Cancer Patients' and Caregivers' Views on Therapy Using Psychedelic Drugs

Participants were either advanced cancer patients or their carers. Eligibility required all individuals to be at least 18 years old and either 1) diagnosed with stage 4 cancer and have mild to moderate distress as measured by scores between 5 and 19 on both the General Anxiety Disorder 7-Item Scale (GAD-7) and Patient Health Questionnaire 9 (PHQ-9) or 2) be caring for someone with advanced cancer.

Participants were recruited using advertisements via cancer support organisations, referrals from public health services, or opportunistic recruitment with existing participants who discussed the opportunity with associates. Study flyers asked for volunteers who have advanced cancer and are feeling down or anxious, or are caring for someone who is. To minimise the possibility of a sample bias, flyers did not mention psychedelics and simply asked “can you help us with our research about advanced cancer”. A total of 21 prospective patients/carers were screened for eligibility. Screening assessed demographic details, basic information about diagnosis, treatment and relevant medical history in patients, and patients were additionally assessed for psychological distress as measured by GAD-7 and PHQ-9.

As part of the interview, participants were presented with the following summary of findings from Ross et al. [18] and Griffiths et al. [17]:A couple of recent clinical trials have investigated the use of a single high dose of Psilocybin alongside psychotherapy in people with advanced cancer. Participants reported clinically significant improvements in anxiety, depression, and overall quality of life. These effects were sustained in 60–80% of participants at 6 months follow up.

All interviews were recorded using either a Sony ICDPX470 Digital Voice Recorder or the record function of video-conference software.

All interviews were transcribed verbatim by researchers AA and AW. Transcripts were compiled using NVivo 12 by AW. Initial coding and organising of themes were completed manually by AW and were iteratively reviewed and revised in consultation with LR and CC. Reflexive thematic analysis was used following the steps outlined by Braun and Clarke [25]. A large number of codes were initially produced and these were refined into potential themes. The final stages of analysis involved piecing together themes in relation to the underlying narrative, as well as within the context of wider literature.

Several of the sub-themes described how perspectives at the end of life can change, impacting how participants reacted to the concept of PAT.

Other sub-themes reflected a desire to balance the risks of novel treatments with a reverence for safety and a desire to avoid further harm.

Theme 1 identified descriptions of patient experiences of isolation and existential distress. That participants would describe such fears is unsurprising given that the literature on psychopathology in advanced cancer describes existential distress as increasingly common with disease progression [26]. This theme speaks to the significance of existential distress as a common psychological burden faced by cancer patients.

The intersection between existential distress and isolation has been recognised as a qualitatively distinct form of isolation termed existential loneliness; a feeling of acute awareness that one is separated from others and the universe, and the negative emotion this brings [27]. Such sentiments were reported by participants who felt that no one in their lives could understand their experience. Acknowledgement of existential distress and isolation in the advanced cancer experience is critical to understanding how cancer patients might respond to psychedelic-assisted therapy. Not only does it highlight the necessity for intervention but also reflects a life landscape characterised by vulnerability and desperation, thereby giving context to the reasons why stakeholders in advanced cancer treatments may express a high degree of receptivity to controversial treatments. Additionally, because research suggests that psychedelic experiences might be particularly beneficial for improving feelings of connectedness and reducing death-related anxiety, the presence of existential loneliness in this patient group supports the logic which suggests PAT may be well-suited to use with advanced cancer patients.

Participants framed their support for PAT by acknowledging that options and time are limited, quality of life can be poor, and “anything that helps” has value. This fits with other research demonstrating greater support in situations of unmet need [28] and a need for interventions that alleviate the suffering of cancer patients [29]. However, such sentiments communicate a sense of desperation. Research investigating the use of unconventional therapies in cancer patients has reported feelings of desperation as a common form of motivation to try alternative treatments [30]. It is important to consider that while openness may, at face value, appear positive, receptivity driven by desperation needs to be handled ethically and carefully.

The notion that one size does not fit all informed reactions of both hesitancy and receptiveness to psychedelics. Participants’ reference to the needs of advanced cancer patients was highly individualised, calling for unique treatment approaches on a person-to-person basis. Other qualitative research has reported similar themes, finding that cancer patients making decisions about taking novel or alternative medicines described the process as highly individualised [31]. The acknowledgement of these feelings is likely important in empowering patients, and does appear to be effective and well-received. Qualitative interviews in a trial of CBT for anxiety in advanced cancer reported that patients perceived the approach as relevant and useful [32]. Overall, the exploration of PAT was considered an expansion of treatment approaches that acknowledged the varied needs of patients, and continuing to increase the repertoire of available treatments was valued.

A general acceptance to the concept of PAT was also tempered with a desire to minimise risk. This was evident in the view that microdosing was preferred to larger doses. Favouring a conservative approach to dosing suggests patients and carers held caution with the idea of unfamiliar treatments. This suggests that while there may be an increasing openness to risky or unfamiliar therapies in the context of life-threatening illness, this openness still has its limits.

Participants also had conflicting views about natural versus synthetic compounds. Many people express a preference for natural medicines and foods relative to synthetic alternatives [33] and, similarly, participants commonly framed their more favourable perceptions of naturally occurring psychedelics as based on the view that natural seemed “less risky”. However, participants also reported desiring products which are trusted and have been subject to rigorous scientific testing. The common tie between these apparently opposing preferences is an orientation to cues of safety. While natural compounds seem to innately signal safety by appearing “gentler”, synthetic products demonstrate evidence of safety in the rigorous clinical testing involved in their production.

Participants’ perceptions of risk were often tied to perceptions of recreational drug use in the ‘60s and ‘70s. Individual knowledge and perceptions are coloured by wider societal attitudes [34]. Ultimately, this cultural knowledge appeared to inform concerns about psychedelics; for instance, that people were having bad trips or engaging in experimentation. Public attitudes about such concepts tend to be negatively skewed, and hence the potential stigma of associations between psychedelics and the Hippie era. Increasing representation of fact-based narratives on therapies using psychedelics may be helpful in overcoming misconceptions.

Reference to cannabis by participants in this study can be understood as a heuristic. The similarity heuristic describes how people make evaluations of ideas for which they have limited information, based on comparisons to a sufficiently similar concept or event [35]. The use of such a strategy by participants in this study suggests people make sense of novel treatments by referring to established ones. However, such processes are approximate and have a tendency to produce biased or uninformed judgements.

As with all qualitative inquiry, this study is limited in its ability to generalise findings more broadly. This study was conducted in New Zealand and therefore may not be generalisable to cancer populations in other countries. Further, the sample included only two Indigenous (Māori) participants and, as such, is limited in being able to comment on this perspective. Given the inequities in health outcomes and care that are known to exist for Indigenous populations, this is an important concern. This is significant especially when considering the historical context of naturally occurring substances and their links to Indigenous cultural practices, particularly given that concerns about how such compounds are procured were voiced by one Māori participant. Beginning to test these therapies in clinical trials is a logical direction. Future PAT should involve spiritual and Māori perspectives of health [36]. Similarly, most participants identified as female, with only four male participants recruited. Finally, it is notable that very few negative reactions were reported. Although our study advertisements did not mention psychedelics in an attempt to minimise bias and our interview questioning specifically asked about concerns and negative views (as well as positive beliefs), it is possible that our positionality as researchers within a psychological medicine context may have resulted in bias.