‘Impressed With Impact’ of Ketamine in Cancer Palliative Care

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Cancer Treatment Ribbon

Like many in her field, Toronto psychiatrist Madeline Li, MD, PhD, was skeptical when one of her psychiatry residents suggested they launch a study into the effects of ketamine for depression in cancer palliative care.

But now, after treating about 15 patients, she’s a convert.

“When I saw what it did, it was remarkable,” said the clinician-scientist in the Department of Supportive Care at the Princess Margaret Cancer Center in Toronto, Canada.

Today, she is running the only registered study to investigate ketamine specifically for the treatment of depression in cancer patients.

Although the team has recruited only five patients so far, “they have all had remarkable results,” she reported. “Within 1 hour of the first dose, they feel different, and they’re not even sure how to describe that. I have been so surprised.”

The study aims to enroll 20 patients to assess feasibility for a randomized, placebo-controlled trial.

In the meantime, on the basis of her observations, Li has started offering ketamine to her other cancer patients with moderate to severe depression. “I’ve now tried it on maybe 10 outpatients off label, and it’s worked for maybe six of them, so not all of them.”

One of the patients for whom it worked was Jim Newman, 78. His reaction to ketamine was a game changer, says his wife, Louise Roberge.

Jim had esophageal cancer, and an emergency esophagectomy in October 2018 left him unable to eat, drink, or even swallow, she told Medscape Medical News.

“He came out of the hospital with an estimated 8 to 13 months to live, and he’s now lived 14 months,” she said, smiling. “He’s beaten the odds.”

However, during those months, her husband sank into a fatigue-fueled depression, she said. Two rounds of chemotherapy left him so sick that he abandoned the treatment, and his previously active lifestyle was snatched away. Skiing, golfing, tennis, fishing ― all were out of reach. “When Dr Li offered ketamine, we thought, what is there to lose?” she said.

She never imagined how much they would gain.

“I got my husband back,” she said, flipping through the photos of this past summer on their boat, his day out on the golf course, and the fish he caught with his buddy.

“Even after the first half dose at the hospital…what a big difference,” she said, laughing. She described how Jim’s veil of depression lifted and how he looked up and spoke to her.

Jim agrees that the drug was transformative. “The reaction I had almost instantly ― and it was almost instantly ― was that I didn’t seem to be depressed,” he told Medscape Medical News.

“I don’t really remember what I was like before, but I know I started off very negative,” he said. In fact, he had sought and gained approval to receive Medical Aid in Dying (MAID), an option which he subsequently postponed after starting the ketamine regimen.

Original Article: https://www.medscape.com/viewarticle/924261

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