Making the Case For Ketamine-Assisted Psychotherapy in Serious Illness Care: Research and Clinical Practice in Conversation

Abstract: Psychiatric and existential distress are common in patients with serious medical illness and treatment options are limited. While a growing body of evidence suggests Psychedelic-Assisted Therapies (PAT), primarily with classical psychedelics (psilocybin, LSD), can safely and effectively facilitate rapid, sustained improvements in outcomes across psychiatric and existential domains, many unanswered questions remain about implementation into existing support structures. Classical psychedelics remain under schedule I status and are projected to become clinically available in two to three years.

Ketamine, a ‘dissociative anesthetic’ with psychedelic properties at sub-anesthetic doses, has a substantial evidence base in the treatment of refractory depression and suicidality in patients with primary psychiatric disorders, leading to FDA approval of the s-enantiomer for certain psychiatric uses. Ketamine-Assisted Psychotherapy (KAP), which embeds a ketamine-induced altered state of consciousness into a psychotherapy framework in a similar model to classical PAT, has been shown to prolong positive outcomes in primary psychiatric populations. Ketamine is used frequently for pain management in patients with serious medical illness, and a small but growing evidence base exists for ketamine and KAP for psychiatric and existential indications in patients with serious medical illness. With a strong safety record, greater familiarity amongst physicians, and present legal accessibility, KAP presents as an attractive option for a readily available intervention for an unmet clinical need.

This session will provide a review of pharmacology, indications, delivery models, and the evolving scientific evidence base for ketamine and KAP for psychiatric and existential outcomes in patients with serious medical illness. Two authors, Dr. Sholevar and Dr. Thielking, will then present their experiences developing and implementing KAP clinical programs for patients with medical illness in both the academic and community care settings, and how their experience in recently completed clinical trials using psilocybin-assisted therapies in the serious illness care setting informed their program development. Dr. Sholevar will present an individual KAP clinical model of care for embedded within the Department of Psychosocial Oncology & Palliative Care at an academic cancer center. Dr. Thielking will present an innovative group KAP model of care for patients with chronic and serious medical illness in the community setting. The discussant, Dr. Buxton, will provide reflections on program development from the administrative perspective in supportive oncology, including practical and financial considerations.

1. Overview of evidence for ketamine and KAP in serious illness care (Dr. Sholevar): 15 minutes

2. Presentation of individual KAP clinical model for cancer patients with psychiatric and existential distress (Dr. Sholevar): 15 minutes

3. Presentation of group KAP clinical model for patients with chronic serious medical illness (Dr. Thielking): 15 minutes

4. Discussion of administrative considerations in KAP and PAT program development in supportive oncology (Dr. Buxton): 15 minutes

This session will be best delivered in a LIVE format, as the final 15 minutes will be reserved for an interactive portion where audience members will be broken into groups and encouraged to discuss how they best envision KAP and PAT care models articulating with existing support structures in their work setting.

Content Contributors:

Diversity, Equity, and Inclusion: Our presentation will directly address how clinical implementation of PAT and KAP models of care for patients with serious illness is impacted by inequities among patient populations and how access must be considered in program building.