Linda Ellen Carlson

Background: Survivors of cancer experience chronic gastrointestinal (GI) and psychosocial health symptoms and reduced gut microbial diversity. This may compromise their long-term health and wellbeing. No studies have investigated probiotics for managing both GI and psychosocial symptoms together, or their effects on the composition of the gut microbiota in post-treatment cancer survivors. Aims: To investigate the effects of a probiotic vs. placebo on (i) abdominal pain and depressive symptoms (primary outcomes); (ii) (a) GI (i.e., gas/bloating, diarrhea, and constipation), and psychosocial (i.e., anxiety, cognitive function, and fatigue) symptoms and (b) gut microbiota composition; and (iii) relationships between bacteria and GI and psychosocial symptoms. Methods: This double-blind, placebo-controlled, two-arm, randomized trial will recruit N = 66 participants allocated 1:1 to the probiotic or placebo group for a 12-week trial. Adult survivors diagnosed with a solid tumor or blood cancer who have completed chemotherapy within the last 5 years and show elevated GI or psychosocial symptoms will be included. The probiotic capsule contains a blend of Lacticaseibacillus rhamnosus, Lactobacillus helveticus, and Bifidobacterium animalis subsp. lactis strains, ingested orally once daily. Stool samples will be collected at baseline and week 12 and analyzed using 16S rRNA gene sequencing. GI and psychosocial surveys will be completed at baseline and at weeks 6 and 12. Descriptive statistics, frequencies, paired-samples t-tests, linear mixed models, and Spearman’s correlational analyses will be used. Conclusions: We explore a novel, microbiota-based intervention for chronic GI and psychosocial symptoms following cancer treatment. Our findings and commitment to person-centered knowledge translation via creating informational materials will enable people to make informed decisions about their health.

PURPOSE: Sleep, fatigue, and pain are common symptoms in cancer survivors. Mindfulness-based cancer recovery (MBCR) and Tai Chi/Qigong (TCQ) are beneficial for these conditions, but have not been studied together. The Mindfulness and Tai Chi for Cancer Health (MATCH) study was designed to incorporate innovative design features, including patient choice, while evaluating two interventions for distressed cancer survivors with predefined secondary outcomes, including sleep, fatigue, and pain. METHODS: Participants chose one of the two interventions or chose to be randomly assigned into either intervention, then were further randomly assigned into immediate intervention or waitlist groups. We evaluated the efficacy of MBCR and TCQ, whether participants' choices affected intervention effects, and correlations among changes in sleep, fatigue, and pain. RESULTS: Participants (N = 587) were on average 60.7 years, with multiple types and stages of cancer. At postintervention, compared with waitlist controls, the TCQ group had an average improvement of 1.9 points on the sleep quality scale, which remained statistically significant compared with controls after adjustment for age, sex, cancer stage, and preference ( P = .004). Compared with waitlist controls, both MBCR and TCQ groups had significantly improved fatigue with mean improvements of 3.66 and 3.42 points, respectively (MBCR: P = .036. TCQ: P = .043) and over 1 point of change on pain interference (MBCR: P = .029. TCQ: P = .002). MBCR and TCQ did not differ from one another. Preference status did not affect outcomes. Significant correlations were observed among changes in sleep, fatigue, and pain interference, suggesting mild to moderate associations. CONCLUSION: Compared with waitlist controls, MBCR and TCQ both improved fatigue and pain interference at post-intervention, and TCQ also improved sleep quality. Correlations across outcomes highlight the importance of addressing clusters of cancer symptoms within a whole-person health framework.

This review summarizes the definition, diagnosis and prevalence of anxiety and depression symptoms and disorders in people with cancer, followed by an overview of integrative therapies that are guideline-recommended for managing these conditions. Recommended therapies include mindfulness-based interventions, yoga, relaxation, music, reflexology, Taichi/Qigong, acupuncture, lavender aromatherapy and hypnosis. This is followed by a summary of emerging therapies that show preliminary evidence of efficacy, but are not yet included in guideline recommendations, including other forms of aromatherapy, light therapy, biofield therapies, psychedelic-assisted therapy and nature-based interventions. The paper concludes with a summary of common methodological issues and suggestions for future research directions.

