Integrating PAP into Comprehensive Cancer Care for Mental Health

CancerNetwork® spoke with Michael P. Bogenschutz, MD, director of the NYU Langone Center for Psychedelic Medicine and professor of Psychiatry at NYU Grossman School of Medicine, about how he envisions psilocybin-assisted psychotherapy (PAP) being implemented into clinical practice in the context of a pooled analysis of 2 phase 2 trials published in Nature Mental Health.¹

Bogenschutz began by prefacing that use of PAP in cancer-related psychological care is in the early stages of research. He then explained that patients are already referred for psychiatric evaluation and that psilocybin use can be integrated into pre-existing behavioral health practices for comprehensive cancer treatment.

To that end, he expressed that this strategy could be implemented through in-house operation, which may build the capacity to provide PAP within the cancer center or through a referral system to a licensed provider who has the experience and credentials to clinically administer psilocybin.

Bogenschutz concluded by highlighting the importance of considering and confronting challenges to treatment, thereby ensuring availability of this regimen to patients who may benefit from its use.

Across both trials assessed in the pooled analysis (NCT00957359, NCT00465595), 87 patients were randomly assigned 1:1 to receive either psilocybin first (n = 45) or control therapy first (n = 42), followed by a crossover.^2,3 Patients received either 21 mg per 70 kg or 22 to 30 mg per kg of psilocybin either preceded by or followed by a control dose of 250 mg of niacin or low-dose (1 to 3 mg per 70 kg) psilocybin.

Transcript:

We are still [in] the early stages of demonstrating safety and efficacy [for PAP in patients with cancer]. Of course, patients with cancer are already engaged in medical treatment, and they have a team that they are working with to treat their cancer. In that context, it is normal for patients to be referred for psychiatric evaluation if they are having symptoms related to the cancer diagnosis or otherwise. This is something that would need to be incorporated into the behavioral health aspects of comprehensive cancer treatment.

That could be done either by building the capacity within the cancer center for providing the psilocybin-assisted treatment or by developing referral networks whereby the cancer center could refer to a local provider who is skilled, has whatever credentials [that] are ultimately required to use psilocybin clinically, and has enough experience with [patients with] cancer that they are able to provide that that service on a referral basis.

On one hand, we are certainly not at the point of implementation, but on the other hand, it is important to be thinking about the challenges and unique aspects of this treatment that will need to be dealt with to make it widely available to patients [with cancer] who may benefit [from its use].

References

1. Petridis PD, Grinband J, Agin-Liebes G, et al. Psilocybin-assisted psychotherapy improves psychiatric symptoms across multiple dimensions in patients with cancer. Nat Mental Health. 2024;2:1408-1414. doi:10.1038/s44220-024-00331-0
2. Ross S, Bossis A, Guss J, et al. Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. J. Psychopharmacol. 2016;30(12):1165-1180. doi:10.1177/0269881116675512
3. Griffiths RR, Johnson MW, Klinedinst MA, et al. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. J. Psychopharmacol. 2016;30(12):1181-1197. doi:10.1177/0269881116675513