Oncology Providers’ Perspectives on Psychedelic-Assisted Therapy

Abstract

Purpose:

Despite most psychedelic substances remaining Schedule I, clinical research exploring psychedelic-assisted therapy (PAT) in oncology is expanding. We sought to assess oncology providers’ attitudes toward and understanding of PAT.

Methods:

We conducted a cross-sectional survey of healthcare professionals involved in oncology across five academic institutions in California, South Carolina, and Florida, and one nonacademic institution in Georgia. The survey was also distributed to 4500 members of the American Academy of Hospice and Palliative Medicine. Items assessed demographics, familiarity and concerns regarding psychedelic medications, and willingness to recommend PAT based on case-based scenarios.

Results:

Of 5084 surveyed, 385 responded (8% response rate). Most respondents (85%) were palliative care physicians. Only 44% were familiar with the legal and regulatory status of psychedelic agents. While 49% had received patient inquiries about PAT, 80% did not feel comfortable counseling patients on its use. Primary concerns included unknown drug interactions with cancer therapies and safety in the setting of oncologic comorbidities. Factors encouraging future PAT adoption included increased education and access to experienced treatment centers. On multivariate analysis, willingness to recommend PAT was associated with familiarity with emerging PAT data, knowledge of the legal and regulatory status of psychedelics, and prior patient inquiry about PAT. Provider age, specialty, and other clinicodemographic factors were not significant predictors.

Conclusion:

Many oncology providers report patient interest in PAT but lack confidence to counsel them. Findings underscore the need for targeted provider education and further clinical research to support informed decision-making about PAT in oncology.

Introduction

A cancer diagnosis imparts a significant burden on the well-being of patients, with up to 40% of cancer patients having comorbid mental health disorders.^1,2 This imposes a significant financial cost, is associated with increased cancer related mortality, and decreased treatment compliance.^3,4 Research on psychedelics such as psilocybin, ketamine, and MDMA demonstrates promising results in improving mental health outcomes.⁴ However, investigation on these substances remains limited as most psychedelics are classified as schedule I drugs, mandating strict regulations on research and procural. Despite these regulations, there have been encouraging findings which support psychedelic-assisted therapy (PAT) for mood disorders and other cancer-related symptoms.

Ketamine has demonstrated efficacy in cancer-related pain and treatment-related depression.⁴ These findings mark a shift on the public’s view of PAT, culminating in the FDA approval of intranasal esketamine in 2019. Pilot studies for agents, such as MDMA, have shown benefit in reducing anxiety and depression for life-threatening illnesses.⁵ Furthermore, administration of a single dose of psilocybin can confer sustained improvements in patients with major depressive disorder (MDD), aiding in treatment-related depression in cancer patients.^6–8 Despite prior stigmas, cancer patients may be more receptive to trying these agents to help their symptoms.⁹

However ethical, legal, and safety considerations persist. It remains unclear how oncology providers view PAT in the current landscape. These patients represent a uniquely vulnerable population with both high unmet psychosocial needs and limited evidence-based options. It is therefore critical to understand oncologists’ perspectives on PAT.

The goal of this study was to assess oncology providers’ familiarity with the emerging data on PAT as well as their knowledge of the regulatory and legal status of various psychedelic medications.

Methods

Study Participants

The survey was distributed to healthcare professionals involved in the care of oncology patients across multiple regions in the United States from December 2024 to June 2025. Recruitment included clinicians from five academic medical centers in California, South Carolina, and Florida, as well as from one non-academic oncology practice in Georgia. These sites were intentionally selected to capture a broad range of geographic, cultural, and regulatory environments that may influence provider attitudes toward PAT. The survey was also disseminated to approximately 4500 members of the American Academy of Hospice and Palliative Medicine. Participation was voluntary, and the study granted exemption by the Institutional Review Board, (IRB #5231).

Survey Design

We conducted a cross-sectional, anonymous, web-based survey of oncology practitioners to evaluate their perspectives on PAT in cancer care. The survey instrument was created and administered using the REDCap platform and was accessible through a publicly available survey link. Eligible respondents included any clinician involved in the care of oncology patients. The survey first collected demographic and practice-related characteristics, including clinical role (eg, physician; advanced practice provider; nurse; social worker; psychologist; chaplain; pharmacist), oncology subspecialty (eg, medical, surgical, or radiation oncology; palliative care; geriatrics; psychiatry/mental health), practice setting (private practice; hospital-affiliated teaching or non-teaching; government or VA), practice environment (inpatient, outpatient, home-based care, hospice), geographic setting (urban or rural), and approximate weekly patient volume, both overall and oncology-specific.

