This study explored the interest in psychedelic-assisted psychotherapy among cancer patients undergoing radiation therapy, revealing that nearly half of the respondents were open to such treatment for managing cancer-related mental health conditions. Notably, interest in PAT was higher among those with greater depressive symptoms, poorer spiritual well-being, higher demoralization, worse quality of life, and more pain—symptoms that are targeted with PAT.

Understanding the current status and potential applications of psychedelic medications in the United States requires examination of the historical context. In the mid-twentieth century, psychedelics were initially investigated for their therapeutic benefits in psychiatry, with particular interest in their ability to address mental health conditions such as depression, anxiety, PTSD, and addiction [21,22,23]. During this period, these substances were frequently administered in clinical settings to evaluate their effects on mood, cognition, and behavior. However, as the 1960 s progressed, recreational use of psychedelics surged, particularly within countercultural movements, and substances like LSD, psilocybin, and mescaline became emblematic of the broader anti-establishment sentiments [24]. As their popularity grew, so did public concerns about the potential risks of these substances, including their safety profiles and their capacity for abuse. In response to these concerns, the Controlled Substances Act of 1970 was enacted, which categorized substances into five schedules based on their potential for abuse, recognized medical use, and relative safety. Psychedelic substances became classified as Schedule I drugs. Some argue that this classification was influenced more by the political and social climate of the time marked by a growing"War on Drugs"narrative and fear of the counterculture rather than by definitive scientific evidence. At the time, ongoing research had already suggested potential therapeutic uses for psychedelics, but these findings were overshadowed by the political context. [25]

Following their Schedule I classification, psychedelic research virtually ceased for several decades. However, at the turn of the century, a resurgence of interest in the therapeutic potential of psychedelics emerged. Recent clinical trials have demonstrated promising results for the use of psychedelics in treating mental health symptoms, including several small randomized controlled trials demonstrating that even a single high-dose psilocybin session significantly reduced depression and anxiety by in patients with life-threatening cancer in about 80% of patients at 6-month follow up [8, 10, 11]. Both the scientific community and public interest have recognized this movement, as demonstrated by the FDA’s issuance of a draft guidance for psychedelic clinical investigations in June 2023. [26]

There are limited data into the patient perspective of psychedelic medications. In a survey of athletes, 61.2% expressed willingness to engage in PAT for persisting post-concussion symptoms, and among cancer patients in New Zealand, 59% were open to considering PAT for psychological distress [27, 28]. The results of our study support that sentiments towards therapeutic use of psychedelic medications may be shifting, with nearly half of patients treated with radiation therapy expressing some interest in psychedelic therapy to combat cancer-related mental health conditions. Notably, the main reason for hesitancy towards psychedelics is the lack of information. Furthermore, those who reported higher levels of depression, worse spiritual well-being, worse demoralization, worse quality of life, and more pain, symptoms that are targeted for psychedelic-assisted therapy, were more likely to be receptive to it. Interestingly, individuals with higher levels of anxiety demonstrated a reduced interest in psychedelics. Potential explanations include that patients with generalized anxiety disorder may perceive PAT as less targeted for their condition, given the current focus of clinical trials on depression, PTSD, and existential distress. Additionally, heightened anxiety may predispose apprehension towards novel treatments.

Limitations of this study include the innate selection and framing biases of a voluntary survey study, small sample size, and heterogenous diagnoses and prognoses. Future directions will incorporate the perspectives of physicians and other providers toward PAT, sub-analysis by cancer type or prognosis, and impact on HRQoL or survival with administration of palliative psychedelic therapy. To aid in integrating psilocybin-assisted psychotherapy into healthcare systems, Dorval et al. propose specific recommendations of actionable steps emphasizing the need for regulatory reform, clinician education, dedicated treatment infrastructure, and public awareness initiatives to ensure equitable access in palliative care settings. [29]