people confront the sense of their own mortality.
“Psychedelic medicine is the only thing that has been shown to make a difference in terms of alleviating some of the existential distress [felt by cancer patients],” Beck said.
Psychedelics like psilocybin and LSD were studied extensively by scientists in the 1950s, ’60s and into the ’70s. Early research demonstrated the drugs could be valuable in treating the existential distress of cancer patients. A renaissance of psychedelic research in the past 20 years has built and improved upon the findings of those early studies.
Paul Thielking helped design Huntsman’s psychedelic clinical trial and serves as the project’s lead therapist. He also used to work as a palliative care doctor under Beck. Thielking said he was frustrated by the limited toolbox available to him, but psychedelics could be a game changer for end-of-life care.
“Even with one [psychedelic] dose,” Thielking said, “some people have transformational experiences that seem to shift their perspective on their life, their illness and on death and dying.”
And he said those remarkable benefits seem to last.
One study of the long-term effects of psychedelic treatment on a group of cancer patients found their anxiety and depression was markedly reduced more than four years after a single dose.
Breaking the Mold
Psychedelics may hold great promise to treat existential distress, and there may be hundreds of thousands of people who could potentially benefit from them. But two significant barriers stand in the way.
Since the passage of the Controlled Substances Act in 1970, they have been listed as Schedule 1 drugs, the most restrictive class, sharing company with substances like heroin, Spice and marijuana.
The growing body of high-quality scientific research demonstrating the many potential uses of psychedelics, especially psilocybin, has led to rumors that the drug could be rescheduled.
KUER spoke to several researchers for this story who said that could happen in as little as four or five years. Until then, however, the drugs remain illegal in every context except clinical trials, which require the authorization of the U.S. Food and Drug Administration.
The other barrier to their wider use is how psychedelics have come to be administered in clinical study. For a medical intervention, it’s incredibly resource intensive.
“The model up to date,” said Thielking, “is you’ve got two therapists with one patient for a series of preparatory sessions, an eight-hour dosing session, and then several follow-up sessions. So it really becomes daunting when you think about rolling this out, if and when psilocybin becomes FDA approved for use. How is this going to work?”
That’s the problem the Huntsman study is designed to explore. First, it reduces the two-to-one ratio of therapist to patients down to one patient paired with one therapist. Four of those pairs then go through the whole process together as a group.
“This study is helping us explore the idea of is it feasible to offer [psychedelic psychotherapy] in a group format, where you have several people at once taking the medicine together in the same room at the same time,” Thielking said. One of the main questions they are hoping to answer is whether reducing that ratio is safe.
The first group of participants passed through the study during the fall of 2021.
Each person was given a high dose of psilocybin, 25 milligrams, and sat with their therapist at individual stations in a large room at Huntsman — the same room where they receive their cancer treatments.
Music played on speakers and the participants wore black-out eye shades. It’s supposed to be an inward-directed experience, Thielking said.
He and his fellow researchers are still gathering and analyzing data from the first cohort.
KUER attempted to speak to some of the patients but researchers said no, citing the need to maintain the integrity of their study.
Offering her impressions of the trial so far, Dr. Beck said participants have struggled to put words to the experience.
“The two words I hear most often [are] powerful and indescribable,” she said.
Participants in previous studies have related experiences of feeling at one with the universe, encountering God or the ultimate reality, being bathed in “unconditional and undying love,” and the loss of boundaries between the subjective and objective worlds.
Dr. Stephen Ross, a researcher at New York University Langone Health uninvolved in the Huntsman study, thinks the mystical experience may play an important role in addressing the emotional symptoms cancer patients sometimes develop.
“I strongly suspect that the spiritual nature of the experience, and the insights it provides, may be the secret sauce that helps the patients improve,” Ross said.
A clinical trial conducted last year at the Aquilino Cancer Center in Maryland used a model similar to the Huntsman one. Early results from that trial show that all 30 of the participants experienced significant improvements in their depression and half of them showed full remission of their depression symptoms.
If the findings of the Utah study follow a similar path, Ross said it may mark an important turning point in how psychedelics are administered. By adding the drug to the group setting where participants bond over their shared experience, he said the studies may discover a way of enhancing the benefits of both treatments.
Ross said psilocybin and LSD have been proven to be extremely safe from a medical standpoint. Nevertheless, some people do hit rough patches during their experiences, and that could prove to be an issue.
“If you have six people in a room and three people are having a difficult time, even one person may start wailing and crying and have a difficult experience that could disrupt someone else’s therapeutic experience,” Ross said.
Stretching and Growing
Ross remains skeptical of early clinical trials like Huntsman’s. Even so, he’s excited about the potential implications. He said if studies can demonstrate the safety of reducing the patient-therapist ratio, it could help make psychedelic psychotherapy a more widely available treatment.
As for Beck, she said she’s driven by what she calls the “revolutionary research” of psychedelics and their potential to help people face their last days with pride and dignity.
“As a palliative care [doctor] my personal goal is that if people are approaching end of life, you just want them to know they’ve done a great job,” she said. “They should feel like they’ve done their best and they’ve been well-supported, and everybody’s proud of them. And I think this study is helping them approach end-of-life feeling like they’ve done their best and stretched and grown through the process.”
Beck and her colleagues are currently recruiting participants for the second of three groups in their study. Results of their research should be available later this year. If the findings are encouraging, Beck said it could pave the way for future psychedelic study at Huntsman.