Abstract
People living with cancer (PLWC) often face profound existential distress that is insufficiently addressed by conventional psychosocial supports. This qualitative study explored PLWC’s attitudes, beliefs, and experiences regarding psychedelic-assisted therapy (PAT) as a novel approach to addressing psychosocial suffering, particularly existential distress. Fifteen participants with varying cancer types and stages were recruited from a national survey. Semi-structured interviews were analyzed using reflexive thematic analysis informed by the Theory of Planned Behavior. Four key themes were identified: (1) Cautious Optimism and Substance-Specific Attitudes Toward Psychedelics reflected varied knowledge, openness, and perceptions of specific agents; (2) Relational and Societal Influences: Stigma, Support, and Cultural Framing; (3) Structural and Systemic Barriers: Cost, Legality, Provider Attitudes, and Unequal Access; and (4) Cancer Context and Psychosocial Needs: Seeking Relief from Existential and Emotional Distress captured the emotional, spiritual, and existential dimensions of living with and beyond cancer. Participants expressed cautious optimism about PAT, driven by unmet needs in conventional care, particularly after active treatment and at advanced stages of cancer, where existential and spiritual concerns often go unaddressed. PAT was seen as a potential adjunct that could meaningfully engage with suffering beyond symptom management. However, concerns about safety, access, and stigma underscore the need for culturally responsive, patient-informed, and equity-focused implementation strategies. Integrating PAT into oncology will require dismantling structural barriers and shifting toward a model of care that embraces the full human experience of serious illness.
“Healing is not merely the repair of bodily wounds, but the restoration of spiritual wholeness.”
Introduction
Individuals diagnosed with cancer frequently experience profound psychological and existential distress, including anxiety, depression, fear of death, loss of meaning, and social isolation. A cross-sectional study found 70% of cancer inpatients experienced high levels of distress, with common issues including both fears and worry. 1 This highlights the substantial psychological burden faced by people living with cancer (PLWC), particularly those with advanced disease stages (Stage III or IV). Despite advancements in oncology, traditional psychosocial interventions often fail to adequately address the depths of existential suffering encountered by these patients. 2 While approaches such as Meaning-Centered Psychotherapy aim to alleviate suffering and death anxiety, 3 significant challenges in cultural adaptation, 4 limited efficacy, addressing the complexity of existential distress, 5 and overcoming implementation barriers 6 persist. The existential nature of cancer-related distress across all disease stages necessitates innovative therapeutic approaches that can facilitate profound perspective shifts. Psychedelic-assisted therapies (PAT) have emerged as promising interventions to address these deep-seated concerns, potentially offering relief where conventional methods fall short. 7 Notably, early research in the 1960s and 70s explored psychedelic compounds such as lysergic acid diethylamide (LSD) in patients with terminal cancer, demonstrating preliminary benefits in alleviating psychiatric symptoms—laying foundational insights for the current resurgence of interest.8 -10 This aligns with the comprehensive model of palliative care, which emphasizes the integration of somatic, psychological, social, and spiritual dimensions of care as essential to alleviating serious health-related suffering across the illness trajectory. 11 Integrating PAT into such frameworks may offer a more holistic response to the unmet needs of patients facing cancer at any stage of disease. 12
Clinical trials have demonstrated that classic psychedelics, such as psilocybin and LSD, can significantly reduce anxiety, depression, and existential distress in patients with advanced cancer or other life-threatening illnesses.7,13,14 These therapeutic effects are primarily mediated through serotonin receptor (5-HT2A) agonism, which modulates neurobiological pathways associated with emotional and cognitive processing.15,16 Similarly, empathogens such as 3,4-methylenedioxymethamphetamine (MDMA) enhance serotonin and oxytocin release, promoting emotional openness and reducing fear, which can benefit patients dealing with trauma related to their cancer diagnosis and treatment. 17 Ketamine, a dissociative anesthetic and N-methyl-D-aspartate (NMDA) receptor antagonist, may offer rapid antidepressant effects and has been used for immediate relief in severe or treatment-resistant depression that can often accompany cancer diagnoses. 18
Other psychedelics with historical and cultural significance, such as ayahuasca and mescaline, show preliminary promise for emotional and existential healing but have limited clinical data supporting their use in cancer care.19 -24 Ayahuasca, a traditional Amazonian brew containing N,N-dimethyltryptamine (DMT), and mescaline, found in cacti like peyote, may have therapeutic applications, but require more rigorous studies to determine their role in supportive care for PLWC at various disease stages.
Understanding patient openness to PAT is crucial, as numerous interrelated factors influence patients’ attitudes toward this therapy. These factors include societal stigma, cultural norms, historical anti-substance narratives, and practical barriers such as cost, accessibility, and legal constraints. 25 Recent studies have provided insights into these complex dynamics. For example, a New Zealand survey identified advanced cancer stage, younger age, and prior awareness of psychedelics as significant predictors of favorable attitudes toward PAT. 26 Complementing these quantitative findings, qualitative research highlights how psychedelic experiences can facilitate emotional acceptance and reconnect individuals with their personal values, irrespective of their disease stage.27 -29 As global interest in psychedelics grows, particularly in jurisdictions such as Canada, acquiring a nuanced understanding of these influencing factors will be essential to effectively integrate PAT into comprehensive cancer care models.
In this qualitative exploration, we examine how PLWC across all disease stages perceive PAT in the context of therapeutic potential, stigma, and structural realities. By analyzing patient narratives, we aim to identify facilitators and barriers to acceptance, thereby informing the development of interventions that address cancer-related psychological and existential distress throughout the cancer journey.
