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SALT LAKE CITY — Suzy Mang said she isn't afraid of dying, but she worries about getting her life in alignment and figuring out what the biggest priorities are for her while she lives with stage 4 cancer.
About two and a half years ago, Mang was searching for the source of some back pain when a doctor found her intestine was flipped. She went to a specialist who looked at the scans and saw something more urgent — a mass.
A gynecology oncologist found a tumor about the size of a lopsided baseball that had caused the intestine to flip, and about 24 smaller tumors, many of which were about the size of a pencil eraser.
Mang was diagnosed with a gastrointestinal stromal tumor — a rare stage 4 cancer that was first discovered in 1991. She learned it was not treatable, but there has been some success in keeping the cancer from growing.
"I've had a lot of real emotional upheaval, and I still have been pretty teary about it ... but I've made a lot of progress," she said.
Pretty quickly, Mang reached out to sources to help with her mental health. She met with a shaman in Peru, spending 10 days in the jungle, and has found meditation important.
More recently, she received help for her mental health through a psychedelic drug typically used to treat depression — ketamine.
Psychodelic therapy for cancer patients
Dr. Ben Lewis is a psychiatrist at the Huntsman Mental Health Institute and primarily does clinical work with adults in the in-patient facility. He said over the last 14 years, he has noticed there are gaps where people with large burdens can't be treated.
"It's just been increasingly clear to me, our tools are just very, very limited for a lot of folks," he said.
Lewis said one of those is patients who has mental health symptoms related to a serious illness or end-of-life diagnosis. Psychedelic-assisted therapy with ketamine and other drugs is one of the areas he is researching to try to fill some of these gaps in his practice at the Park City Behavioral Health Clinic.
Cancer patients, he said, often are dealing with existential issues, wondering what the meaning of their life is, how to have a meaningful life and why something like a cancer diagnosis is happening to them. Lewis said they also deal with denial, anger, grief, lack of control or guilt.
"There can be a wide range of experiences that people have. I think at the same time, those moments open up certain possibilities for people to really grow in a lot of ways," he said.
Lewis said this intervention can help people find acceptance and learn from their struggles. The clinic uses robust psychotherapy, an online psychotherapeutic curriculum and meetings with an individual therapist to help each patient.
Mang's experience
Mang prepared for her first ketamine session with meditation and felt ready, but she said her mind was blank during the treatment.
"There was nothing, there was absolutely zero. And and I thought that was so weird," she said.
But the clinicians said it sometimes takes two or three sessions to see a benefit, and she decided to go back the next week for her second session.
She said the next time she had no expectations, and when she began the treatment she felt like she was being squeezed out, and her mind was shutting down. Then she felt like she was in a "between" space where there was music and a light pink aura. She said it was nurturing and comforting.
"I came home knowing that I was so out of balance with my mind ... it was going to be really important for me to operate from you know, a more emotive spot — because there's no solving cancer," Mang said.
During the third and final treatment, she was immediately drawn to what she called a "zero space," where there was music and orange and yellow — Mang said it was bold, beautiful and loving. She felt the energy and love from her two daughters swirl into what she called a "vortex of love and understanding" during the treatment.
"It was just outstanding," Mang said.
She said she was tearing up and crying as her animals joined in, as well, as she experienced overwhelming branches of love coming toward her. After talking about the experience with her therapist, Mang said she learned those connections are important, that they are why she is here, and that her heart is the master.
A few months later, Mang said she is still seeking counseling as her cancer progresses, but she is still benefiting from her experience with ketamine.
Lewis said people can have a lot of expectations going into psychedelic treatment, and there are often surprising things that end up being "therapeutically useful." Lewis said Mang's treatment was an example of this; he said the process is often more useful than any individual experience.
Even though the first session did not seem useful immediately to her, it had a purpose when viewed as a whole process rather than an experience, he said.
Other research
Researchers are still trying to maximize the potential of ketamine, Lewis said, and the Huntsman Mental Health Institute in Park City opened a ketamine-assisted psychotherapy clinic that uses ketamine as a tool to make the brain more open and flexible.
"We're thinking of it more as like a catalyst for the psychotherapy piece," he said.
Lewis said they use music playlists while people use the drug to encourage an internal therapeutic experience, and then talk through the experience with patients.
"For me, it has offered a path of ... trying to help people for whom our standard treatments have not been that successful — and in that sense it's been really, really rewarding," he said.
Lewis has also done multiple drug trials with psilocybin, the active ingredient in what is commonly known as magic mushrooms. One study, in conjunction with the Huntsman Cancer Institute for people who have depression associated with a cancer diagnosis, found the use of the drug and group therapy was helpful for depressive symptoms and improved quality of life for patients with nonoperable cancers.
Psilocybin, however, is a Schedule 1 drug, meaning it is prohibited by the federal government and therefore can't be used outside of an approved study. Lewis explained ketamine has been used for depression in the past and has been effective, and it is available for clinical use, but there has not been much research into use specifically with cancer.
Lewis said his team is working closely with the Huntsman Cancer Institute to create a pathway for patients who are not responding to normal mental health treatment to have different options. He said there is "really good empirical evidence" suggesting that treatments with ketamine or psilocybin are uniquely useful to address existential issues.
One downside, Lewis said, is that ketamine is not covered by insurance. Each time someone comes in for a ketamine treatment session it costs $500, although all other treatments at the clinic are billed to their insurance.
He said the quality and ethics of ketamine clinics varies significantly. One of Lewis' goals with his research is to learn how to optimize the process and publish studies that will help each clinic offer the most useful process to patients.
The treatment Mang participated in uses high intramuscular injections and sublingual ketamine, which is different from many clinics, including one at the Huntsman Mental Health Institute, that use IV infusion. This allows for a broader range of doses, which can sometimes be helpful.
