This qualitative interview study (n=12) examined the perspectives and attitudes of cancer healthcare workers towards psychedelic-assisted therapy. In general, they were open to the concept, viewed it as an innovative approach, and acknowledged their responsibility towards alleviating suffering in advanced cancer patients. However, this view was also met with caution and highlights the need for further research to ensure efficacy and safety.

Abstract

“Introduction: Recent clinical trials suggest that psychedelic-assisted therapy is a promising intervention for reducing anxiety and depression and ameliorating existential despair in advanced cancer patients. However, little is known about perceptions toward this treatment from the key gatekeepers to this population. The current study aimed to understand the perceptions of cancer healthcare professionals about the potential use of psychedelic-assisted therapy in advanced cancer patients.

Methods: Twelve cancer healthcare professionals including doctors, nurses, psychologists and social workers took part in a semi-structured interview which explored their awareness and perceptions toward psychedelic-assisted therapy with advanced cancer patients. Data were analysed using thematic analysis.

Results: Four inter-connected themes were identified. Two themes relate to the role and responsibility of being a cancer healthcare worker: (1) ‘beneficence: a need to alleviate the suffering of cancer patients’ and (2) ‘non-maleficence: keeping vulnerable cancer patients safe’, and two themes relate specifically to the potential for psychedelic-assisted therapy as (3) ‘a transformative approach with the potential for real benefit’ but that (4) ‘new frontiers can be risky endeavours’.

Discussion: The findings from this study suggest intrigue and openness in cancer healthcare professionals to the idea of utilising psychedelic-assisted therapy with advanced cancer patients. Openness to the concept appeared to be driven by a lack of current effective treatment options and a desire to alleviate suffering. However, acceptance was tempered by concerns around safety and the importance of conducting rigorous, well-designed trials. The results from this study provide a useful basis for engaging with healthcare professionals about future research, trial design and potential clinical applications.”

Authors: Lisa M. Reynolds, Amelia Akroyd, Frederick Sundram, Aideen Stack, Suresh Muthukumaraswamy & William J. Evans

Summary

Researchers conducted a semi-structured interview with 12 cancer healthcare professionals to explore their awareness and perceptions toward psychedelic-assisted therapy with advanced cancer patients. Four inter-connected themes were identified, including a need to alleviate the suffering of cancer patients and keeping vulnerable cancer patients safe. The findings from this study suggest that cancer healthcare professionals are intrigued by the idea of psychedelic-assisted therapy, but are tempered by concerns around safety and the need for rigorous, well-designed trials.

Introduction

Advanced-stage cancer is commonly associated with psychiatric disorders, including treatment-resistant depression and anxiety, and psychological distress more broadly. Psychedelic-assisted therapy may be a promising new approach, but little is known about perceptions toward this treatment from cancer healthcare professionals.

The standard treatment offerings for depression, anxiety and existential despair in cancer patients are limited, and a recent review found that combining psychopharmacology with psychotherapeutic approaches can lead to outcomes superior to either treatment alone.

One combined approach that appears to offer particular promise lies in administering psychedelic compounds alongside psychotherapy. This approach is based on the theoretical idea that psychedelics stimulate 5-HT2A receptors in the brain and increase synaptic function and proteins that are associated with neural plasticity.

Although several studies combining psychedelics with psychotherapy were conducted with cancer patients in the 1960s and 70s, interest in this area has only re-emerged in the last decade. These studies have all found sustained reductions in depression, anxiety, and existential despair and increases in quality of life.

Despite research reporting only mild or transient side effects, there are several reasons to suspect that cancer healthcare professionals may have concerns about this approach. This study investigated the awareness, knowledge, attitudes, and perceptions of cancer healthcare workers toward psychedelic-assisted therapy.

Materials and Methods 2.1. Researcher Declaration

The researchers involved in this study are health psychology practitioners, medical clinicians, and academic researchers. One of the researchers had a professional relationship with some participants.

2.2. Participants

Participants were recruited from a database of healthcare professionals who provided treatment or support to patients with advanced/metastatic cancer.

2.3. Study Procedure

To minimise recruitment bias, the study was advertised in neutral terms as an interview exploring a new way of supporting patients with advanced cancer. Participants were offered a gift worth approximately NZD 25 for their involvement in the study.

The interviews were conducted in a location of the participant’s choice, and followed a semi-structured format. The participants were asked to describe their professional role and their observations about how their patients coped with advanced cancer before moving to specific questions about psychedelics.

2.4. Data Analysis

Twelve healthcare professionals working in either cancer care or palliative care settings across the Auckland/Northland region of New Zealand took part in the study. They had a mean age of 40.5 years (SD = 11.9), were female (75%), New Zealand European (58%), and doctors (42%), and had an average of 11 years of experience.