Methods
Study Design
Ethics approval was granted by the University of Calgary Health Research Ethics Board of Alberta – Cancer Committee (HREBA.CC-23-0004). The study follows the Consolidated Criteria for Reporting Qualitative Research (COREQ) to ensure transparency and rigor. 30
Research Positionality
This study was led by a Master’s student with training in psychosocial oncology and PAT, under the supervision of a senior investigator with expertise in integrative oncology. An interdisciplinary team comprising research assistants, patient partners, and integrative oncology researchers contributed diverse perspectives throughout the entire research process, from protocol development and interview guide design to recruitment, analysis, interpretation, and dissemination planning. Patient partners included a woman with Stage IV cancer who had experience with psychedelics, as well as a male cancer survivor and his female caregiver with no prior psychedelic experiences. Reflexivity was central throughout. While several team members recognize the potential value of PAT, we remained attentive to the risks of confirmation bias and over-interpretation, particularly within the charged cultural context surrounding these therapies.
Participant Recruitment and Sample
Fifteen PLWC with diverse cancer types and disease stages were recruited through a national survey on attitudes toward PAT. All participants were 18 years of age or older, had a current or past cancer diagnosis, and expressed willingness to discuss their beliefs and attitudes toward PAT. Prior experience with psychedelics was not a requirement. This approach allowed for a broad spectrum of perspectives, ranging from those who had never tried psychedelics to those with previous experience using psilocybin or ketamine. The final sample of 15 participants was deemed sufficient to achieve data saturation, consistent with earlier qualitative studies on PAT.31,32 However, we acknowledge that saturation may be partial given the sample’s demographic homogeneity, and further research with more diverse populations is warranted to confirm and extend these findings. Informed consent was obtained prior to all interviews. Table 2 provides an overview of participant demographics.
Data Collection
Individual semi-structured interviews were conducted virtually (50-90 minutes each). Participants were invited to discuss their experiences living with cancer, current approaches to managing psychosocial symptoms, and attitudes toward PAT, including anticipated benefits, risks, and barriers to access. The interviewer maintained a neutral, non-leading stance, allowing participants to shape the conversation around their personal insights. All interviews were audio-recorded, transcribed verbatim, and de-identified to ensure confidentiality. The interview guide, developed using theoretical constructs (e.g., the Theory of Planned Behavior) and prior survey findings, was piloted with patient partners to ensure clarity, relevance, and comprehensibility. The final interview guide is available in Supplemental materials (S1).
Analytical Framework
A hybrid inductive-deductive reflexive thematic analysis 33 was used to examine PLWC’s perspectives on PAT. The Theory of Planned Behavior (TPB) 34 served as a guiding framework to categorize emerging data into attitudes, subjective norms, and perceived behavioral control. Simultaneously, inductive coding permitted the capture of themes beyond TPB constructs, such as existential concerns and substance-specific attitudes. An overview of the transcript analysis process is summarized in Table 1.
Overview of Transcript Analysis Method.
Following Braun and Clarke’s 33 guidelines, three independent coders analyzed transcripts using NVivo 12. 35 Data saturation was reached once no new codes or themes were identified. Combining a TPB lens with inductive coding provided a comprehensive view of how PLWC perceive, experience, and navigate the possibility of PAT.
Reflexivity and Rigor
The study team engaged in regular reflective exercises to acknowledge personal biases, including a predisposition toward integrative oncology approaches. Patient partners reviewed the themes to ensure that the interpretations resonated with their lived experiences and perspectives. Peer debriefing sessions provided an opportunity for feedback on coding accuracy and thematic clarity, thereby enhancing methodological trustworthiness.
Results
Our sample comprised 15 PLWC, spanning diverse ages, religious beliefs, cancer types, and treatment stages, as described in Table 2. Participants age spanned between 25 and 65+ years old. Majority of participants were of European/white ancestry (80%) and female (66.7%). Additionally, most participants came from an educated background, with a minimum of a bachelor’s degree. Sixty percent of participants had personal experience with the use of psychedelics, and the majority (80%) were supportive of PAT.
Participants’ Demographics and Health Information.
Multiple psychedelics were selected by participants.
Thematic Analysis and Applied Theory of Planned Behavior Framework
Through thematic analysis, participants’ behavioral intentions were mapped onto TPB’s core constructs, while recognizing cancer-specific dimensions beyond the framework. Cautious Optimism and Substance-Specific Attitudes Toward Psychedelics (Theme 1) reveal how PLWC weigh PAT’s perceived therapeutic potential against risks, informed by fragmented knowledge, cultural stigma, and agent-specific biases. Relational and Societal Influences: Stigma, Support, and Cultural Framing (Theme 2) contextualize these attitudes within relational and societal dynamics, where stigma and support networks vie to legitimize or marginalize PAT. Structural and Systemic Barriers: Cost, Legality, Provider Attitudes, and Unequal Access (Theme 3) shifts focus to structural barriers—financial, legal, and systemic—that mediate access, reframing “choice” as a privilege contingent on institutional enablers. Finally, Cancer Context and Psychosocial Needs: Seeking Relief from Existential and Emotional Distress (Theme 4) transcends TPB’s individualistic focus, grounding intentions in the existential realities of cancer: unmet psychological suffering, mortality confrontation, and demands for holistic care.
Cautious Optimism and Substance-Specific Attitudes Toward Psychedelics
PLWC express a complex mix of hope and caution toward PAT. The tension is structured through three interrelated sub-themes: (1.1) Foundational Knowledge and Influences; (1.2) Balancing Openness with Caution; and (1.3) Attitudes Toward Specific Agents (see Figure 1). Demographic factors such as age, cancer stage, education, cultural background, and prior psychedelic use further shaped these attitudes.
