Cancer Healthcare Workers' Perceptions toward Psychedelic-Assisted Therapy: A Preliminary Investigation

Advanced-stage cancer is frequently accompanied by psychiatric disorders and broader psychological distress, including treatment-resistant depression, anxiety, existential despair, loss of meaning and desire for a hastened death. Such problems not only reduce quality of life but have been linked to worse physical outcomes, for example increased pain, reduced treatment adherence and higher mortality. Standard pharmacological and psychological treatments show mixed and often limited efficacy in advanced cancer populations, and several meta-analyses have failed to demonstrate clear benefit. In this context, renewed interest in psychedelic-assisted therapy has emerged: classical serotonergic psychedelics such as psilocybin and LSD act at 5-HT2A receptors, have been associated with neural plasticity markers (for example BDNF), and recent small trials in cancer populations have reported rapid and sometimes sustained reductions in depression, anxiety and existential distress. This study aimed to explore how cancer healthcare professionals perceive the potential use of psychedelic-assisted therapy with advanced cancer patients who have depression and/or anxiety. Reynolds and colleagues set out to document awareness, knowledge, attitudes and concerns among clinicians and other cancer care staff, arguing that these professionals are important gatekeepers whose views matter for research translation and future clinical applications. The work is positioned as an initial, qualitative investigation to inform trial design, stakeholder engagement and clinical planning in this emerging field.

A qualitative, semi-structured interview study was conducted with cancer healthcare professionals who provided treatment or support to patients with advanced or metastatic cancer. Eligibility required English proficiency and an active role in cancer or palliative care; recruitment sought variation in age, gender, professional role and experience because prior work suggested attitudes may differ across these variables. Recruitment materials used neutral language (“exploring a new way of supporting patients with advanced cancer”) to reduce selection bias, and invitations were distributed by email and via flyers at clinical meetings. Recruitment continued until the investigators judged data saturation had been reached and a sufficient demographic range obtained. Twelve participants took part between October 2019 and January 2020. Interviews lasted 30–59 minutes and took place at locations chosen by participants (workplace, university, home or by phone). Two researchers conducted interviews; one researcher had a prior professional relationship with some participants but did not collect data from those individuals and data were de-identified before analysis. Ethics approval was obtained from the Health and Disability Ethics Committee (19/STH/122) and the Auckland District Health Board (A + 8576), and participants provided written consent. Interviews began with participants' professional roles and observations about how patients cope with advanced cancer, then moved to specific discussion of psychedelics. Prompts included cards listing terms such as 'psychedelics', 'psilocybin', 'LSD', 'ayahuasca', 'ibogaine', 'MDMA', 'micro dose' and 'high dose'. Interviewers also presented a brief summary of recent clinical studies and invited participants' impressions. Sessions were audio-recorded and transcribed verbatim by an external service. Analyses adopted a critical realist stance and used inductive reflective thematic analysis. The team followed a six-step process: data familiarisation, coding, generating initial themes, reviewing themes (organised in NVivo12), defining/naming themes, and writing the report. This approach emphasised rigorous, iterative coding to elicit themes while allowing interpretive judgements through a biopsychosocial lens.