The questionnaire was structured around several conceptual domains designed to assess provider familiarity with PAT, perceived clinical need, and attitudes toward future adoption. Respondents rated their familiarity with emerging research on PAT in oncology, including associations with improvements in anxiety, depression, and demoralization, as well as their knowledge of the legal or regulatory status of agents such as psilocybin, ketamine, and MDMA in their region. Participants were asked whether they had previously been approached by patients regarding PAT and whether they felt they currently possessed sufficient information or expertise to counsel patients on PAT. The survey also assessed barriers to clinical adoption, allowing respondents to select factors that would support future referral—such as additional evidence in oncology populations, more education regarding indications and safety, or improved access to specialized providers—and to identify concerns that might limit use, including uncertainty about safety, interactions with cancer treatments, insufficient evidence of benefit, or perceived lack of patient interest. Free-text fields were included to allow elaboration beyond predefined categories. Clinical vignettes incorporated common psychosocial challenges in oncology (refractory depression or anxiety, existential distress, demoralization, fear of death, survivorship anxiety), with respondents rating PAT appropriateness assuming no regulatory or insurance barriers.

Statistical Analysis

Descriptive statistics were used to summarize respondent characteristics and to report the distribution of answers to all multiple-choice survey items. To evaluate factors associated with provider attitudes toward PAT, multivariate logistic regression analyses were performed, and odds ratios with 95% confidence intervals and two-sided P-values were calculated. Statistical significance was defined as P < 0.05. All analyses were conducted using RStudio (R version 4.0.1).

Provider willingness to consider PAT was assessed using responses to the five clinical vignettes included in the survey. Each vignette asked respondents to rate the appropriateness of PAT for a hypothetical patient using a four-point scale (1 = “very likely to benefit,” 2 = “might benefit,” 3 = “unlikely to benefit,” and 4 = “should not be prescribed PAT”). Scores across the five scenarios were averaged for each respondent to generate a composite willingness measure. This continuous score was then dichotomized to allow logistic regression modeling; respondents whose mean ratings fell within the 1-2 range were classified as more willing to prescribe PAT, while those whose averages aligned with the 3-4 range were categorized as less willing.

Results

Demographic Data

The study was distributed to 5084 providers with 385 responses (8% response rate). 59% of the respondents identified as female, 40% as male, and 1% other. Respondent age ranged from 29 to 75 with a median age of 42. 85% of respondents practiced palliative care, 7% practiced medical oncology, 4% practiced radiation oncology, 2% practiced psychiatry and geriatrics, and 1% practiced surgical oncology. 86% were physicians, 7% advanced practice providers, 3% nurses, 3% chaplains, and 1% as pharmacists. 48% practiced in inpatient settings, 42% in outpatient settings, 7% in hospice, and 3% in home-based care. 85% of respondents practiced in urban areas and 15% in rural areas. 54% practiced in university-affiliated hospital settings, 22% in teaching but not university-affiliated, 11% in private practice, 9% in non-teaching hospital, and 4% in government or military affiliated institutions. Most respondents reported seeing more than 20 oncology patients per week. 49% of respondents reported having been asked by patients about PAT, while only 44% reported familiarity with the legal and regulatory status of psychedelics and data surrounding the use of PAT for mental health conditions (Table 1).

Table 1.