Attitudes toward PAT. This figure outlines the thematic structure of attitudes toward PAT, structured into three sub-themes: (1) Balancing openness with caution, reflecting tensions between perceived therapeutic benefits (eg, emotional relief, existential support) and psychological risks (eg, fear of adverse effects), (2) Foundational Knowledge and Influences, capturing media narratives, historical antidrug messaging, and gaps in clinical knowledge, and (3) Attitudes Toward Specific Agents, distinguishing between psilocybin, ketamine, LSD, MDMA, and other psychedelic agents.
Foundational Knowledge and Influences
Participants’ baseline understanding of psychedelics was primarily informed by media reports, pop-science articles, word-of-mouth, and personal experience. Nine of 15 participants had previously used psychedelics, and their views were clearly informed by these experiences. In contrast to those relying on secondary sources, these participants described psychedelics with familiarity and confidence, often drawing on past personal insights.
Older participants, many of whom grew up during the “war on drugs” era, often retained caution influenced by anti-drug messaging. Most participants rated themselves as having moderate or high psychedelic knowledge, yet the content of their interviews frequently revealed only superficial or anecdotal familiarity.
“I guess when I think of psychedelics, I know reading news and pop science that there’s definitely a trend toward using psychedelics in treating trauma and anxiety and depression.” (PLWC 4) “I have some knowledge of how psychedelics have proven to be helpful . . . and that research was kind of squashed, not allowed to continue.” (PLWC 10)
Many acknowledged a lack of formal, in-depth information about dosing and safety, with those holding moderate to high psychedelic knowledge offering more detailed reflections.
Balancing Openness With Caution
Participants expressed complex attitudes toward PAT, balancing openness influenced by potential therapeutic benefits, professional guidance, and controlled settings, with notable caution driven by fears of psychological side effects, loss of control, and anxiety about adverse experiences, as described in Table 3. The nuanced interplay between openness and caution highlights the importance participants place on safety and effective oversight in considering PAT as a therapeutic option.
Codes Descriptions, and Representative Quotes Illustrating Participants’ Complex Attitudes Toward PAT.
Attitudes Toward Specific Agents
In addition to their general perspectives on PAT, participants held distinct attitudes toward individual substances. Factors such as perceived “naturalness,” cultural stigma, therapeutic potential, and personal experience shaped how each agent, ketamine, LSD, psilocybin, MDMA, and other psychedelics (ayahuasca and mescaline) were viewed, as described in Table 4.
Summary of Participant Attitudes Toward Specific Psychedelic Agents.
PLWC’s attitudes toward PAT exist at the nexus of hope-driven pragmatism and risk-averse deliberation. While foundational knowledge gaps and historical stigma often anchored skepticism, therapeutic desperation, particularly in advanced cancer, fostered receptivity. Younger, educated participants engaged in more nuanced discourse, weighing agent-specific profiles (eg, psilocybin’s “natural” appeal vs MDMA’s recreational associations) against their psychosocial needs. Conversely, older participants, shaped by the “war on drugs” era, exhibited caution, though not uniform resistance. Critically, cultural and educational backgrounds functioned as lenses through which stigma or legitimacy was filtered. These dynamics underscore that attitudes are neither static nor monolithic but contextually contingent, forged through the interplay of personal vulnerability, sociocultural legacies, and the evolving medicalization of psychedelics. Ultimately, PLWC’s openness to PAT hinges on reconciling the promise of psychological liberation with the perceived safety of structured, professionalized care; a balance reflective of broader societal shifts in redefining psychedelics from taboo to therapeutic.
2. Relational and Societal Influences: Stigma, Support, and Cultural Framing
Subjective norms, as conceptualized by TPB, reflect an individual’s perception of social pressures to engage in or avoid a behavior, shaped by their beliefs about whether significant others (eg, family, peers, society) approve or disapprove of the action, combined with their motivation to comply with these expectations. In this context, participants’ openness or caution toward PAT was shaped by broader social and cultural factors, including historical stigma, generational attitudes, media portrayals, and support from personal networks. Four interrelated sub-themes emerged: (2.1) Historical and Generational Influences, (2.2) Stigma and Judgment, (2.3) Media Influence, and (2.4) Asymmetrical Support Networks (see Figure 2).
Subjective norms influencing PAT engagement. This figure outlines four sub-themes in subjective norms: (1) Historical and Generational Influences (war on drugs legacy, cultural taboos), (2) Stigma and Judgment (fear of social repercussions), (3) Media Influence (sensationalized vs science-based narratives), and (4) Asymmetrical Support Networks (peer advocacy, family dynamics) with their respective codes.
Historical and Generational Influences
Participants frequently referenced the “war on drugs” era and past anti-drug campaigns as shaping their early perceptions of psychedelics. Older participants recalled stringent anti-drug messaging, while younger ones, diagnosed with cancer at earlier ages, felt more open-minded but still aware of lingering stigma. Cultural context also played a role; for instance, 1 participant, who identified as Asian, described strict prohibitions in her upbringing that framed psychedelics as particularly taboo:
“I think there’s always been a lot of, especially culturally from my background, it’s like psychedelics were a big no-no. They were scary.” (PLWC 5)
Generational differences also influenced attitudes; some older participants admitted needing to “unlearn” prohibitive views, whereas younger participants, exposed to more recent discussions of medical cannabis and psychedelics, reported fewer entrenched biases.
“I grew up during the 60s in the southern interior of BC, so there were lots of substances around when I was a kid. . . . I never, never used any psychedelics.” (PLWC 15)
Stigma and Judgment
Despite growing interest, many participants feared judgment from family, friends, or professional peers. They noted a reluctance to discuss psychedelics publicly, especially if workplace or extended family environments were perceived as conservative. Some chose not to disclose their curiosity or past psychedelic use, fearing negative perceptions or social repercussions.
