Journal of pain and symptom management · 2026
Intranasal Ketamine for Existential Distress in Advanced Cancer.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
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Aguiar Stefan, Makarious Mary, Lipsitz Orly, deVries Froukje E, Doyle Zoe, McIntyre Roger S, Rodin Gary, Zimmermann Camilla, Mak Ernie, Hannon Breffni, Schulz-Quach Christian, Al Kindy Aida, Patel Zeal, Rosenblat Joshua D, Li Madeline
Аннотация
CONTEXT: Depression and existential distress are highly prevalent among patients with advanced cancer, and there is growing evidence for ketamine as a rapidly acting antidepressant in the population, but few studies have examined existential distress outcomes with ketamine treatment. The INKeD-PC trial demonstrated efficacy of intranasal racemic ketamine for depression in patients with cancer receiving palliative care.
OBJECTIVES: We now report on secondary trial outcomes, including those related to existential distress.
METHODS: This analysis is based on 15 trial participants who received 3 doses of ketamine and completed the primary endpoint measures, including Montgomery-Åsberg Depression Rating Scale as primary outcome, as well as the Patient Health Questionnaire-9 for depression, Generalized Anxiety Disorders-7, Edmonton Symptom Assessment System-Revised, McGill Quality of Life Questionnaire (MQOL), and the Death and Dying Distress Scale. Qualitative comments from participants were used to support quantitative findings.
RESULTS: Improvements were observed across all secondary outcome measures, exceeding established minimal clinically important differences. Were as follows: Generalized Anxiety Disorders-7 (d = 1.22, P= 0.004), Death and Dying Distress Scale (d=0.91, P=0.003), Edmonton Symptom Assessment System-Revised (d = 1.21, P= 0.003) and McGill Quality of Life Questionnaire (d = 1.53, P= 0.004). Correlations between changes in Montgomery-Åsberg Depression Rating Scale and secondary outcomes were not significant, and subscales related to psychological symptoms improved more than physical symptoms, including the MQOL Existential Well-Being factor (d=1.02, P=0.015).
CONCLUSION: Intranasal ketamine was associated with clinically meaningful improvements in existential distress in individuals with advanced cancer being treated for depression. Ketamine may have relevance as a single agent for multidimensional distress in palliative care.
OBJECTIVES: We now report on secondary trial outcomes, including those related to existential distress.
METHODS: This analysis is based on 15 trial participants who received 3 doses of ketamine and completed the primary endpoint measures, including Montgomery-Åsberg Depression Rating Scale as primary outcome, as well as the Patient Health Questionnaire-9 for depression, Generalized Anxiety Disorders-7, Edmonton Symptom Assessment System-Revised, McGill Quality of Life Questionnaire (MQOL), and the Death and Dying Distress Scale. Qualitative comments from participants were used to support quantitative findings.
RESULTS: Improvements were observed across all secondary outcome measures, exceeding established minimal clinically important differences. Were as follows: Generalized Anxiety Disorders-7 (d = 1.22, P= 0.004), Death and Dying Distress Scale (d=0.91, P=0.003), Edmonton Symptom Assessment System-Revised (d = 1.21, P= 0.003) and McGill Quality of Life Questionnaire (d = 1.53, P= 0.004). Correlations between changes in Montgomery-Åsberg Depression Rating Scale and secondary outcomes were not significant, and subscales related to psychological symptoms improved more than physical symptoms, including the MQOL Existential Well-Being factor (d=1.02, P=0.015).
CONCLUSION: Intranasal ketamine was associated with clinically meaningful improvements in existential distress in individuals with advanced cancer being treated for depression. Ketamine may have relevance as a single agent for multidimensional distress in palliative care.