Throughout my medical training and more than 20 years as a practicing oncologist, the emphasis in cancer treatment has always been on treating the tumor. But I also know that my patients’ suffering extends far beyond the physical. Over time, the deep, emotional distress that turns their lives upside down has gone from a whisper of concern to a deafening, unavoidable blast.
Those of us who treat cancer patients cannot deny the painful emotions they and their families experience. Facing that reality includes looking for practical, effective ways of easing the pain. The trouble is the tools to address the emotional dimensions of cancer have been scant.
That began to change a few years ago when evidence emerged indicating that psychedelics could reduce death-anxiety that many cancer patients experience. In the United States, more than 90 clinical trials are exploring whether one of these substances — psilocybin, a natural hallucinogenic found in certain mushrooms — can give patients the emotional relief they desperately seek.
Along with my work as an oncology clinician, I’m the principal investigator for one of those trials. Our trial is suggesting that these drugs, which were banned decades ago, might have a meaningful, positive effect in treating major depression, anxiety other mood issues.
One patient with metastatic cancer, who has suffered from severe emotional distress because of her difficult diagnosis and treatment, decided to participate last year in the clinical trial my colleagues and I were conducting. She found that shortly after a single psilocybin therapy session her life and perspective changed dramatically.
Her session had been quite challenging in contrast to the typical mystical experience some have recounted; she faced her death directly, which she found to be painful. Then, while at her lake house a day after her psilocybin session, as the light was fading into darkness and the chirping of crickets rose to a crescendo, she felt a blanket of peace envelop her, and she arrived at an insight: All these crickets would inevitably soon die and a new crop of them will take their place. It reminded her that, when she was born, she was replacing others who had died, and, with her death, others will come after her. All this was a part of the natural cycle.
This feeling of being part of something greater than herself, of seeing how she fit into the complex puzzle of nature, helped her place her fast-approaching mortality in a larger context and with that the heavy weight of anxiety about her death lifted.
In the past, I might have said to her, “Dying is natural; it’s part of the human experience,” but without this experience, it would not have landed well. She had to feel this in her whole person, not just as an intellectual or philosophical exercise. By her own account, it was an experience that she had never had before and that lasted for many weeks and months more. She could only attribute her dramatic change only to her psilocybin treatment.
Another trial participant recalled during her psilocybin session a scene in nature where she saw trees that had died and were filled with living organisms and nutrients that allowed younger trees to feed and grow. It left her feeling that, even after her death, she would leave to her children a legacy that provides them with emotional and spiritual support.
Results from the clinical trials my colleagues and I conducted have not yet been published, so it is too soon to make any definitive conclusions about the use of psilocybin for treatment of depression. But the pre-publication evidence is promising: half of all the 30 participants no longer had clinical depression eight weeks after a single dose of psilocybin and accompanying therapy, and 80 percent of the people studied had their depression scores drop by at least 50 percent. (The trial measured depression with the Montgomery-Asberg Depression Rating Scale, or MADRS.)
These clinically significant results are consistent with a growing number of other studies on psychedelics’ effect on illnesses, such as depression and post-traumatic stress disorder. One small study from Imperial College London, reported in the New England Journal of Medicine last year, suggested that psilocybin could ease symptoms of major depressive disorder (or MDD) at least as effectively as a conventional selective serotonin reuptake inhibitor antidepressant — but with potentially fewer side effects. Another study, conducted at Johns Hopkins Bayview Medical Center, indicated that psilocybin treatments provided relief from MDD among cancer patients and others. And a study published last year concluded that the psychedelic drug MDMA “represents a potential breakthrough treatment” for PTSD.
The promise of psychedelic therapy is significant for not only patients but also clinicians like me who have exhausted our arsenal to help those crushed by the emotional burden of cancer.
Intense psychological agony
Oncologists are well-equipped to fight the physical threats of cancer with powerful, yet sometimes-imperfect tools including chemotherapy, radiation and surgery, but they often feel helpless when it comes to treating the intense psychological agony many patients experience.
Many of the approved therapies to treat my cancer patients’ mental health don’t help them. Not surprisingly, research has shown a high degree of depression and burnout among oncologists as well, some of which stems from watching patients suffer and not being able to help.
Clinical trials studying psilocybin and MDMA are now picking up where others left off before 1970, when the federal government passed the Controlled Substances Act that banned the use of and even research into psychedelics. They’re finding that, for some people, even a single dose of psilocybin in a supportive environment — accompanied by therapy — may be more impactful and have longer lasting effects than current protocols: talk therapy combined with existing antidepressant drugs.
Like many of my colleagues, I was initially skeptical about embracing psychedelics, which many see as easily abused recreational drugs. But the growing evidence from rigorous research has caused many physicians, like me, to reassess. In the trials at our center, we provide treatment within a highly controlled, safe environment. The format is the opposite of a traditional “take two of these and call me in the morning” form of care.
Trial participants are screened based on a set of inclusionary and exclusionary criteria and meet for hours before their session with our well-trained therapists. And a team closely monitors the administration of the treatment, sitting with each patient until the effects of the drug completely wear off. There are then several meetings after the session to help integrate the psilocybin session, so the insights and experience gained continue to have benefit.
The research is also helping to diminish concerns many have about the potential for the abuse of psychedelics. While abuse is always possible, developing standards of care and rigorous training criteria help assure that trial participants and future patients are getting safe and qualified care.
One of the messages I share with patients is that the deep distress and the dark feelings they experience after being diagnosed with cancer are normal and deserve as much attention as the physical effects of their cancer. Patients should not have to go somewhere outside the cancer treatment center to get that help.
If further research into psychedelic therapy is validated and approved by the Food and Drug Administration, I think cancer centers would do well to offer it as part of an in-house continuum of cancer care. Besides chemotherapy and radiation, oncologists must work to address the psychological issues their patients face.
I have never witnessed the sort of dramatic response to any medical intervention as I have with some patients through psychedelic-assisted therapy. It is not a magic bullet or cure for a cancer patient’s suffering — and it won’t change their prognosis or life expectancy. But it could be a spark that begins their healing journey, helping them come to terms with their most difficult fears.
Manish Agrawal is an oncologist for Maryland Oncology Hematology at the Aquilino Cancer Center in Rockville, Md., where he is medical director. In 2021, he helped launch Sunstone Therapies, whose mission is to address the emotional effects of cancer diagnoses.