“Yeah, it’s the very reason I wouldn’t talk to my family about it. I don’t think they’d be open-minded.” (PLWC 12) “I would not share this online . . . I’m a [professional in healthcare], so that’s why I’m sharing this here, in a confidential space.” (PLWC 6)
The stigma surrounding psychedelics was particularly strong in contexts where they were still viewed as “taboo” or “dangerous,” even if participants found scientific literature suggesting otherwise. This created tension between their growing openness and the potential social risk of being associated with psychedelics.
Media Influence
Media coverage had a powerful impact on initial impressions. Some participants recalled negative or sensational stories, reinforcing fears of “bad trips.” Others discovered more balanced or positive portrayals (e.g., Michael Pollan’s popular book How to Change your Mind
36
), which reshaped their perceptions and increased openness. Only one participant actively sought out formal, evidence-based sources, relying instead on anecdotal stories and popular media to guide their views:
“There were always these shows before, showing people doing crazy things while on it. That definitely affected how I viewed psychedelics.” (PLWC 5) “I think it’s getting better, especially with psilocybin and magic mushrooms talked about in pop science by people like Michael Pollan. It makes it seem like this is a good thing.” (PLWC 4)
Although participants occasionally expressed caution about “hype” versus reality, most reported predominantly positive accounts from these informal channels. This tendency to rely on media and friends rather than formal research left some feeling uncertain about where to find credible, unbiased information on PAT.
Asymmetrical Support Networks
Personal networks significantly shaped participants’ attitudes. Friends or peers who shared positive psychedelic experiences helped dispel fears, while supportive family members encouraged exploration. However, conservative values or generational divides could limit open discussion.
“I think I had one friend say he did mushrooms and he was really positive about it . . . it opened my eyes to the possibility that it could be helpful.” (PLWC 5) “I do have a partner who is open-minded about this stuff, so it helps to have someone to talk to without being judged.” (PLWC 7) “I know that within my family there’s probably a wide variety of views on it, you know, and somewhat you would expect the younger people maybe have a more relaxed attitude towards it.” (PLWC 15)
Participants frequently observed heterogeneous perspectives toward PAT across their social networks. While some described asymmetrical support networks, receiving greater endorsement from peers than family members, others identified specific confidants (eg, siblings, close friends) who fostered nonjudgmental dialog about PAT. Notably, several PLWC positioned themselves as advocates within their circles, actively championing integrative therapies to counteract prevailing skepticism.
Subjective norms, deeply entwined with sociocultural legacies, profoundly influenced these dynamics. Historical associations of psychedelics with illicit “drug use,” coupled with stigmatizing remarks from relatives or peers and polarized media portrayals, often cultivated reticence or concealment. Conversely, allyship from socially progressive individuals, whether personal connections or public figures, ignited curiosity and mitigated apprehensions. Ultimately, participants’ inclination to pursue PAT hinged on a perceptual equilibrium: the degree to which affirming voices within their immediate milieu offset broader cultural ambivalence or disapproval. This dialectical tension underscores how behavioral intentions are negotiated at the intersection of intimate relational trust and collective societal narratives.
3. Structural and Systemic Barriers: Cost, Legality, Provider Attitudes, and Unequal Access
Participants’ willingness or ability to pursue PAT was shaped by practical concerns, from accessing trusted sources to affording treatment, alongside personal motivation and healthcare provider support. Five sub-themes emerged: (3.1) Accessibility, (3.2) Financial Barriers, (3.3) Legal, Regulatory, and Research Gaps, and (3.4) Healthcare Provider Dynamics (see Figure 3). Demographic factors such as age, income level, and cancer stage often intersected with these considerations, influencing how participants navigated each barrier or facilitator.
Perceived behavioral control: structural barriers to accessing PAT. Key barriers (sub-themes) include accessibility (opaque referral pathways), variable clinician support, financial exclusion (cost prohibitions), and legal/regulatory inertia (slow policy reform). Arrows denote how these structural inequities intersect with demographic factors (eg, income, cancer stage), disproportionately limiting agency for marginalized groups. Recommendations for systemic reforms (e.g., insurance mandates, provider training) are highlighted as pathways to equitable access.
Accessibility
Participants faced informational and logistical opacity regarding PAT, with many uncertain how to identify credible providers or navigate referral pathways. While some referenced underground networks or media-reported clinics, most described a fragmented landscape that discouraged exploration:
“I wouldn’t really even know where to start in order to get, I would assume I would get a doctor’s referral. I don’t know where it’s located and how accessible it would be for me to do it.” (PLWC 10) “What is stopping me is access. I have no idea how I would get it, so that would be one, but I wouldn’t let the fact, if it’s illegal, stop me right now if there’s a way to get it.” (PLWC 7)
This sense of inaccessibility hindered many from exploring PAT, even if they were otherwise open to its therapeutic benefits.
Financial Barriers
Cost was another concern; participants worried PAT would be prohibitively expensive and unlikely to be covered by insurance. Despite this, many expressed willingness to pay out-of-pocket if they believed treatment would offer meaningful benefits.
“I think yes, it would depend on the amount . . . I do have a willingness to pay a higher amount maybe than I would for other things.” (PLWC 10) “I’m lucky enough that I could probably afford it. But it’s something that makes you think, right, especially if it’s thousands of dollars.” (PLWC 12)
Those with limited financial resources felt particularly disadvantaged, noting that effective mental health supports should be equitable and accessible, not solely a “premium” service for those who can afford it.