When asked about their knowledge and experiences with psychedelics, participants expressed initial surprise and exhibited subtle body language that suggested some hesitation about the subject matter. However, this hesitation was short-lived in all interviews, and participants moved on to talk freely about their knowledge and experiences.

Recent clinical trials have investigated the use of Psilocybin alongside psychother apy in people with advanced cancer. The results show that Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer.

2.4. Data Analysis

A qualitative approach was taken in this work, and data were analysed using inductive reflective thematic analysis. The six steps of analysis were: data familiarization, coding, generating initial themes, reviewing themes, defining and naming themes, and writing a report.

Results

Twelve healthcare professionals, mostly female, New Zealand European, and doctors, worked in cancer care or palliative care settings in New Zealand.

When asked about their professional experiences with patients, participants were open and honest, but initially expressed surprise and hesitation about the subject matter. However, this hesitation was short-lived, and participants moved on to talk freely about their knowledge and perceptions of psychedelics.

Participants had a range of knowledge and awareness about psychedelics, with some knowing very little and others claiming to have good knowledge.

[Doctor, 12]

When participants had limited knowledge of psychedelics, they seemed to rely on a heuristic informed by information gained through various sources, such as the media, literature and personal experience. However, as knowledge increases, perceptions are likely to change.

3.1. Key Themes

Four inter-connected themes related to the role and responsibility of cancer healthcare workers were identified, and two themes related specifically to psychedelic-assisted therapy were described below with example quotes from participants.

Advanced cancer patients face particular suffering including dealing with complex and physically demanding treatment regimens, coping with challenging emotions such as fear and anxiety, negative cognitions like worries about dying, and unhelpful avoidance behaviours or denial.

Participants described their role as healthcare workers as trying to alleviate suffering. One psychologist stated that she wanted to take away the pain.

Participants acknowledged that there were times when suffering of patients could not be alleviated, and that current treat- ments could frustrate attempts to alleviate suffering.

Participants described the particular suffering that advanced cancer patients face including dealing with complex and physically demanding treatment regimens, coping with challenging emotions such as fear and anxiety, negative cognitions like worries about dying, and unhelpful avoidance behaviours or denial.

[Psychologist, 6]

Participants described their role as healthcare workers as trying to alleviate suffering, such as mental stress caused by chemo treatment.

[Psychologist, #8].

Participants acknowledged that there were times when the suffering of patients could not be alleviated, and that there were patients who were afraid of dying.

[Psychologist, #8].

The alleviation of suffering could also be frustrated in the context of current treatment approaches that are not always helpful or fall short in addressing patient need.

[Doctor, #2]

In situations where someone has a short time to live, healthcare workers often feel helpless and want to alleviate their suffering.

Participants were generally open to an approach that might alleviate suffering in their patients, and they also reported that patients themselves would probably be open to such an approach.

When you have advanced cancer, you are willing to do anything to improve your life. This theme captures the professional responsibility and desire of health-care workers to alleviate suffering.

All participants noted that incorporating psychedelics in health-care stretched the current medical paradigm and had potential to offer real benefit. However, one participant questioned whether society was ready for such an approach.

Participants who had limited prior knowledge of psychedelic use as a therapy expressed initial hesitation, but later switched to a more open and supportive view after hearing about results from recent studies.

In contrast to previous knowledge, participants who had prior knowledge of psychedelics were more open to the idea of trying them. Some doctors were convinced that psychedelics could be a major advancement in medicine.

Participants thought that an experience like this would help patients process their existential concerns, and explore some of the existential ideas that typically comfort patients when they have advanced cancer.

[Psychologist, #4]

There were comments demonstrating the idea that a medication that impacts neural activity seemed like an intuitive mechanism of change.

Although psychedelics were perceived as innovative in the context of the West, one participant highlighted that they have a long history in many indigenous cultures. This participant cautioned against exploitation of such indigenous knowledge and the spiritual aspects of such an approach.

3.1.3. Theme III: New Frontiers Can Be Risky

Participants’ perceptions of potential benefits were tempered by their perceptions of risks, which included problems with being associated with “illegal” and “recreational” drug use.

Medical marijuana is portrayed as something that is used for fun, rather than for medicinal use.

The manufacturing process of psychedelics is unregulated, which means there could be risks associated with taking it. There are also concerns about altered states of consciousness and the negative impact of ‘bad trips’ or being put in dangerous situations.

Advanced cancer patients are often on many medications and are concerned about drug interactions. The feeling that they have is similar to the feeling that they have about high voltage electricity.

Participants raised concerns about the risks of using psychedelic medicine with a vulnerable population, and suggested that more research should be done with people who don’t have cancer before advancing to people with cancer.

[Doctor, #12]

Participants suggested that psychedelic medicines could become just another pharmaceutical agent if they were researched in the same way that other drugs are researched, and that a scientific evidence base should be built through well designed and rigorously conducted research trials.

