How to Treat Cancer in Its Entirety

By Manish Agrawal, MD

One in four cancer patients suffers from depression. At least, that’s the number we know about; the real figure is probably higher, but most patients don’t like to talk about mental health, or perhaps even acknowledge it.

In my 20 years as a practicing oncologist, I met many patients who were simply trying to keep their lives on track, often juggling families and attempting to protect loved ones. They didn’t allow themselves time to stop and consider their mental health. Still, it’s a tragedy that 73 percent—the overwhelming majority—of those depressed cancer patients will not receive potentially beneficial mental health treatment. This needs to change, urgently.

As an oncologist, I focused primarily on the tumor. We all do. Cancer care is complex, and the primary aim is to remove the cancer before it spreads any further. There is a well-established treatment plan, and we all follow it to provide the best possible outcome for patients. Mental health is often overlooked, it’s the elephant in the room that we have gotten used to.

Perhaps it’s because of the misconception that a patient’s depression will simply go away at the end of their cancer treatment. Nearly one-third of cancer survivors continue to struggle, and a collusion of denial exists between patients and oncologists when it comes to treating mental health.

For oncologists, this is because mental health can feel harder to treat than the cancer itself, and they often lack awareness of the tools available. For the patient, addressing mental health at the same time as dealing with a cancer diagnosis can be overwhelming—it’s simply easier for all involved to ignore the problem and hope that in time it will go away.

Confronting one’s mortality, grappling with demoralization, the anxiety surrounding recurrence, and survivor’s guilt are long-term psychological burdens that many cancer patients endure. Cancer treatment has made enormous progress in recent years, but the emphasis of treatment remains on the physical tumor and symptoms.

Too often, patients rely on a plastic folder of information and a helpline to call for their mental health. These are simply not sufficient support for the complex, common, and continuous emotional toll that cancer can cause.

After two decades as an oncologist, I realized that mental health care must be integral and integrated into cancer care—and this prompted me to give up my oncology practice to focus on exactly this kind of whole-person healing. For some patients, this might involve access to a mental health professional or a support group. But for the worst affected, I found that psychedelic medicine could present a very real alternative. In some cases, it was so effective it changed the entire paradigm for patients.

Our team conducts psychedelic-assisted therapy to address the emotional impact of cancer and other complex mental health disorders in a meaningful way. Our first study, published in JAMA Oncology, found that a single dose of the psychedelic drug psilocybin—coupled with psychotherapy support—led to significant reductions in depression severity in cancer patients We are currently evaluating the efficacy of MDMA-assisted therapy to treat adjustment disorder in cancer patients as well as one of their concerned significant others. This study acknowledges and addresses the way that cancer can have mental health impacts on families and communities, as well as on patients.

But these are only two studies of many that are now ongoing. We must keep talking about the effect of cancer on patients’ mental health. Patients must be encouraged to ask for help and physicians encouraged to ask unasked questions and be aware of the tools available. Only then can we begin to treat cancer in its entirety.

Manish Agrawal, MD, has worked in medicine, engineering, philosophy, ethics, and research. He currently serves as founder and CEO of Sunstone Therapies, delivering psychedelic-assisted therapy in the medical setting and developing and executing clinical trials for those affected by complex mental health challenges. Manish previously held the position of co-director of clinical research at Maryland Oncology Hematology, where he spent 18 years caring for cancer patients. He completed a fellowship at the National Cancer Institute, National Institutes of Health, and his residency at Georgetown University Medical Center.