Legal, Regulatory, and Ethical Considerations
Participants identified systemic inertia, a slow regulatory process, stigma, and insufficient data, as a critical barrier. Many emphasized the need for rigorous research to legitimize PAT and inform ethical guidelines:
“I guess it’s the research aspect . . . I’d like to see a little bit more of that, because it’s what gives me faith in anything that’s offered.” (PLWC 12)
Others noted that public sentiment is gradually shifting, partly influenced by cannabis legalization in Canada, yet lingering stigma and regulatory inertia remain significant hurdles:
“I was always against drugs of any kind . . . I think my stance has changed over time with the legalization of [cannabis] . . . I am much more interested in exploring complementary or alternative therapies.” (PLWC 7) “I just think that . . . unfortunately, it’s a really long ways away.” (PLWC 12)
These concerns echoed broader calls for clearer guidelines, increased funding, and expanded clinical studies to establish credibility and ensure patient safety.
Healthcare Provider Dynamics
Finally, participants underscored the essential role of healthcare providers who are informed, open-minded, and willing to discuss PAT. Those who had supportive oncologists or mental health professionals reported feeling more at ease and better equipped to navigate their options.
“If it was guided with an expert and someone who was very trained . . . I would trust in the expertise of the staff that was administering it.” (PLWC 5)
Conversely, others felt dismissed or judged when bringing up psychedelics in medical settings, highlighting a critical need for clinician education and training.
“I think it’s just physicians in general—I’ve experienced a resistance to hearing something they don’t already know. It’s frustrating, and it discourages me from bringing this up.” (PLWC 12)
Such experiences highlight the critical need for clinician education and communication training, ensuring that PLWC feel safe discussing PAT as a legitimate therapeutic option.
Perceived behavioral control was predominantly shaped by structural inequities rather than individual choice. Systemic factors—opaque access pathways, financial exclusion, regulatory delays, and variable clinician support—collectively eroded participants’ sense of agency. While having advanced cancer stages or financial privilege occasionally mitigated barriers, most faced a labyrinth of institutional and socioeconomic constraints. These findings underscore the need for systemic reforms: standardized access protocols, insurance coverage, accelerated research, and clinician education. Without such shifts, PAT risks perpetuating existing disparities, accessible only to those with resources to navigate its fragmented landscape.
4. Cancer Context and Psychosocial Needs: Seeking Relief from Existential and Emotional Distress
The final theme explores how participants envision PAT within the broader landscape of cancer care. Many expressed existential distresses tied to their diagnoses, particularly those in advanced stages of illness, who saw PAT as a potential avenue for end-of-life anxiety relief. By contrast, some earlier-stage patients showed less immediate interest, prioritizing conventional treatments. Across all stages, participants voiced a desire for whole-person support that addresses both psychological and spiritual dimensions of cancer through 3 sub-themes: (1) psychosocial suffering, (2) existential distress tied to confronting mortality, and (3) aspirational visions for integrating PAT into future cancer care (see Figure 4).
Cancer context and psychosocial needs: PAT as a response to existential and systemic gaps. This diagram visualizes the interplay between cancer’s psychosocial toll and participants’ openness to PAT. Three sub-themes structure the theme: (1) psychosocial suffering (depression, support gaps), (2) existential distress (mortality confrontation), and (3) future care visions (palliative integration). Nodes represent codes (eg, “post-treatment abandonment,” “stage-specific priorities”), with advanced-stage patients emphasizing PAT’s role in existential reconciliation. The hierarchical layout underscores PAT’s potential to address unmet needs in oncology, bridging biomedical and holistic care paradigms.
Psychosocial Suffering
Participants universally described cancer as a catalyst for profound psychological and spiritual turmoil. Three codes structure their narratives in Table 5.
Codes, Descriptions, and Representative Quotes Illustrating Psychosocial Suffering Among Participants Living With Cancer.
Existential Distress and Fear of Dying
For advanced-stage participants, the confrontation with mortality transcended clinical anxiety, evolving into a profound existential reckoning. This distress was characterized not merely by fear of death itself, but by the process of dying and psychological weight of uncertainty—grappling with the meaning of suffering, the irreversibility of loss, and the erosion of future-oriented identity. Many described conventional therapies (eg, antidepressants, counseling) as inadequate to address these metaphysical dimensions:
“There’s some potential benefit there, especially for people who are deathly afraid of dying . . . it’s a serious thing to confront.” (PLWC 15)
Participants framed PAT as a unique existential tool, offering a means to reframe mortality through altered states of consciousness. Those who had undergone psychedelic experiences reported transformative shifts in their relationship to death:
“I was able to connect with the vulnerable side of me . . . let myself cry . . . it was really helpful.” (PLWC 4) “It was quite life-changing . . . in how I viewed existential distress and how I look at death down the road.” (PLWC 3)
Others who had tried psychedelics echoed similar sentiments, suggesting less fear of dying and an enhanced sense of the present:
“I can see a high value of the psychedelic experience helping people cope with . . . death and dying.” (PLWC 6) “And that’s what happened. I heard myself laugh, and that depth of depression broke.” (PLWC 14)
This sub-theme reveals a critical tension: while biomedical oncology often prioritizes tumor suppression, participants sought interventions that address mortality’s psychological imprint. PAT emerged as a bridge between these paradigms, offering a space to process existential questions that conventional care sidesteps. Notably, participants did not universally seek “answers” about death but rather emotional permission to confront it without paralyzing fear.
Future Care Visions
Participants across different disease stages expressed interest in incorporating psychedelics into cancer care. Those with advanced disease saw immediate applications for relieving end-of-life distress, while earlier-stage patients viewed psychedelics as potential options if psychological distress intensified. Many hoped for enhanced research, clearer regulations, and trained providers to facilitate safe PAT integration.
