Aims
Existential distress is common in advanced cancer and often inadequately relieved by existing treatments. Psilocybin's 2023 Australian rescheduling does not extend to oncology, yet interest in psychedelic-assisted therapy (PAT) is growing. Little is known about how people with cancer imagine PAT before exposure. We explored pre-treatment expectations, hopes, concerns and support needs to inform delivery models.
Methods
Semi-structured interviews were conducted with 10 adults with advanced cancer, recruited purposively through two comprehensive cancer centres. Sample size was determined by recruiting until accounts were sufficiently rich and varied to address the aim, consistent with reflexive thematic analysis in which saturation is not a fixed endpoint. Participants completed the Knowledge and Attitudes Questionnaire and Existential Distress Scale, then received a neutral primer on PAT before discussing two delivery models. Interviews (mean 50.5 minutes) were transcribed verbatim and analysed by line-by-line coding and constant comparison.
Results
Participants (seven female; mean age 50.1 years; seven cancer types) reported positive attitudes (mean 5.8/7), moderate knowledge (3.5/5) and low-to-moderate existential distress. Three themes were developed. The imagined session: a calm, de-medicalised, sometimes nature-based environment with continuous but non-intrusive presence; trained, safety-minded facilitators with clinical back-up; one-to-one dosing with optional group preparation and integration. Anticipated benefits: perspective-shift and "unsticking", acceptance and peace, reconnection and meaning, with structured integration seen as essential to carrying insights into daily life. Concerns and ambivalence: loss of control, medical legitimacy and dose standardisation, cultural stigma, cost and equitable access. Boundaries for acceptable practice included regulated products, relationally skilled facilitators, clear screening and escalation protocols, and continuity of care before and after dosing.
Conclusions
People with advanced cancer were cautiously open to PAT within well-governed, patient-centred models. These findings offer patient-specified design cues for oncology PAT services and identify workforce training, dose standardisation, stigma reduction and funding as implementation priorities.