With progression of cancer, patients and their caregivers experience challenging emotional distress, which can make them feel depressed and very anxious. Patients with advanced cancer often do not have long to live. However, most antidepressants take a long time to act and cause unwanted side effects. There is hence a need for a fast acting antidepressant with fewer unwanted side effects. Ketamine is an effective and fast acting antidepressant originating from pain treatment, which has few unwanted side effects. It can be taken by a patient as a nasal spray when it is needed. The idea of treating depression and anxiety in cancer patients in palliative care with ketamine nasal spray is new. How effective ketamine will be at reducing depression and anxiety in patients is unknown . It is also unknown whether this kind of treatment will be safe and practical for palliative care patients. This study aims to answer these questions. Patients will be treated with a low dose (5 mg) of ketamine nasal spray and then measure its effectiveness, practicality and safety. Questionnaires will be used to measure these outcomes. If treating depression and anxiety with ketamine nasal spray proves to be effective, practical and safe, then it could help to improve the quality of life for palliative care patients and reduce the burden of their caregivers.
With progression of cancer, patients, but also their caregivers, are predisposed to experience challenging emotional distress due to their terminal illness, resulting in depression and anxiety. However, the overall limited survival time and often complex medication regimes complicate a timely and tolerable treatment of these symptoms, when time-consuming psychotherapeutic sessions or classic antidepressant medication with side effects are unfavorable. Ketamine is an effective and fast acting antidepressant originating from pain treatment, which can be administered non-invasively as easy to handle nasal spray. The possibility of using ketamine as needed, and not necessarily daily as classical antidepressants, limits the occurrence of side effects and has the potential to ease symptom burden in patients as well as caregivers in this vulnerable cohort. Yet, the efficacy and feasibility of intranasal ketamine self-administration in palliative care cancer patients has not been investigated to date. In the open-label feasibility study proposed here, we aim at assessing the safety, feasibility and efficacy for the treatment of depression and anxiety with low-dose (5 mg per stroke) intranasal ketamine in a population of early palliative care cancer patients in an out-patient setting. If self-administered nasal ketamine proves efficient and safe in this study population of often neglected palliative care patients, an easy to handle, low-cost and fast-acting drug with lower risk for interactions would be available to ease burden and emotional symptom load, and eventually increase quality of life for patients and caregivers.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
100
Flexible-dose intranasal ketamine hydrochloride (5 - 50 mg)
University Hospital Zurich
Zurich, Canton of Zurich, Switzerland
Change in depressive symptoms assessed by the MADRS
Montgomery- Asberg Depression Scale (MADRS), 10 items, higher values indicate increasing symptom burden and total scores range from 0 to 60.
Time frame: From start of treatment at week 1 (baseline) to the end of treatment at 8 weeks
Change in anxiety assessed by the HAM-A questionnaire
Hamilton Anxiety Rating Scale (HAM-A), 14 items, higher values indicate increasing symptom burden and total scores range from 0 to 56.
Time frame: From start of treatment at week 1 (baseline) to the end of treatment at 8 weeks
Change in quality of life assessed by the QLQ-C30 questionnaire
EORTC Quality of Life Questionnaire (QLQ-C30), 30 items, higher values of questions 1-28 indicate increasing symptom burden / decreasing quality of life and total scores range from 0 to 112. Higher values on the questionnaires final two questions (29, 30) indicate improved health and quality of life. Total scores on these final two questions range from 0 to 14.
Time frame: From start of treatment at week 1 (baseline) to the end of treatment at 8 weeks
Change in sleep quality assessed by the PSQI questionnaire
Pittsburgh Sleep Quality Index (PSQI), 10 items, higher values indicate decreasing sleep quality and total scores range from 0 to 21.
Time frame: From start of treatment at week 1 (baseline), at week 4 and at end of treatment at 8 weeks
Change in depressive symptoms assessed by the HADS questionnaire
Hospital Anxiety and Depression Scale (HADS), 14 items, higher values indicate increasing symptom burden and total scores range from 0 to 21.
Time frame: From start of treatment at week 1 (baseline) to the end of treatment at 8 weeks
Change in caregiver burden assessed by the ZBS questionnaire (caregivers)
Zarit Burden Scale (ZBS), 22 items, higher values indicate increasing caregiver burden and scores range from 0 to 88.
Time frame: From start of treatment at week 1 (baseline) to the end of treatment at 8 weeks
Change in caregiver quality of life assessed by the CarGoQoL questionnaire (caregivers)
The CareGiver Oncology Quality of Life Questionnaire (CarGoQoL), 29 items, higher values indicate increasing caregiver quality of life and total scores range from 0 to 100.
Time frame: From start of treatment at week 1 (baseline), at week 4 and at end of treatment at 8 weeks
Change in sleep quality assessed by the PSQI questionnaire (caregivers)
Pittsburgh Sleep Quality Index (PSQI), 10 items, higher values indicate decreasing sleep quality and total scores range from 0 to 21.
Time frame: From start of treatment at week 1 (baseline), at week 4 and at end of treatment at 8 weeks
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