Some participants envisioned psychedelics becoming a standard offering within cancer centers:
“I would like to see it offered through [the cancer centre] . . . maybe one session could make a big difference.” (PLWC 12)
Others highlighted the potential for psychedelics to address anxiety and depression at diagnosis, potentially supporting physical healing:
“I am hoping. . . when you’re first diagnosed. . . it could be used to help the anxiety come down and the depression come down. Because if your body’s not fighting that, then it’s working on healing itself.” (PLWC 1)
Young adults with cancer particularly emphasized the need for better post-treatment psychological support:
“There’s a lot more younger patients now being diagnosed like myself, I was diagnosed at 26, so after that point, what am I supposed to do? And I think for so long we haven’t discussed the after of it, and I think psychedelics are an area that could help with that.” (PLWC 9)
In sum, inadequate psychosocial support coupled with profound existential concerns drove participants’ interest in psychedelics as potentially transformative. By helping reframe fear, ease psychological burdens, and facilitate emotional release, PAT emerged as a promising approach, particularly for those with advanced disease, for coping with cancer’s deep uncertainties.
Discussion
Thematic analysis identified four primary themes: (1) Attitudes toward PAT characterized by cautious optimism and substance-specific preferences, particularly for psilocybin, which was perceived as more “natural” and safer than other psychedelics; (2) Subjective Norms and Cultural Influences revealing persistent stigma and generational perspectives influenced by historical drug policies; (3) Perceived Behavioral Control highlighting practical barriers including accessibility, cost, and regulatory challenges; and (4) Cancer Context emphasizing how existential distress and inadequate psychosocial support drive interest in PAT, especially among those with advanced disease.
Participants with advanced cancer and those of younger age exhibited greater openness to PAT, highlighting how prognosis and generational influences shape attitudes. Many viewed psychedelics as uniquely beneficial for overcoming emotional barriers and facilitating introspection, aligning with evidence supporting psilocybin’s role in addressing existential distress in palliative contexts. 37 By contrast, older participants remained cautious, a perspective shaped by anti-drug messaging from their formative years. Additionally, higher education correlated with more nuanced risk-benefit assessments, reflecting the role knowledge and information play in shaping perceptions of safety and efficacy. Regardless of demographic differences, participants consistently emphasized the necessity of professional guidance, controlled therapeutic settings, and equitable access, underscoring the importance of patient-centered approaches to implementing PAT within comprehensive cancer care. These insights are critical for developing protocols that effectively address psychological suffering without exacerbating existing disparities.
Natural Origins, Clinical Credibility, and Synthetic Hesitancy: Factors Shaping Psychedelic Preferences in Oncology
Participants viewed psilocybin as the most favorable psychedelic agent due to 3 key factors: its perceived “natural” origin in mushrooms, positive media representation, and a perception of robust evidence supporting its efficacy for cancer-related existential distress.37,38 This preference was contextualized within patients’ experiences of standard oncology care, where many reported overwhelming medication regimens and treatment fatigue. Unlike daily pharmaceutical interventions, psilocybin’s time-limited dosing schedule (typically 1-3 sessions) offered a welcome alternative for those experiencing medication burden and seeking treatments that would not further complicate their already complex care routines. 39 Additionally, psilocybin’s structured therapeutic protocol, which includes preparation, supported dosing experiences, and integration therapy, enhanced patient trust in this approach as a legitimate medical intervention rather than recreational drug use. 29
By contrast, synthetic agents such as LSD and MDMA were met with greater caution due to their association with recreational use, historical stigma, and concerns around long-term safety. 40 Psilocybin has advanced through late-stage clinical trials (e.g., Phase II/III) with reproducible results for conditions such as depression 41 and end-of-life distress, 13 whereas research on LSD and MDMA remains comparatively limited in these populations. Systematic reviews highlight gaps in scope and consistency for these synthetic agents, particularly regarding unresolved long-term safety concerns in addressing psychosocial symptoms associated with life-threatening illnesses.7,42
Similarly, ketamine’s dissociative effects (eg, perceptual disturbances, detachment) are perceived by some patients as disorienting rather than therapeutically meaningful. 43 Research predominantly targets depression and anxiety, with limited exploration of existential concerns (demoralization, death anxiety). Sustainability challenges arise from its short-lived antidepressant effects (hours–days), necessitating repeated dosing that risks tolerance, dependence, and abuse liability.44 -46 This profile may limit its appropriateness for populations requiring durable, insight-oriented care, such as those with chronic existential distress (eg, demoralization in advanced illness). However, in palliative contexts or at the end of life, concerns around long-term use may be less clinically relevant, and ketamine’s rapid onset and potential for facilitating transient insight may offer valuable therapeutic benefit.
Lastly, it was unsurprising that most participants had limited or no knowledge of ayahuasca and mescaline, given their cultural specificity and minimal representation in clinical research and mainstream media.22,23 Among the few who were familiar, these substances were generally not considered suitable for clinical contexts due to their strong cultural traditions, limited evidence supporting efficacy, and intense psychoactive effects. Consequently, psilocybin emerged clearly as the most viable and acceptable candidate for integration into cancer care, owing to its balanced therapeutic profile and growing scientific validation.
Balancing Fear, Loss of Control, and the Reality of Potential Side Effects
Fear of adverse effects, such as bad trips or loss of control, was a recurring theme among PLWC. This aligns with findings in previous literature. For example, some participants reported that potential mental health service users often express concerns about the safety and unpredictability of psychedelics. 47 Notably, altered states of consciousness can indeed involve a sense of letting go, which may feel unsettling or even threatening. However, reframing this loss of control as a central feature of the therapeutic process could be key to unlocking deeper emotional processing and psychological growth. In this light, professional oversight and controlled dosing become essential for fostering a safe environment in which patients can engage productively with these challenging experiences.