Demographic Data

Survey respondent characteristics (n = 385)	n (%)	Willingness to prescribe psychedelics OR (CI 95%)	P-value
Sex
Female	226 (59%)
Male	154 (40%)	1.20 (0.74-1.9)	0.46
Other	5 (1%)
Age (years, n = 349)	42 (median) 29-75 (range)
29-35	61 (17%)
36-50	181 (52%)	1.13 (0.59-2.18)	0.71
51-65	79 (23%)	1.96 (0.86-4.45)	0.11
>65	28 (8%)	0.69 (0.27-1.81)	0.46
Specialty
Palliative care	326 (84.6%)
Medical oncology	25 (6.5%)	1.20 (0.57-2.54)a	0.63
Radiation oncology	16 (4.2%)
Psychiatry/mental health	9 (2.3%)	0.71 (0.17-2.90)	0.63
Geriatrics	6 (1.6%)	1.76 (0.20-15.41)	0.61
Surgical oncology	3 (0.8%)
Type of practitioner
MD/DO	330 (85.7%)
Advanced practice provider	27 (7%)	1.91 (0.90-4.01)b	0.09
Nurse	12 (3.1%)
Chaplain	10 (2.6%)
Pharmacist	3 (0.8%)
Social worker	2 (0.5%)
Psychologist	1 (0.3%)
Clinical environment
Inpatient	186 (48%)
Outpatient	162 (42%)	1.19 (0.73-1.93)	0.47
Hospice	25 (6.5%)	2.05 (0.67-6.29)	0.21
Home-based	13 (3.4%)	1.30 (0.34-4.95)	0.70
Practice setting
Urban	329 (85%)
Rural	56 (15%)	3.28 (1.36-7.94)	0.008
Practice details
University affiliated teaching hospital	207 (54%)
University unaffiliated teaching hospital	83 (22%)	1.15 (0.64-2.06)	0.64
Private practice	43 (11%)	2.00 (0.84-4.77)	0.12
Non-teaching hospital	37 (9%)	1.21 (0.54-2.73)	0.64
Government/Military/Veterans affairs	15 (4%)	1.07 (0.22-3.51)	0.91
How many patients a week do you see on average?
>20	208 (54%)
11-19	136 (35%)	0.78 (0.48-1.27)	0.32
<10	41 (11%)	1.34 (0.58-3.01)	0.49
How many oncology patients do you see per week?
>20	199 (51%)
11-19	156 (41%)	1.31 (0.80-2.12)	0.28
<10	30 (8%)	1.29 (0.52-3.18)	0.58
Have you ever been asked by any patient in a clinical setting about psychedelic assisted therapy?
No	197 (51%)
Yes	188 (49%)	2.83 (1.74-4.63)	<0.0001
How familiar are you with the legal and regulatory status of psychedelics and the emerging data on the use of PAT in treating anxiety, depression, and demoralization?
Not familiar/somewhat familiar	216 (56%)
Familiar/very familiar	169 (44%)	1.71 (1.06-2.75)	0.03

^aMedical/radiation/surgical oncology vs palliative care.

^bAll other practitioners vs MD/DO.

Provider Knowledge

When asked about familiarity with the emerging data demonstrating improvement in depression, demoralization, and anxiety with the use of PAT in oncology patients, 19% were not familiar, 37% were somewhat familiar, 31% were familiar, and 13% were very familiar. Regarding the regulatory and legal status of psilocybin, 55% of respondents were not familiar, 24% were somewhat familiar, and 21% were familiar. For ketamine, 23% of respondents not familiar, 27% were somewhat familiar, and 50% were familiar. And for MDMA, 20% were not familiar, 20% of respondents were somewhat familiar, and 60% were familiar.

In response to “Which of the following symptoms do you struggle to manage for your oncology patients? Choose all that apply” the top three listed symptoms were existential and/or spiritual suffering, depression/anxiety, and hopelessness/demoralization (Figure 1A).

Figure 1.

(A-C): Provider responses regarding symptom management and opinions on psychedelic-assisted therapy (A) symptoms providers struggle to manage (B) factors that would encourage referral to psychedelic therapy (C) concerns regarding psychedelic-assisted therapy

When asked “What would encourage you to refer patients to PAT in the future? Choose all that apply” the top the listed reasons were access to a knowledgeable provider or center to refer to, more education on safety risks and contraindications, and more education on indications. (Figure 1B). Other reasons cited included approval of psychedelic medications by the federal government, availability, evidence and guidelines for pediatric patients, commercial availability, affordability, and clear hospital policies regarding their use.

In response to “What concerns do you have when considering PAT for patients? Choose all that apply” most common reasons were safety concerns for patients with comorbidities, unknown interaction with patients’ medications, and unknown interaction with oncology treatments (Figure 1C).

Case Based Data

The first case consisted of a 76-year-old male with stage IV lung cancer with progression on his third line of chemotherapy who had been diagnosed with depression and anxiety and previously treated unsuccessfully with multiple antidepressants. 28% responded that the patient would be very likely to benefit, 69% responded patients might benefit, and 3% indicated patient is unlikely to benefit.

The second case consisted of a 65-year-old post-menopausal female with a history of early-stage breast cancer in remission with significant illness anxiety who had previously declined SSRI therapy, but she is interested in PAT. 20% of respondents thought that the patient is very likely to benefit from PAT, 57% indicated that patient might benefit, and 23% chose unlikely to benefit.

The third case involved a 30- year male with a history of a metastatic sarcoma that had progressed on multiple lines of systemic therapy and who was considering hospice with an impending sense of doom. He had previously tried antidepressants which had not helped. 60% of respondents thought that the patient is very likely to benefit from PAT, 37% indicated that patient might benefit, and 3% chose unlikely to benefit.

