Effects of Intranasal Ketamine on Depression and Anxiety in Palliative Care Cancer Patients
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Intranasal ketamine hydrochloride.
- Who it may be relevant to
- Registry conditions: Depressive Symptoms Mild to Moderate in Severity, Anxiety, Quality of Life (QOL), Caregiver Burden. Basic parameters: from 18 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Switzerland
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Official title
Keta-Care - Antidepressant and Anxiolytic Effects of Intranasal Ketamine Self-administration in Palliative Care Cancer Patients: an Open-label Feasibility Study
Overview
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.
Detailed description
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.
Interventions
- Drug Intranasal ketamine hydrochloride
Flexible-dose intranasal ketamine hydrochloride (5 - 50 mg)
Primary outcome measures
- Change in depressive symptoms assessed by the MADRS [Time frame: From start of treatment at week 1 (baseline) to the end of treatment at 8 weeks]
Secondary outcome measures (7)
- Change in anxiety assessed by the HAM-A questionnaire [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 [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 [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 [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) [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) [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) [Time frame: From start of treatment at week 1 (baseline), at week 4 and at end of treatment at 8 weeks]
Eligibility criteria
Inclusion Criteria (patients):
- Informed Consent as documented by signature;
- HADS total score of 6 or greater;
- Age 18 years or older;
- Progressive cancer diagnosis (estimated life expectancy 24 months or more)
- Able to attend study visits;
- Ability to speak and understand German;
Exclusion Criteria (patients):
- Clinician assessed cognitive impairment;
- Clinician assessed alcohol or drug abuse;
- Pregnancy or breast-feeding;
- Severe hypertension (greater than 200/120 mmHg);
- Anamnestic mood disorder (major depressive disorder, treatment resistant depression, etc.);
- Suicidality (C-SSRS total score of "low" or less);
- Weight less than 39 kg, greater than 170 kg;
- Angina pectoris or myocardial infarction in the last 6 months;
- Lifetime abuse or dependence on ketamine or phencyclidine;
- Substance abuse or dependence in the 6 months before screen;
- Nasal obstructions or history of nasal surgery.
- Serious health risk caused by increased blood pressure or intracranial pressure:
- Known aneurysmal vascular disease (including intracranial, thoracic or abdominal aortic or peripheral arterial vessels);
- Known history of intracerebral hemorrhage;
- Recent (within 6 weeks) cardiovascular event including myocardial infarction (MI).
Inclusion criteria (caregivers):
- Informed Consent as documented by signature;
- Age 18 years or older;
- Able to attend study visits;
- Ability to speak and understand German.
Exclusion criteria (caregivers):
\- None.
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Allocation
- Non-randomized
- Model
- Single group
- Masking
- Open label
- Primary purpose
- Treatment
Study locations
Switzerland · 1 center
- University Hospital Zurich — Zurich
Identifiers
NCT: NCT06665568 · Keta-Care · KLS-5644-08-2022