However, considering these concerns, looking at reported side effects provides additional perspective. A recent systematic review and meta-analysis found that serious adverse events (SAEs) were rare in clinical settings, with no reports of deaths by suicide, persistent psychotic disorders, or hallucinogen persisting perception disorders following high-dose classic psychedelic administration. 48 However, SAEs such as worsening depression, suicidal behavior, psychosis, and convulsive episodes were reported in approximately 4% of participants with preexisting neuropsychiatric disorders. Non-serious transient adverse events requiring medical intervention, such as paranoia and headache, were similarly rare. 48
The nuanced understanding of risks and benefits among more educated participants in our study suggests that knowledge level influences perceptions of efficacy. This emphasizes the need for continued research to characterize the potential harms of psychedelic treatment, including enduring perceptual disturbances, triggering or enhancing the risk for onset of mania or psychosis, and acute cardiovascular effects. 49
Beyond the Headlines: Understanding Patient Knowledge
Participants predominantly acquired psychedelic knowledge through informal channels (eg, media reports, popular science literature, and personal narratives) rather than structured educational resources. This pattern mirrors a study that documented how Australian public perceptions are shaped by cultural narratives and often sensationalized media coverage that amplifies both therapeutic optimism and stigma. 47 This was similarly observed by palliative care patients, who typically construct their understanding through fragmented, non-clinical information sources. 38 While media exposure cultivates initial interest, it simultaneously creates vulnerabilities to misconceptions, including confusion between recreational and clinical applications, and inadequate attention to safety protocols.
The absence of formal education for PLWC highlights a critical communication gap in oncology settings, where existential distress may heighten susceptibility to misinformation. This situation raises significant equity concerns, particularly for populations already experiencing barriers to healthcare access. Clinicians occupy a privileged position as trusted knowledge intermediaries, yet their effectiveness is compromised by insufficient training and organizational support for psychedelic-focused discussions. Developing integrated approaches that connect scientific evidence with accessible patient education would enable PLWC to approach PAT as informed participants rather than passive recipients of unevenly distributed information.
Subjective Norms
Generational context, stigma perceptions, media influence, and social networks shaped attitudes toward PAT. Older participants expressed skepticism tied to anti-drug campaign exposure, while younger ones showed greater openness, aligning with trends observed in another study. 43 Fear of judgment from peers, professionals, or family posed a major barrier, mirroring stigma-related hesitations in palliative care. 38
Notable in our findings was the relative absence of religious affiliation as a determinant of PAT receptivity, despite literature documenting religion’s influence on psychedelic attitudes.50,51 Nevertheless, participants acknowledged the intrinsic spiritual dimensions of psychedelic experiences, suggesting that personal spirituality, rather than institutional religious identification, may be more predictive of patient openness to PAT interventions. This aligns with broader secularization trends in Canada, where individuals are less likely to identify as “religious” or attend religious services, reflecting weaker institutional religiosity’s societal influence compared to other populations.52,53 However, given our small sample and limited diversity in ethnoracial background, gender, and educational attainment, these findings should be interpreted with caution—particularly regarding their generalizability across broader populations.
Access and Affordability: Perceived Behavioral Control
Financial barriers pose a substantial challenge to accessing PAT, as patients frequently anticipate prohibitive out-of-pocket costs due to restricted insurance coverage for novel therapies. The concerns regarding affordability resonate with the findings of Plourde et al, 39 who report that many patients face severe trade-offs between standard treatments, which are often covered by insurance, and potentially beneficial but financially burdensome complementary approaches such as PAT. This financial strain limits innovative therapies mainly to affluent individuals, exacerbating healthcare access inequalities.12,54
Regulatory complexities further complicate access to PAT, as patients express confusion regarding clinical trial eligibility criteria, variations in legal statuses across jurisdictions, and unclear standards for provider qualifications. Research emphasizes the urgency for regulatory standardization, advocating for clearer guidelines that can help increase patient confidence and promote informed decision-making in the therapeutic landscape, especially in the face of rapid advancements in treatment options.38,55
Gaps in Psychosocial Supports and the Limitations of Western Medicine
Western medicine’s approach to cancer care reveals significant limitations in addressing existential distress, particularly for patients with advanced disease. Conventional healthcare paradigms often frame death as a biological failure rather than a natural process, creating a “death-denying” culture that emphasizes cure over comprehensive care.56,57 This approach neglects the spiritual, existential, and emotional dimensions that are central to patients’ experiences, especially as they approach end of life.
Research consistently demonstrates that patients with advanced cancer experience severe existential distress, including fear of death, loss of meaning, and profound isolation.58,59 These concerns extend beyond standard anxiety and depression, representing what Victor Frankl termed an “existential vacuum.” 60 While psychotherapeutic and pharmacological interventions may address symptomatic distress, they typically fail to engage with the deeper existential challenges that patients face, creating a critical unmet need in palliative care. 61
This gap becomes particularly pronounced after active treatment concludes, when patients often report feeling abandoned precisely when psychological support becomes most essential. 26 Conventional treatments like antidepressants or cognitive-behavioral therapy may mitigate symptoms but rarely address the qualitative depth of existential suffering that characterizes terminal illness experiences. 62 In this context, specialized approaches such as Managing Cancer and Living Meaningfully (CALM),63,64 Dignity Therapy,63,64 mindfulness-based interventions (MBIs),12,65 and meaning-focused psychotherapy 3 have demonstrated efficacy in addressing these existential dimensions, though further research is needed to fully integrate these therapies into standard care and potentially combine them with PAT.