Background: Healthcare providers’ (HCPs) perspectives on psychedelic-assisted therapy (PAT) are critical to clinical integration but remain underexplored in Canadian palliative and oncology contexts. This study examines HCP attitudes toward ketamine, psilocybin, and MDMA, and the systemic and ethical factors influencing implementation. Methods: An exploratory qualitative study using semi-structured interviews was conducted with 12 HCPs across Canada. Interviews explored attitudes, perceived barriers, and implementation considerations. Data were analyzed using thematic analysis and interpreted through the Theory of Planned Behaviour (TPB) to examine how attitudes, subjective norms, and perceived behavioural control shape clinical integration. Results: Attitudes toward PAT ranged from caution to advocacy, with neutral-to-cautious positions predominating. Ketamine was pragmatically accepted for rapid efficacy but raised concerns regarding commercialization and misuse. Psilocybin elicited mixed views, particularly in relation to end-of-life existential distress. MDMA was considered promising for trauma-related indications but was constrained by neurotoxicity concerns and regulatory barriers. Subjective norms were shaped by stigma, media narratives, and institutional culture, while perceived behavioural control was limited by restrictive policies, infrastructure gaps, and funding inequities. An ethical tension emerged between access to medical assistance in dying (MAiD) and restrictions on PAT in end-of-life care, highlighting perceived policy inconsistencies. Conclusion: Participants expressed a range of attitudes toward PAT, from caution to advocacy, alongside substantial ethical, regulatory, and systemic constraints to clinical integration. A notable ethical tension emerged between MAiD accessibility and PAT restrictions in end-of-life contexts, reflecting broader questions about Canadian health policy. Participants emphasized the need for substance-specific guidelines, interdisciplinary education, and evidence-informed regulatory reform to guide future clinical consideration of PAT.

Intro: Mind-body therapies (MBTs) are promising forms of treatment for depression and anxiety symptoms in people with cancer, however, their effectiveness has not been compared. The objective of this study is to rank the effectiveness of MBTs for depression and anxiety symptoms in people with cancer. Methods: EMBase, PubMed, Cinahl, PsychINFO, IndMED, CSI-NISCAIR, CNKI, Clinicaltrial.gov, ChiCTR, and CTRI were searched until February 2025 for randomised controlled studies in which MBTs were tested in a cancer population. Network meta-analyses were used on the selected studies to rank the reduction in depression and anxiety symptoms compared with usual care. Results: A total of 182 studies which involved 16,835 participants were included. The network meta-analysis showed a statistically significant large effect compared with usual care for biofeedback (standardised mean difference, SMD = -1.18, p = 0.038), spiritual interventions (SMD = -0.98, p = 0.047), and mindfulness-based interventions (MBIs; SMD = -0.87, p < 0.001) for depression symptoms and yoga (SMD = -1.13, p < 0.001), MBIs (SMD = -1.02, p < 0.001), physical relaxation (SMD = -0.93, p < 0.001), qigong/Tai Chi (QTC; SMD = -0.90, p = 0.004) and music therapy (SMD = -0.90, p < 0.001) for anxiety symptoms. Conclusions: The MBTs that should be prioritised are biofeedback, spiritual interventions, and MBIs for depression symptoms and yoga, MBIs, physical relaxation, QTC, and music therapy for anxiety symptoms in people with cancer.

Background: Insomnia symptoms are common in people with cancer and have detrimental effects on quality of life and survival rates. Mind-body therapies (MBTs) are promising forms of treatment for people with cancer and insomnia symptoms. The objective of this study is to assess the effectiveness of MBTs for insomnia symptoms in people living with cancer. Methods: EMBase, PubMed, Cinahl, PsychINFO, IndMED, CSI-NISCAIR, CNKI, Clinicaltrial.gov, ChiCTR, and CTRI were searched until February 2025 for randomized controlled studies in which MBT was tested in a cancer population. Network meta-analyses were used to rank the relative effectiveness of MBTs for insomnia symptoms compared with usual care. Results: We identified a total of 99 studies, which involved 9,562 participants. Compared with usual care, MBTs with a statistically significant large effect (standardized mean difference, SMD >0.8) for insomnia symptoms were relaxation training (SMD = −1.97, P < .001), music therapy (SMD = −1.99, P < .001), body-mind-spirit intervention (SMD = −1.56, P = .187), biofeedback (SMD = −1.28, P = .208), mindfulness-based interventions (MBIs) (SMD = −1.04, P < .001), Tai Chi/qigong (SMD = −0.80, P = .068), and yoga (SMD = −0.80, P = .012). Only Tai Chi/qigong (SMD = −0.51, P = .267) and (MBIs, SMD = −0.25, P = .444) were supported by the sensitivity analysis with studies from “advanced” economies, which had a lower risk of bias. Conclusions: Where MBT is recommended by clinicians for insomnia symptoms in people with cancer, priority should be given to Tai Chi/qigong and MBIs.

