By Jennifer Bires, LCSW, OSW-C, CST 

Aggressive medical care at the end of life leads to decreased quality of life for the patient and increased difficulty in bereavement for family members, but often these conversations are difficult to have for patients and providers alike (Baile et al., 2002; Wright et al., 2008). There have been limited pharmacological advances in treating psychological distress, and specifically in cancer, the American Society of Clinical Oncology in conjunction with the Society for Integrative Oncology, advocates that current day pharmacological options should not be first line treatment for depression and anxiety in cancer patients (Andersen et al., 2023; Yaden et al., 2022). Psychedelic medicines have recently reemerged on the scene as a potential joint pharmacological agent adjoined with therapy that could make a lasting difference in the anxiety, depression and existential distress patients and families experience with serious illnesses and the contemplation of death (Yaden et al., 2022). 

While significant technological advances have been made in detection and treatment options for people diagnosed with cancer, there is still a significant amount of fear and distress that accompanies a diagnosis (Lee, 2008; Vehling & Kissane, 2018). Increased anxiety around the prospect of death lessons quality of life in patients and caregivers (Sherman et al., 2010). While there is limited quality research specifically in cancer, some studies suggest that antidepressants have not been shown to work better than placebos in the treatment of depression in cancer (Ostuzzi et al., 2018). A systemic review looking at psychedelics as a possible treatment for depression, anxiety and existential distress for people with a serious illness found that psychedelics have a helpful impact on quality of life, existential distress and anxiety and depression with limited safety issues or negative impacts, although the research lacks in areas of quality and rigor (Reiff et al., 2020; Ross, 2018; Schimmers et al., 2022). With the exception of ketamine, psychedelics are not approved by the FDA, limiting access to these medications to use through clinical trials and underground use (Commissioner, 2023). Though recently, the FDA listed MDMA, a psychedelic agent, as a “breakthrough therapy” (Smith et al., 2022), and there is a lot of excitement in the field that approval will be coming in the next year. 

Outside of approval, it will be important to address stigma and create a pathway to reimbursement for psychedelics to limit disparities in access and use (Belouin & Henningfield, 2018; Smith et al., 2022). While the American Medical Association has approved CPT codes for psychedelic therapy, this does not ensure insurance companies will provide reimbursement (American Medical Association to Issue First New Code for Psychedelic Therapies | MAPS Public Benefit Corporation, n.d.). 

While it is still early, research has preliminarily shown psychedelics to be safe and efficacious in the treatment of depression, anxiety and existential distress in people with serious illness which can lead to less aggressive treatment at the end of life, increased quality of life and improved caregiver distress and bereavement (Baile et al., 2002; Marks & Cohen, 2021; Yaden et al., 2022). Oncology social workers can be key allies in helping to reduce stigma and increase access to psychedelics through early education to patients and colleagues, knowing about available local clinical trials, and even getting trained in how to provide integration and support for when these medicines are more readily available. This will help ensure broader awareness and access to a therapy that could have major implications for how we think about, support, and treat patients at the end of life.  

 References

American Medical Association to Issue First New Code for Psychedelic Therapies | MAPS Public Benefit Corporation. (n.d.). Retrieved October 1, 2023, from https://mapsbcorp.com/news/american-medical-association-to-issue-first-new-code-for-psychedelic-therapies/ 

Andersen, B. L., Lacchetti, C., Ashing, K., Berek, J. S., Berman, B. S., Bolte, S., Dizon, D. S., Given, B., Nekhlyudov, L., Pirl, W., Stanton, A. L., & Rowland, J. H. (2023). Management of Anxiety and Depression in Adult Survivors of Cancer: ASCO Guideline Update. Journal of Clinical Oncology, 41(18), 3426–3453. https://doi.org/10.1200/JCO.23.00293 

Baile, W. F., Lenzi, R., Parker, P. A., Buckman, R., & Cohen, L. (2002). Oncologists’ Attitudes Toward and Practices in Giving Bad News: An Exploratory Study. Journal of Clinical Oncology, 20(8), 2189–2196. https://doi.org/10.1200/JCO.2002.08.004 

Belouin, S. J., & Henningfield, J. E. (2018). Psychedelics: Where we are now, why we got here, what we must do. Neuropharmacology, 142, 7–19. https://doi.org/10.1016/j.neuropharm.2018.02.018 