The fourth case involved a 77-year-old male with a history of metastatic hormone-refractory prostate cancer with controlled hypertension and atrial fibrillation on anti-coagulation. He had spiritual suffering around his fear of death. 37% of respondents thought that the patient is very likely to benefit from PAT, 48% indicated that patient might benefit, and 15% chose unlikely to benefit.

The final case involved an 85-year-old female with a history of metastatic triple negative breast cancer that had progressed on several lines of chemotherapy. She had a sense of hopelessness and meaninglessness related to her cancer and had tried multiple anti-depressants which had not helped. She had tried psilocybin in her youth and was interested in PAT. 38% of respondents thought that the patient is very likely to benefit from PAT, 57% indicated that patient might benefit, and 5% chose unlikely to benefit. (Figure 2).

Figure 2.

Case Based Responses

Willingness to Recommend PAT

Psychiatrists were the most comfortable recommending PAT to patients (44%), followed by Geriatricians (33%), Palliative Care physicians (20%), Medical Oncologists (20%), Radiation Oncologists (7%), and finally Surgical Oncologists (0%) (Table 2).

Table 2.

Provider Comfortability Recommending PAT by Specialty

Specialty	n (%)
Psychiatry/Psychology/Mental health	4 (44%)
Geriatrics	2 (33%)
Palliative care	66 (20%)
Medical oncology	5 (20%)
Radiation oncology	11 (7%)
Surgical oncology	0 (0%)
Overall	25.0%

On multivariate analysis, familiarity with the legal and regulatory status of psychedelics and the emerging data on the role of PAT, as well as having been approached by patients regarding their potential utility remained significant (Table 3). Provider age, sex, specialty, and other clinicodemographic factors were not associated with increased willingness to recommend PAT.

Table 3.

Multivariate Analysis of Predictors of Recommending PAT

Predictor	OR	P-value
Familiarity with psilocybin	2.37	0.013
Familiarity with MDMA	2.08	0.021
Familiarity with ketamine	1.74	0.018
Familiarity with emerging data	1.92	0.016
Having been asked about PAT	2.95	0.0007

Abbreviations: OR – Odds Ratio.

Discussion

This study explored oncology providers’ knowledge, familiarity, and perceptions regarding PAT for managing depression, anxiety, existential distress, and demoralization in cancer patients. Using both survey data and hypothetical patient cases to assess willingness to recommend PAT, this study found that 49% of providers have been asked by patients about PAT, yet the majority do not feel prepared to guide patients about its use. Demographic variables, such as age and provider specialty, do not predict recommendation of PAT to patients. On the other hand, provider familiarity with specific psychedelic medications is a significant predictor of willingness to recommend PAT, underscoring the importance of education and exposure in shaping provider attitudes.

Management of psychiatric comorbidities remains a major unmet need in oncology care. Previous research estimates as much as 30-40% of oncology patients experience mental health comorbidities globally, and possibly 5 times odds of having a psychiatric disorder than the general population.^1,2,10 These disorders heighten the burden that already vulnerable cancer patients must carry. From national survey data, patients with cancer and comorbid depression may face up to 31.7% greater health care expenditures compared to those without depression.¹¹ Financial burden creates a self-reinforcing cycle, worsening mental health outcomes and contributes to high rates of PTSD.^12,13 Understandably, these factors negatively impact quality of life scores in cancer patients, and guidelines to manage anxiety and depression in cancer patients have been published.^3,14

Existing guidelines recommend screening with validated psychometric screening tools.^15,16 Initial management involves psychotherapy (cognitive behavioral therapy, mindfulness-behavioral therapy, and interpersonal therapy etc.) for mild symptoms to pharmacotherapy, such as selective serotonin reuptake inhibitors (SSRI’s), for more severe symptoms^17,18. However, both SSRI’s and psychotherapy can take weeks to months of administration for patients to report symptom improvement, and this benefit may also be short-lived.^19,20 Furthermore, medical comorbidities, such as cancer, may be risk factors for treatment-resistant depression (TRD), and therefore these patients may have poorer response to these interventions.²¹ In contrast, evidence supports that PAT can provide sustained and a much more rapid improvement (as soon as 8 days) in depressive symptoms with even a single-dose of psilocybin compared to placebo.⁶ In psychiatric emergencies such as active suicidal ideation, nasal esketamine has been shown to improve depressive symptoms in as soon as 4 hours when compared to placebo.²²

Case-based responses demonstrated that when patients had either failed or were not interested in traditional antidepressants, more than half of providers felt that PAT could be beneficial (Figure 2). This confirms that oncologists see the therapeutic promise in PAT for TRD, and highlights the need to continue to explore its role for TRD and other mood disorders. Without established guidelines, how providers should best respond to these scenarios remains unclear and warrants further research.

