Psychedelics for the treatment of end-of-life distress in patients with a life-threatening disease.

Patients with a life-threatening disease (LTD) sometimes suffer from end-of-life distress (EOLD) which refers to the physical, psychological, emotional, and spiritual suffering related to chronic illness and the possibility of death. Palliative care interventions seek to improve the quality of life of patients with EOLD and their significant others. Currently, a range of psychological and pharmacological palliative care interventions may be used to mitigate the various symptoms related to EOLD. However, the evidence for their efficacy is inconclusive with only short- to moderate effects. Another significant and relevant limitation in the context of LTDs is that palliative care interventions often require months to take effect. In the past decade, psychedelic-assisted therapy (PAT) has been increasingly investigated for its therapeutic potential in addressing EOLD in various LTDs characterized by highly significant and sometimes sustained decreases in symptoms of depression and (death) anxiety along with other EOLD-related improvements (e.g., meaning, spiritual well-being, optimism, life satisfaction, and change attitudes towards LTDs). The current chapter will provide a detailed description of the concept of EOLD followed by estimated prevalence rates in a range of LTDs. Next, the chapter provides a brief overview of palliative interventions and their limitations. The chapter then introduces a description of PAT, its evidence-base, and why it seems to work in particular for patients with EOLD. The chapter is concluded with future perspectives.