To develop cancer drugs, you have to understand the toxicity of the medicine. Phase One studies help you understand these things.

Participants noted that a smaller dose (i.e., a micro dose) would be associated with less risk of side effects and that they would feel more comfortable referring someone to a micro-dose treatment or trial. However, a comment was also made that a micro dose might also be less effective.

Discussion

A study was conducted to understand the perceptions of cancer healthcare workers toward psychedelic-assisted therapy. The study identified two overarching themes: the responsibility for beneficence and nonmaleficence in cancer healthcare workers, and the potential for real benefit but also high risk.

4.1. The Responsibility of Healthcare Workers: Beneficence and Non-Maleficence

Advanced cancer patients are a population with complex vulnerabilities. Healthcare workers are aware of their duty of care, but must balance the responsibility not to cause harm with the responsibility to alleviate suffering.

The parameters of cost versus benefit decision-making may differ at the end of life compared to other contexts, and patients in advanced cancer may be well versed on balancing therapeutic value with potential side effects.

The results of the study suggest that cancer healthcare workers are optimistic about the possible benefits of psychedelic approaches but are also mindful of adverse effects.

Participants noted that well-designed and rigorously conducted phased research trials are the best way to navigate the risk and reward dichotomy in psychedelic-assisted therapy in advanced cancer contexts. However, pragmatic trials may also provide important insight.

Our findings highlighted that there is a range of knowledge about psychedelics among cancer healthcare workers, and that this knowledge base influences perceptions. As the therapeutic potential of psychedelics is becoming more widely discussed, perceptions will inevitably change.

4.3. Study Limitations and Research Agenda

The current study offers insight into the perceptions of cancer healthcare workers regarding psychedelic-assisted therapy, but it is not without limitations. Further research is required to determine the prevalence of these views across demographic and professional variables, and to determine whether these perspectives hold across geographical boundaries.

Although the settings in which the interviews were conducted appeared to influence initial responses by some participants, it was important to note this impact. A tension appeared between participants’ professional role and personal identity when talking about psychedelics.

Future research should consider how psychedelics might be used by cancer patients, their caregivers, palliative patients, and indigenous practitioners, spiritual leaders, and cultural groups. This research should also consider how psychedelics might fit alongside current medical paradigms.

Conclusions

In the current work, cancer healthcare workers were open to the concept of psychedelic-assisted therapy, but cautioned that further research was needed to ensure efficacy and safety.

A.A., L.M.R., W.J.E., S.M. and F.S. designed the study, conducted the interviews, coded the data, identified potential themes, and refined the themes collectively using NVivo12. All authors reviewed the manuscript and contributed to the final version.

The prevalence of anxiety and depression in palliative care patients with cancer in Western Australia and New South Wales is high, and anxiety and depression contribute to poor quality of life, treatment adherence, and prognosis in patients with advanced non-small cell lung cancer. Several studies have been conducted on the impact of psychiatric morbidity and mortality on cancer patients receiving stem-cell transplantation, and on the efficacy and safety of pharmacotherapy in cancer-related psychiatric disorders across the trajectory of cancer care. Antidepressants are used to treat depression in people with cancer. Awareness and barriers to use of cancer support and information resources by HMO patients with breast, prostate, or colon cancer are also reviewed. A systematic review of modern-era clinical studies on the effects of classic serotonergic psychedelics, including LSD, shows that these drugs promote structural and functional neural plasticity. Several studies have shown that psychedelics enhance suggestibility in healthy volunteers, and that psychedelics may play a mediator role in psychedelic therapy, spirituality, and creativity.

Psilocybin reduces anxiety and depression in patients with life-threatening cancer: A randomized double-blind trial. Grob, C.S., Danforth, A.L., Chopra, G.S., Hagerty, M., McKay, C.R., Halberstadt, A.L., Greer, G.R. A pooled analysis of experimental studies of psilocybin and lysergic acid diethylamide in healthy humans shows that the drugs have acute, subacute, and long-term subjective effects. The US Drug Enforcement Administration has issued a statement regarding the use of psychedelic drugs in patients with serious illness. Barnett, Siu, and Pope (2018) surveyed American psychiatrists’ attitudes toward classic hallucinogens, and Maxwell (2015) presented a critical realist perspective for qualitative research. Using thematic analysis in psychology, Braun, Clarke, Inserra, Garcia-Romeu, A.; Richards, W.A., Puspanathan, P. and Koffman, J. investigated the vulnerability of black Caribbean and white British patients with advanced cancer in palliative care research. Psilocybin-assisted psychotherapy for psychiatric and existential distress in patients with life-threatening cancer: a long-term follow-up. In the article “Adverse effects of cancer chemotherapy: Anything new to improve tolerance and reduce sequelae?” the authors discuss the advantages and disadvantages of randomized controlled trials and real life studies, and discuss the importance of critical appraisal in qualitative research.