Commissioner, O. of the. (2023, June 23). FDA Issues First Draft Guidance on Clinical Trials with Psychedelic Drugs. FDA; FDA. https://www.fda.gov/news-events/press-announcements/fda-issues-first-draft-guidance-clinical-trials-psychedelic-drugs 

Greif, A., & Šurkala, M. (2020). Compassionate use of psychedelics. Medicine, Health Care, and Philosophy, 23(3), 485–496. https://doi.org/10.1007/s11019-020-09958-z 

Lamkin, M. (2022). Prescription Psychedelics: The Road from FDA Approval to Clinical Practice. The American Journal of Medicine, 135(1), 15–16. https://doi.org/10.1016/j.amjmed.2021.07.033 

Lee, V. (2008). The existential plight of cancer: Meaning making as a concrete approach to the intangible search for meaning. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 16(7), 779–785. https://doi.org/10.1007/s00520-007-0396-7 

Marks, M., & Cohen, I. G. (2021). Psychedelic therapy: A roadmap for wider acceptance and utilization. Nature Medicine, 27(10), Article 10. https://doi.org/10.1038/s41591-021-01530-3 

Ostuzzi, G., Matcham, F., Dauchy, S., Barbui, C., & Hotopf, M. (2018). Antidepressants for the treatment of depression in people with cancer. Cochrane Database of Systematic Reviews, 4. https://doi.org/10.1002/14651858.CD011006.pub3 

Reiff, C. M., Richman, E. E., Nemeroff, C. B., Carpenter, L. L., Widge, A. S., Rodriguez, C. I., Kalin, N. H., & McDonald, W. M. (2020). Psychedelics and Psychedelic-Assisted Psychotherapy. American Journal of Psychiatry, 177(5), 391–410. https://doi.org/10.1176/appi.ajp.2019.19010035 

Ross, S. (2018). Therapeutic use of classic psychedelics to treat cancer-related psychiatric distress. International Review of Psychiatry (Abingdon, England), 30(4), 317–330. https://doi.org/10.1080/09540261.2018.1482261 

Schimmers, N., Breeksema, J. J., Smith-Apeldoorn, S. Y., Veraart, J., van den Brink, W., & Schoevers, R. A. (2022). Psychedelics for the treatment of depression, anxiety, and existential distress in patients with a terminal illness: A systematic review. Psychopharmacology, 239(1), 15–33. https://doi.org/10.1007/s00213-021-06027-y 

Sherman, D. W., Norman, R., & McSherry, C. B. (2010). A Comparison of Death Anxiety and Quality of Life of Patients With Advanced Cancer or AIDS and Their Family Caregivers. Journal of the Association of Nurses in AIDS Care, 21(2), 99–112. https://doi.org/10.1016/j.jana.2009.07.007 

Smith, D. T., Faber, S. C., Buchanan, N. T., Foster, D., & Green, L. (2022). The Need for Psychedelic-Assisted Therapy in the Black Community and the Burdens of Its Provision. Frontiers in Psychiatry, 12, 774736. https://doi.org/10.3389/fpsyt.2021.774736 

Vehling, S., & Kissane, D. W. (2018). Existential distress in cancer: Alleviating suffering from fundamental loss and change. Psycho-Oncology, 27(11), 2525–2530. https://doi.org/10.1002/pon.4872 

Wright, A. A., Zhang, B., Ray, A., Mack, J. W., Trice, E., Balboni, T., Mitchell, S. L., Jackson, V. A., Block, S. D., Maciejewski, P. K., & Prigerson, H. G. (2008). Associations Between End-of-Life Discussions, Patient Mental Health, Medical Care Near Death, and Caregiver Bereavement Adjustment. JAMA, 300(14), 1665–1673. https://doi.org/10.1001/jama.300.14.1665 

Yaden, D. B., Nayak, S. M., Gukasyan, N., Anderson, B. T., & Griffiths, R. R. (2022). The Potential of Psychedelics for End of Life and Palliative Care. In F. S. Barrett & K. H. Preller (Eds.), Disruptive Psychopharmacology (pp. 169–184). Springer International Publishing. https://doi.org/10.1007/7854_2021_278