Twelve healthcare professionals participated; the sample had a mean age of 40.5 years (SD = 11.9), was 75% female, 58% New Zealand European, and contained 42% doctors. Mean years of experience were 12.08 (SD = 10.19). General observations from the interviews included initial surprise or hesitation when the topic of psychedelics arose—often linked to associations with recreational or illicit drug use—but this apprehension typically diminished as the conversation progressed. Participants displayed a wide range of knowledge about psychedelic therapies: some relied on media or anecdote while others, particularly some doctors, reported familiarity with the scientific literature and recent conference presentations. Participants also mentioned recent clinical trials of single high-dose psilocybin with psychotherapy that they understood to show clinically significant improvements in anxiety, depression and quality of life, sustained in 60–80% of participants at 6 months. Four inter-connected themes were identified. Theme I, beneficence: a need to alleviate suffering, captured participants' awareness of the intense physical and psychological burden experienced by advanced cancer patients and their professional desire to relieve that suffering. Clinicians described seeing patients who were not coping and expressed willingness to consider novel approaches if these could improve quality of life; one psychologist stated, "I want to take away the pain." Participants also acknowledged limits of current treatments and moments of professional helplessness when distress could not be fully ameliorated. Theme II, a transformative approach with the potential for real benefit, reflected a view that psychedelic-assisted therapy could stretch existing medical paradigms and offer meaningful change. Some participants saw an intuitive mechanism—enhanced neural plasticity facilitating psychotherapy—and noted the long history of these substances in indigenous contexts. Prior knowledge of the psychedelic literature was associated with greater openness, and several clinicians emphasised that evidence-based trials could justify clinical use. At the same time, participants warned against trivialising spiritual or cultural dimensions, with concerns about cultural appropriation of indigenous traditions linked to compounds such as ayahuasca and ibogaine. Theme III, new frontiers can be risky, summarised perceived risks drawn from associations with illicit use, media reports and clinical concerns. Specific worries included drug-induced psychosis or "bad trips," loss of control during altered states, risk of physical harm if used unsafely, drug interactions with ongoing cancer treatments, and issues surrounding unregulated manufacture. Participants described a need for careful risk assessment and control; one doctor likened the potency of psychedelic treatment to "high voltage electricity," emphasising the importance of caution. Theme IV, non-maleficence: keeping vulnerable patients safe, described how responsibility to avoid harm shaped views. Participants were generally open to research but highlighted the need for phased, rigorous clinical trials akin to conventional drug development. Suggested safeguards included controlled, medically supervised settings, thorough toxicity and dosing studies (Phase I onward), and a preference among some for micro-dosing approaches because of perceived lower risk—though others questioned whether micro-doses would yield meaningful therapeutic effects. Overall, participants advocated incremental, evidence-based pathways to evaluate safety and efficacy in this vulnerable population.

Reynolds and colleagues interpret the findings as indicating that cancer healthcare workers balance a professional duty to alleviate suffering with an obligation not to cause harm. Participants viewed psychedelic-assisted therapy as potentially transformative but also as carrying significant risks; this risk–benefit calculus informed cautious openness rather than unqualified endorsement. The authors situate these attitudes within broader clinical practice, noting that many cancer treatments already trade toxicity against potential benefit and that established phased research pathways exist to manage such dilemmas. Knowledge emerged as a key moderator of attitudes: clinicians with greater familiarity with the literature tended to be more receptive, and even brief exposure to study results during interviews often increased openness. The investigators therefore highlight the dynamic nature of perceptions as public and professional awareness evolves. They recommend pursuing well-designed clinical trials, including both randomised controlled trials and more pragmatic, real-world studies that assess clinical applicability and implementation. The paper acknowledges several limitations. As a small qualitative study, the findings cannot quantify how widely these views are held or capture the full diversity of perspectives; interviewer positionality and the interview setting may have influenced responses; and the team did not systematically probe participants' personal recreational experiences with psychedelics, which could have informed attitudes. Geographical restriction to one region in New Zealand and the modest sample size limit generalisability. The authors call for larger, quantitative work to test whether the themes observed here replicate across different professions, ages, ethnicities and jurisdictions. Finally, the researchers stress the importance of engaging broader stakeholders in future work—patients, caregivers, palliative populations more generally, indigenous practitioners and cultural leaders—and of respecting spiritual and cultural contexts associated with psychedelic use. They note that considerations about spirituality and mystical-type experiences, which have been relevant in prior psychedelic research, were not explicitly explored here and warrant attention when designing future clinical trials and implementation strategies.

Understanding cancer healthcare workers' perspectives is an essential preliminary step for designing interventions and research that can be translated into clinical practice. In this study, clinicians acknowledged both a strong duty to relieve suffering in advanced cancer patients and a parallel responsibility to avoid harm. Overall, participants were open to psychedelic-assisted therapy as an innovative approach, but this openness was tempered by concerns about safety, cultural context and the need for robust, phased research to establish efficacy and manage risks.