Demoralization syndrome (DS) - a distinct clinical entity characterized by helplessness, hopelessness, and a persistent loss of meaning - affects approximately one in five Canadians with advanced cancer and is associated with increased desire for hastened death, negative clinical outcomes, and higher economic burden, yet recognition and treatment of DS remains suboptimal in modern oncology. While current pharmacological treatments fail to address demoralization's existential dimensions, and despite the potential effectiveness of a number of psychosocial interventions, not everyone responds to behavioral therapies and they remain chronically underfunded in mainstream oncology. Mindfulness-Based Psilocybin-Assisted Therapy (MB-PAT) offers enhanced therapeutic potential by synergistically integrating evidence-based mindfulness training with psilocybin's neuroplastic effects; however, the traditional dyadic delivery model limits scalability within healthcare s settings. This viewpoint opines that MB-PAT delivered in a group format represents a potentially optimal solution to this evidence-implementation gap. Our contention is that MB-PAT may harness synergistic biopsychosocial mechanisms that directly counter the isolation of demoralization through an integrative approach. We finish by highlighting the Canadian Network for Psychedelic-Assisted Cancer Therapy (CAN-PACT) as a pioneering initiative poised to generate critical evidence, infrastructure and capacity through its planned multi-phase initiatives and projects. By leveraging existing group-therapy infrastructure and therapist familiarity with mindfulness-based interventions as the basis for multi-site national clinical trials, and developing a scalable, equity-focused delivery model, MB-PAT offers a pragmatic pathway to integrate potentially transformative existential care into publicly funded Canadian oncology practice.

The CAnadian Network for Psychedelic-Assisted Cancer Therapy (CAN-PACT) was launched in 2025 to address urgent gaps in supportive care for Canadians with cancer experiencing demoralization syndrome (loss of meaning, dysphoria, disheartenment, helplessness, a sense of failure) and related psychosocial distress. CAN-PACT has six major objectives: (1) to develop a national interdisciplinary research and practice network; (2) to set research priorities through structured stakeholder engagement; (3) to develop and provide PAT training and education for clinicians, researchers, and patients; (4) to pilot test the feasibility of intervention and assessment procedures; (5) to conduct a multi-center, randomized controlled trial of PAT for people with advanced cancer; and (6) to inform and influence healthcare policy on PAT in Canada. We discuss the background and need for PAT in cancer, describe challenges currently limiting its use, and outline CAN-PACT’s strategy for building capacity, generating Canadian evidence, and preparing the oncology healthcare environment for potential implementation. This manuscript presents a summary overview of CAN-PACT as a multi-objective research program; detailed protocols for each discrete study component will be published separately as the research program progresses. Through environmental scans, national engagement, targeted training, rigorous research, and ongoing collaboration with policymakers, CAN-PACT aims to enable equitable access to safe, evidence-based PAT for people with advanced cancer in Canada’s publicly funded cancer centers.

Objectives: While Mindfulness-Based Interventions (MBIs) are evidenced to reduce common psychosocial symptoms experienced by people with cancer (PWC), few studies have tested their mechanisms. Additionally, studies have yet to assess sex assigned at birth as a moderator of the relationship between mindfulness and psychosocial symptoms through specified mediators. This study (1) explored the mediating role of rumination and experiential avoidance (EA) in the relationship between mindfulness and a range of psychosocial symptoms and (2) tested sex as a moderator of the mediation models. Methods: This cross-sectional study assessed baseline data from 134 participants recruited for a mindfulness app clinical trial. Validated patient reported outcome measures of trait mindfulness, rumination, experiential avoidance, depression, anxiety, FCR, and fatigue were collected. Structural Equation Modelling was employed in R. Results: Rumination was a significant partial mediator between mindfulness, depression and anxiety and FCR, but not fatigue. EA acted as a weak mediator from mindfulness to FCR only. Subgroup analyses found that rumination may be more important for females than males in the relationship between mindfulness and depression and anxiety. Conclusions: Rumination may be a stronger mediator than EA for anxiety, depression and FCR, and this may be particularly important for females. Findings may help MBI researchers and developers target potentially relevant mediators to maximize robust study design and intervention efficacy.

This systematic review and meta-analysis evaluates (1) the effectiveness of psychedelic-assisted therapy (PAT) using psilocybin and ketamine for psychosocial symptoms in adults with cancer, (2) contextualizes findings with non-randomized and exploratory studies of other psychedelics, and (3) examines the role of therapeutic frameworks in shaping outcomes. We searched PubMed, Cochrane Library, PsycINFO, and EMBASE (2000–2024) for randomized controlled trials (RCTs) and non-randomized studies investigating psychedelic agents in cancer populations. Meta-analyses pooled RCTs of psilocybin or ketamine using random-effects models. Non-randomized studies were synthesized narratively. Risk of bias and evidence certainty were assessed via Cochrane ROB 2.0, NIH Before–After tool, and GRADE. Eleven placebo-controlled RCTs and four single open-label studies were included. Meta-analysis of four ketamine RCTs (n = 354) showed large, rapid effects on depression/anxiety (Hedges’ g = −1.37, 95% CI: −2.66 to −0.08; I² = 92%). Three psilocybin RCTs (n = 101) showed a large effect of psilocybin on alleviating depression (Hedges’ g = −3.13, 95% CI: −10.04 to 3.77; I² = 95%). MDMA and LSD trials suggested promise but lacked rigor. PAT may offer meaningful relief for cancer-related distress, though effects vary by therapeutic model and context. Oncology-specific trials are needed to standardize and scale for implementation.