Radiation Oncology/Psycho-oncology

• Psycho-oncology is an interdisciplinary field at the intersection of physical, psychological, social, and behavioral aspects of the cancer experience for both patients and caregivers
• Also known as Psychiatric Oncology or Psychosocial Oncology, researchers and practitioners in the field are concerned with aspects of individuals' experience with cancer beyond medical treatment, and across the cancer trajectory, including at diagnosis, during treatment, transitioning to and throughout survivorship, and approaching the end-of-life
• Founded by Jimmie Holland in 1977 via the incorporation of a psychiatric service within the Memorial Sloan Kettering Cancer Center in New York, the field has expanded drastically since and is now universally recognized as an integral component of quality cancer care
• Cancer centers in major academic medical centers across the country now uniformly incorporate a psycho-oncology service into their clinical care, and provide infrastructure to support research efforts to advance knowledge in the field
• Isabelle Lang-Rollin et al. Dialogues Clin Neurosci. 2018 Mar; 20(1): 13–22. Psycho-oncology (PMID: 29946207)

Psilocybin

• Indole alkaloid found in family of mushrooms
• After ingestion, metabolized to psilocin in the body. This metabolite is responsible for psychotropic properties via serotonin 2A receptor
• Psilocin is further metabolized to 4-hydroxyindole-3-acetic acid (4-HIAA)
• No specific studies reviewing effects of psilocybine on radiation oncology patients.

• US Multi-Institutional; 2023 (2019 - 2022) PMID 37651119 -- "Single-Dose Psilocybin Treatment for Major Depressive Disorder: A Randomized Clinical Trial" (Raison CL, JAMA. 2023 Sep 5;330(9):843-853. doi: 10.1001/jama.2023.14530.)
  • Randomized Phase 2. 11 sites. 104 participants with major depressive disorder, >60 days, moderate+ symptoms. Single dose 25 mg psilocybin vs 100 mg niacin placebo. MADRS score (0-60) used.
  • Outcome: MADRS scores psilocybin better by 12.3 points (SS) at 43 days. Also reduced Sheehan Disability Score by 2.3 points (SS). More sustained response
  • Toxicity: Severe AE psilocybin 8% (migraine x1, headache x1, illusion x1, panic attack/paranoia x1) vs control 0%. No suicidal ideation. No changes in vital signs or labs.
  • Conclusion: Psilocybin clinically significant reduction in depressive symptoms and functional disability, without serious adverse events

• Medical University of Vienna; 2022 PMID 34871422 -- "Psilocybin Therapy of Psychiatric Disorders Is Not Hampered by hERG Potassium Channel-Mediated Cardiotoxicity" (Hack B, Int J Neuropsychopharmacol. 2022 Apr 19;25(4):280-282. doi: 10.1093/ijnp/pyab085.)
  • Cell culture. 4-HIAA applied to hERG channels, up to 500x concentration
  • Conclusion: hERG blockade by clinical levels of psilocin does not account for cardiotoxic effects

• Copenhagen University, 2021 PMID 34246868 -- "Psilocybin-induced changes in brain network integrity and segregation correlate with plasma psilocin level and psychedelic experience" (Madsen MK, Eur Neuropsychopharmacol. 2021 Sep:50:121-132. doi: 10.1016/j.euroneuro.2021.06.001. Epub 2021 Jul 8.)
  • 15 participants. MRI data acquistion correlated with psilocin plasma concentrations
  • Outcome: Executive control and dorsal attention networks desegretate
  • Conclusion: Expression network integrity and segregation implicated in the psychedelic experience and consciousness