ALLEVIATING DISTRESS IN OUR MOST VULNERABLE MOMENTS

Dr. James Downar wants to find new ways to treat the distress caused by serious illness

Centered around comfort and quality of life, a palliative approach to care addresses more than the physical symptoms of illness. It encompasses psychological, emotional, and spiritual care for patients and their loved ones.

Dr. James Downar, Senior Investigator with the Bruyère Health Research Institute and Head of the Division of Palliative Care at the University of Ottawa, has seen how patients have placed an increasing value on quality of life rather than quantity of life.

For him, distress needs to be taken just as seriously as physical pain and symptoms. But one of the greatest challenges in palliative and end-of-life care is the time it takes pharmaceuticals or psychotherapy to take effect.

“Not only do we need to be able to identify when patients could benefit from a palliative approach to care, we need options that support them in some of the most distressing moments of their lives,” says Dr. Downar. “I see a future where everyone with serious illness can have their physical, psychological, and existential distress relieved by effective, timely and scalable treatments.”

When time is of the essence

What if existing therapies could yield results faster? Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation treatment that is already used for treating major depression, post-traumatic stress disorder, and other mood and anxiety disorders.

At Bruyère Health, Dr. Downar’s team is testing a new accelerated five-day rTMS treatment protocol that could help patients with psychological distress. Already, they see promise for patients.

In their feasibility trial, the first to study this treatment in a palliative setting, patients with advanced illness experienced a dramatic improvement in their depression, anxiety, or both within days of treatment.

“Seeing the possibility of helping our patients in such a short window is a positive first step,” he shares. “Our patients saw a difference. Their loved ones saw a difference. This is the impact we want to have with research.”

Groundbreaking research with psychedelics

In another first, Dr. Downar’s team is conducting the world’s first study of microdosing psilocybin for improving psychological distress in people with advanced illness.

He shares that early results are encouraging, but there is still a lot of work to be done before we can ensure all Canadians can expect relief of both their physical and psychological distress as they approach end-of-life.

“We have a long way to go, but our team is taking big steps in the right direction,” says Dr. Downar, who co-chairs the Pan-Canadian Palliative Care Research Collaborative. “Palliative care is still a relatively new field of medicine, and we are pushing the boundaries every day with the goal to provide everyone with comfort and care at every stage of life.”