Psilocybin offers promising alternatives by directly engaging with existential and spiritual dimensions of illness. Clinical trials demonstrate that psilocybin-assisted therapy can induce profound shifts in patients’ relationships with mortality, often through experiences of “ego dissolution” or transcendence that correlate with lasting reductions in anxiety and enhanced acceptance of death.13,66 These approaches align with calls for integrating spiritual and existential dimensions into care, as emphasized by researchers advocating for a biopsychosocial-spiritual model of care.67,68
Limitations, Reflexivity, and Future Directions
This qualitative study offers rich insights into PLWC perspectives toward PAT but has several limitations. The Canadian sample limits generalizability, not only due to its geography but also composition of mostly educated white women, and recruitment referencing psychedelics may have introduced self-selection bias toward participants already interested in PAT. Despite efforts to capture a diversity of attitudes, this approach likely skewed findings toward more favorable views. Future research should use strategies targeting broader, more diverse patient populations, including individuals from marginalized communities and those skeptical of PAT.
Research priorities for integrating PAT into cancer care must focus on three interrelated areas to ensure equitable access and effectiveness: First, longitudinal mixed-methods studies are needed to map PAT receptivity across the cancer trajectory, particularly at critical junctures such as diagnosis and palliative transitions to inform targeted interventions. Second, implementation science approaches should examine how structural determinants such as financial barriers and geographic disparities affect access, combining effectiveness trials using patient-reported outcomes with qualitative inquiry into challenges faced by marginalized patients. Third, policy research must engage multiple stakeholders to develop frameworks that balance accelerated access with appropriate safeguards, potentially through adaptive licensing models that prioritize advanced disease while mandating equity audits. Figure 5 provides a stakeholder roadmap for this transformation, outlining actionable steps for policymakers, clinicians, researchers, and advocates to integrate PAT equitably while centering patient-defined priorities and dismantling structural barriers.
Multistakeholder roadmap for equitable implementation of PAT in oncology. Policy makers are urged to prioritize regulatory reform (eg, psilocybin legalization) and insurance coverage to address financial barriers. Patient advocacy groups can counter misinformation through education and partner with communities to co-design PAT access. Researchers must focus on equity-driven studies and culturally adaptive protocols to ensure inclusivity, as well as head-to-head trials comparing psychedelic agents paired with established therapeutic frameworks. Clinicians should adopt training programs to reduce stigma and integrate PAT into palliative care for advanced-stage patients. Actions align with study themes: leveraging psilocybin’s perceived safety (attitudes), improving affordability (perceived control), addressing existential distress (cancer context), and reducing stigma via education (subjective norms). Color-coded nodes (stakeholders: light blue; actions: peach; themes: green) and directional arrows illustrate collaborative pathways. Designed for clinicians, policymakers, and advocates, this visual emphasizes equity, patient-centered care, and systemic collaboration to transform PAT from a novel intervention into an accessible, holistic component of oncology.
Conclusion
Our findings illustrate a spectrum of attitudes shaped by demographic, social, cultural, and historical influences, highlighting a notable openness among younger individuals and those experiencing advanced illness. Participants emphasized significant unmet psychosocial needs, especially around existential distress, anxiety, and inadequate post-treatment support, that position PAT as a potentially valuable adjunct to conventional cancer care. However, concerns regarding safety, stigma, access, and affordability emerged clearly, underscoring the necessity for careful implementation strategies that address existing disparities and ensure equitable access. Addressing these limitations requires coordinated efforts across clinical education, policy reform, and implementation science to transform cancer care from a system that fights death to one that honors the complete human experience.
Supplemental Material
sj-docx-1-ict-10.1177_15347354251370982 – Supplemental material for “Facing Death. . . Now, That’s a Serious Thing to Confront” A Qualitative Analysis of Patient Perspectives on Psychedelic-Assisted Therapy for Cancer-Related Psychosocial Symptoms
Supplemental material, sj-docx-1-ict-10.1177_15347354251370982 for “Facing Death. . . Now, That’s a Serious Thing to Confront” A Qualitative Analysis of Patient Perspectives on Psychedelic-Assisted Therapy for Cancer-Related Psychosocial Symptoms by Haley D.M. Schuman, Sofia Barkova, Raèf Mina, Julie M. Deleemans, Tina Nguyen and Linda E. Carlson in Integrative Cancer Therapies
Footnotes
Acknowledgements
We sincerely thank the patients who generously shared their experiences and insights for this research. Their willingness to discuss sensitive topics surrounding cancer care and psychedelic-assisted therapies was invaluable to our understanding of these complex issues. Additionally, we are grateful to our patient partners, whose contributions were essential throughout the entire research process. Their lived experience shaped our research questions, informed our interview approach, enhanced our analysis, and strengthened our interpretations. Their thoughtful perspectives ensured this work remained grounded in patient realities and priorities. We also thank Chantal Savard for assistance with reference management and Sheila Schuman for editorial support.
Ethical Considerations
Ethics approval was granted by the University of Calgary Health Research Ethics Board of Alberta – Cancer Committee (HREBA.CC-23-0004).
Consent to Participate
Informed consent was collected from all participants.
Author Contributions
HS conceptualized the study, developed the protocol, conducted interviews, performed thematic analysis, and drafted the manuscript. SB contributed to thematic analysis and preparation and interpretation of results. RM assisted with thematic analysis, figure creation, and manuscript formatting. JD contributed to protocol development, participant recruitment, provided patient perspective insights, and assisted with manuscript editing. TN supported protocol development and participant recruitment. LEC is the principal investigator and student supervisor, overseeing protocol conceptualization and development, interview guide creation, participant recruitment, and manuscript revision.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Dr. Linda Carlson holds the Enbridge Research Chair in Psychosocial Oncology, co-funded by the Canadian Cancer Society and the Alberta Cancer Foundation.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Supplemental Material
Supplemental material for this article is available online.
References
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