Strong patient to provider therapeutic alliance is associated with decreased risk of suicidal ideation, willingness to complete treatment, and decreased illness-related grief.^23,24 Results from this present study show that although nearly half (49%) of the surveyed providers had been asked about PAT, many did not feel comfortable counseling their patients on this matter. Existing data shows that patients themselves are curious to learn more about PAT, based on a prior survey study.⁹ Notably, as found in this current study, providers who have been asked about PAT are significantly more likely to recommend its use. This may indicate that patient advocacy and inquiry can shape provider engagement and knowledge-building. Further provider education and training on this matter may therefore lead to improved patient-oncologist alliance, decreased emotional and financial stress, and improved treatment outcomes.

Oncologists continue to struggle to identify signs of these disorders. Previous studies have shown that oncologists have difficulty in detecting depressive symptoms with both low sensitivity (33%) and specificity (71%).²⁵ When these disorders are diagnosed, providers often feel uncomfortable approaching these subjects with patients, which further exacerbates issues of delayed and under-diagnosis.²⁶ Providers in this study similarly reported struggles managing existential dread, depression, and anxiety. Since cancer patients are also at increased risk of TRD, oncologists may be ill-equipped for these complex cases.

This is the first study assessing the perspectives of oncology providers, however there are published data on the opinion of healthcare professionals at large on PAT. Survey data of the attitudes towards psilocybin and MDMA among providers in the US has shown “moderate openness” to using either of these substances for patients, with more belief towards psilocybin.²⁷ Factors such as younger age, prior psychedelic use, self-rated knowledge, and professional role were shown to predict openness to PAT, and physicians were shown to have lower support for legal access to PAT compared to non-physician providers. These findings may signal that physicians generally are opposed to the use of PAT, citing safety concerns and lack of trained providers. Oncology providers in this current study echoed some of these concerns.

However, multiple trials have demonstrated acceptable safety profiles of these drugs, including a randomized trial of nasal esketamine administration in patients with MDD and suicidal ideation. Esketamine was shown to improve depression-rating scores with mild and transient side effects (dizziness, dissociation, nausea, headache, and paresthesias) compared to placebo. There were no differences in serious side effects, such as suicidal ideation, between the two groups.²² Another study of single-dose psilocybin for patients with MDD showed sustained reduction in depressive symptoms with a low and transient adverse event rate at 8%.⁶ A pilot study of MDMA-based PAT showed improved anxiety scores, (though not statistically significant) with once again good tolerance, mild side effects, and no serious psychiatric events.⁵

Physicians appear to have lower openness to and familiarity with legal status of PAT.²⁷ Recreational use of substances such as psilocybin and mescaline was very popular and became a symbol of antiestablishment sentiments during the 1960s.^9,28 Due to safety concerns and potential for abuse, the Controlled Substances Act (CSA) of 1970 was enacted which introduced drug schedules, and classified psychedelic substances as Schedule I. The CSA has imposed strict regulatory hurdles on licensure, procurement, and research on psychedelics.²⁹ Fortunately, with the publication of promising data, the FDA has granted therapy designations for psilocybin and MDMA for TRD and PTSD respectively.³⁰

Most surveyed providers in this study reported a lack of familiarity with PAT data and its legal status. It is apparent that further education significantly increases the willingness of providers to recommend PAT (Table 3). As less than 5% felt that PAT-naïve patients would be unlikely to benefit, providers appear to be open to PAT and may be persuaded with further evidence. With further education and trial data we may be able to break stigmas and potentially help cancer patients who are afflicted with mental health disorders with PAT.

Major limitations include a modest survey response rate (8%), potential response bias from self-reported attitudes, and the use of hypothetical scenarios rather than real-life prescribing decisions. This may limit generalizability, and future studies should recruit more diverse providers and examine actual clinical choices. Rigorous prospective research is especially needed for assessing safety and efficacy of PAT in oncology populations with complex psychiatric and medical needs.

Conclusion

In summary, about half of oncology providers reported patient inquiries about PAT, but most do not feel equipped to counsel on its use. Provider willingness to recommend PAT is strongly linked to their familiarity with psychedelic medications and prior patient requests, rather than age or specialty. More education and well-designed trials focused on oncology populations are needed to guide safe and effective use of PAT. Patient advocacy and emerging clinical research are catalyzing a shift in provider perceptions and may soon transform management of mental health comorbidities in cancer care.

Data Availability Statement

The de-identified dataset supporting the findings of this study is available from the corresponding author upon reasonable request, subject to institutional data sharing policies.