Chemotherapy-induced peripheral neuropathy (CIPN) remains a clinical challenge for up to 80% of breast cancer survivors. In an open-label study, participants underwent three interventions: standard care (duloxetine) for 1 month (Phase 1), oral cannabidiol (CBD) for 2 months (Phase 2), and CBD plus multi-modal exercise (MME) for another 2 months (Phase 3). Clinical outcomes and gut microbiota composition were assessed at baseline and after each phase. We present the case of a 52-year-old female with a history of triple-negative breast cancer in remission for over five years presenting with CIPN. She showed decreased monocyte counts, c-reactive protein, and systemic inflammatory index after each phase. Duloxetine provided moderate benefits and intolerable side effects (hyperhidrosis). She experienced the best improvement and least side effects with the combined (CBD plus MME) phase. Noteworthy were clinically meaningful improvements in CIPN symptoms, quality of life (QoL), and perceived physical function, as well as improvements in pain, mobility, hand/finger dexterity, and upper and lower body strength. CBD and MME altered gut microbiota, showing enrichment of genera that produce short-chain fatty acids. CBD and MME may improve CIPN symptoms, QoL, and physical function through anti-inflammatory and neuroprotective effects in cancer survivors suffering from long-standing CIPN.

Music is integral to Psilocybin-assisted psychotherapy (PAP), believed to enhance therapeutic outcomes by structuring experiences and facilitating emotional expression. However, the effects of conducting PAP without music are underexplored. This study examines the experiences of two breast cancer patients undergoing psilocybin therapy under Canada's compassionate access program, specifically focusing on sessions that incorporated intentional periods without music. Patients had previously experienced psychedelics in therapeutic contexts but only with continuous music, as is common practice. Here, each patient participated in a 30-min silent period involving mindfulness exercises and therapist discussions. These periods of relative silence resulted in both challenges and benefits. One patient found that the absence of music was difficult initially, but that the relative silence allowed for engagement with mindfulness exercises that were experienced as highly meaningful. The other patient reported that music had evoked challenging past memories early in the dosing session, which were then productively explored with her guides during the subsequent period without music. These findings suggest that integrating silent intervals in PAP can enhance mindfulness practices and therapist-patient interactions, potentially offering distinct therapeutic benefits. Further research is necessary to delineate the differential impacts of music, silence, and guided activities in PAP, given that these three common treatment activities can be understood as both complementary and competing. Finally, we emphasize the importance of more detailed reporting on session components in psychedelic research publications, particularly regarding the balance between patients listening to music and interacting with their guides, which is often not clearly detailed in existing studies.

Psychedelic treatment with psilocybin is receiving increased attention following clinical trials showing it may help treat end-of-life anxiety, depression, and several other conditions. Despite this, physicians may be reluctant to prescribe psilocybin and carry out psilocybin treatment because of the stigma surrounding psychedelics and the potential for medical malpractice liability. This paper explores whether psilocybin treatment gives rise to a risk of medical malpractice liability for physicians. Following an overview of psilocybin treatment and its regulatory regime in Canada, exploratory vignettes are used to highlight the relevance and limits of malpractice claims. This paper argues that the lack of established medical standards, standardized training, and credentialing contribute to liability risks surrounding psilocybin treatment. More clinical trials, meta-studies of research analyses, and knowledge sharing will help to develop training programs and medical standards of practice to better realize psilocybin’s potential.

Background: While the adoption of psilocybin-assisted therapy for existential distress offers promising support for patients with life-threatening illnesses, implementing this intervention into palliative care settings presents significant real-world challenges. Aim: To examine palliative care stakeholders’ knowledge and attitudes regarding psilocybin-assisted therapy, and identify barriers and facilitators to its implementation. Design: We conducted a cross-sectional online survey between April 15 and December 18, 2024. The survey assessed perceived knowledge, attitudes, and perceived barriers and facilitators to the effective integration of psilocybin-assisted therapy into palliative care settings. Setting/participants: One hundred and twenty-one adults involved in palliative care (physicians, other healthcare professionals, caregivers, and managers) were recruited from Canada’s four most populous provinces: Québec, Ontario, Alberta, and British Columbia. Results: Forty-three percent of stakeholders reported having good knowledge of psilocybin’s potential benefits and risks. Attitudes towards psilocybin-assisted therapy were predominantly non-favourable (61%), yet varied across occupational groups ( p < 0.0001), with 95% of physicians reporting favourable attitudes. The lack of trained healthcare providers was viewed as the primary barrier to implementation. Key facilitators included further research and developing standardised intervention protocols. Sixty-eight percent of stakeholders endorsed the introduction of psilocybin-assisted therapy during the early stages of the illness trajectory. Conclusions: Translating the potential of psilocybin-assisted therapy for existential distress from clinical trials into palliative care settings requires careful consideration and collaboration with stakeholders. Given the significant divergence in perspectives between clinical and non-clinical groups, tailored interprofessional education could help build shared understanding and support effective implementation. Being conducted in Canada, transferability to different regulatory frameworks may be limited.