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People with advanced cancer often face intense existential distress in the wake of their diagnosis. Standard mental health treatments may not fully meet the needs of such patients.
In an ongoing clinical trial, researchers at Huntsman Cancer Institute (HCI) and Huntsman Mental Health Institute (HMHI), both at the University of Utah, are testing a new form of therapy that integrates ketamine doses with talk therapy to try to help cancer patients when other interventions fall short.
Ketamine, an anesthetic with hallucinogenic and sedative effects, is approved for medical use in treating depression, although it can be prone to abuse.
Researchers in the Ketamine-Assisted Psychotherapy (KAP) Clinic hope that their novel combination of psychedelic medicine and psychotherapy provides relief to patients dealing with grim diagnoses.
“Ketamine loosens the mind’s grip on all the difficult things, and allows me to let life happen,” said KAP patient Suzy Mang. “With a terminal diagnosis like mine, things get thrown into disarray. During these sessions, I started to feel more at ease and not worry about the past or present. I had a lot of fear and anxiety, but the sessions have shut that tension down.”
Addressing a constellation of mental health challenges
“Many people with newly diagnosed cancers see surgery as the best and most definitive treatment,” said Laura Lambert, surgical oncologist and professor of surgery at Huntsman Cancer Institute. “It makes sense to just cut it out. Unfortunately, when people are diagnosed with metastatic cancer, surgery is not often a meaningful option because not all of the cancer can be surgically removed. The true impact of the loss of hope for a surgical cure on existential distress remains unknown and is another aspect that the trial is investigating.”
A co-principal investigator on the clinical trial, Lambert also directs the U’s peritoneal malignancy program.
A diagnosis of advanced cancer can introduce a spectrum of challenges that is distinct from other mental health conditions, explained co-principal investigator Ben Lewis, an assistant professor of psychiatry at HMHI.
“Patients with cancer are often grappling with what is meaningful in life, the nature of their own mortality, and conceptions about what their life was going to be like,” Lewis said. “And they’re often dealing with other really difficult challenges—isolation, loneliness, symptoms of the illness, symptoms of treatment.”
Added Kevin Byrne, an HCI investigator, “Traditional treatments work for some people, but we haven’t had enough tools in our toolbox for treating the issues surrounding existential distress.”
A major advantage of ketamine-assisted psychotherapy is how quickly it often works. According to Anna Beck, director of supportive oncology and survivorship at Huntsman Cancer Institute and director of the supportive and palliative care program at the Spencer Fox Eccles School of Medicine.
“Conventional antidepressants, which are commonly used to help address cancer-related distress, may take up to four weeks before an effect is apparent,” Beck said. But “with ketamine-assisted psychotherapy, patients commonly report relief in just a single session.”
Ketamine rarely interacts poorly with other medications, which is especially important for cancer patients on complex medication regimens. The researchers hope that ketamine-assisted psychotherapy could potentially provide some aid by helping people break out of harmful thought patterns.
Like other psychedelic medicines, ketamine can induce a critical window of time during which the brain works differently, forming new connections between neurons more easily. Within this window, it can be easier for people to move away from painful patterns of thinking and start building something new, especially if the ketamine exposure occurs within a therapeutic context.
“For a period of time following administration of ketamine, the brain becomes more open and flexible to new learning and new ways of adapting,” Lewis explained. “Ketamine-assisted psychotherapy tries to use that opening to get in there and do some work.”
Embracing patients’ experiences
Most other ketamine clinics focus on the medication alone, using a low dose to reduce the likelihood of potentially distressing mind-altering experiences. But at the KAP clinic, ketamine itself is only half the story. Rather than treating a dissociative experience as an unwanted side effect, the researchers aim to acknowledge and explore the experiences and insights that may arise from ketamine, as well as the way those insights are related to patterns of suffering.
Before and after each ketamine dose, patients participate in talk therapy sessions designed to help process their experiences and make the most of the altered state of consciousness that ketamine can induce.
“We carefully prepare patients for the mind-altering effects of ketamine, and we’ve curated an environment that enhances and supports their experience,” Byrne said. “With the help of therapists, we ensure that patients navigate this experience in the most fruitful way possible.”
While patient Suzy Mang was initially worried about whether the treatment would work, she said the controlled, professional environment was “a huge relief.”
“It’s not a wild trip, it’s peaceful,” Mang said. “There is always a medical professional in the room making sure I’m safe.”
While the clinical trial is still in progress, Byrne said that he has already noticed several advantages of KAP for his patients, including enhanced mood, reduced anxiety, changes in perspective, greater flexibility and openness, a sense of connection or unity with others, improvements to relationships, and even spiritual experiences.
“Many patients find that a blend of these elements leads to a beneficial shift,” he said. “This shift helps them address and engage with the profound existential questions often triggered by a life-threatening diagnosis.”
Using science to improve care
In a complementary clinical trial, Lewis and Byrne plan to use machine learning software to analyze videos of patients for behavioral cues that might predict which interventions would be most effective. The software can measure everything from facial expressions to speech patterns—“any behavioral metric you can think of,” Lewis said. By doing a deep dive into patient video data, the researchers hope to find patterns that will help them tailor this emerging treatment for different groups of people.
“The science of using psychedelics to treat existential distress and demoralization in life-threatening illnesses is young, but I’ve seen very powerful results in some of our patients,” Byrne said. “While we still need a lot more science to make sure we’re grounding our clinical practice in evidence-based medicine, I’m very hopeful about the idea that we are working to add promising new treatments for patients who desperately need them.”
To learn more about the KAP clinic or schedule an evaluation, call 435-658-9263 or email firstname.lastname@example.org.
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