Psychedelic Medicine in Cancer Care: What Nursing Teams Need to Know

In an interview with Oncology Nursing News, Jason Konner, MD, founder of Psychedelic Oncology and a clinical consultant at Memorial Sloan Kettering Cancer Center, shares critical insights into the evolving landscape of psychedelic medicine in the world of cancer care.

As psilocybin-assisted psychotherapy rapidly gains clinical traction in research, oncology nurses, advanced practice providers (APPs), and physician assistants (PAs) are on the front lines of patient inquiries, symptom management, and clinical support. Here, Konner discusses the transformative potential of psilocybin for managing cancer-related anxiety, depression, and existential distress, while expanding the scope beyond individual patients to encompass caregivers, bereaved families, and healthcare teams facing secondary trauma and professional burnout.

He also highlights emerging preclinical data on psilocybin’s role in preventing chemotherapy-induced peripheral neuropathy (CIPN), essential safety protocols, contraindications such as psychosis and cardiovascular risks, and the imperative for health systems to build psychedelic literacy across multidisciplinary clinical oncology care teams.

What is the current outlook on psilocybin-assisted psychotherapy in oncology and what key evidence should frontline nurses, APPs and PAs know regarding its efficacy for cancer-related depression, anxiety or distress?

I'm really excited to help bring this information to nurses and APPs because they play such a critical and fundamental role in everything we do and I think there's also a deep potential for their involvement in psychedelic medicine, especially in the cancer space. There's a lot to learn, there really is.

Unfortunately, in standard medical training we're really not exposed to the information that that we need around this. But I would say first off that there are tremendous potential benefits that are shown by the data, looking at existential distress and anxiety and depression and people affected by cancer, but it's also important to know that just giving somebody a mushroom and hoping things work out is not really the best and safest way to do this. It requires people who understand how to work with these substances because challenging experiences with these substances can result and it's really important to provide a safe setting and a lot of social and relational support around the experience uh for it to be helpful and safe for people.

How do psychedelic-assisted retreat models and integration work to help caregivers and the bereaved process things like demoralization, loss of meaning, and existential grief compared to standard support groups?

We have some incredible clinical trials that are being done, but the amount of people involved in that pales in comparison to the number of people doing this out in the real world right now. There's a lot of citizen science and grassroots movements going on and that's where most of what's happening is happening.

But looking at the data, there are very few studies that have looked at group therapy. So that's starting to emerge. But I think the most compelling clinical data are out from Seattle, there's an oncologist and palative care doctor named Anthony Back who has done some wonderful studies with psilocybin and patients with cancer. But he also did a study looking at frontline workers during COVID who had symptoms of burnout and depression, and it was extraordinary. In two days he was hoping to find about 30 candidates and about 3,000 people signed up and unfortunately he couldn't accommodate them all. It was first-come, first-served.

But, the results of the study have been published, and there were some really fantastic outcomes; burnout was linked to depression in that study, partly because burnout really isn't in the DSM5, which is ironic. This is something that affects people in our field in a very broad way and is often overlooked and more often under-treated. Personally, I came to this work through profound burnout during COVID, and I didn't even self-identify burnout. I was just in a dark place. And after experiences with psychedelics, I not only identified burnout but really healed my burnout in so many ways. And that's that's part of what has motivated me in the work that I do.

Given your personal experience with burnout, how can psychedelic medicine, breath work, and structured settings help members of nursing teams and APPs process trauma and restore their own sense of clinical purpose?

I think that's a wonderful question and you're really getting to some key issues. And first of all, just talking about this is really important because these are stigmatized topics. Even burnout is underaddressed in the field. But certainly naming the vicarious trauma that we experience in what we do, all that we witness and especially nurses and APPs are so frontline and so present with so much pain and so much grief and without giving the space and the opportunity to express that and even the permission to feel it and and acknowledge it.

I think that we need to, as a community, come together and recognize that what we do is really challenging on us. And we drink coffee and power on and and get through the day and do what we need to do and it's amazing but we also carry a lot inside of us, and having spaces and opportunities to come together as a community with shared experience and say what we do is really hard and express and be witnessed and be allowed to feel — that alone, even without psychedelics, can be so helpful. When you add on the experience with a mushroom or other substance, it really helps people get in touch with a lot of feelings that have been unprocessed and perhaps disenfranchised.

It's difficult for us to even talk about this with our friends and families sometimes because we see some really unusual things on a regular basis, so I think these opportunities can be really valuable in just feeling and acknowledging and being witnessed and coming to peace with what we do.

In terms of meaning and purpose, that's huge. I mean, working today in these systems where we are just being squeezed harder and harder to do more and more, sometimes we lose sight of what it is that we came here to do, and the transactional nature of clinical care overwhelms the relational nature and it denies our humanity on so many levels. So the psychedelics can really help us get in touch with that and rediscover why we're doing what we're doing or if we don't want to do it. Ultimately there are some problems with the system that are big problems and psychedelics don't solve them, but it helps us get sovereignty over our bodies, over our time, and get clarity about what we're doing and why, and this is what we want to continue to do, and also can reassure us in continuing to do this work if that's the path we want to take.

There was some preclinical research recently published out of MD Anderson that showed that prophylactic psilocybin may be associated with the prevention of chemo-induced peripheral neuropathy. How does this potentially expand psilocybin's therapeutic scope into those who are undergoing active treatment?

The physical and biological benefits of mushrooms have been woefully underststudied. In the 1960s, there were some data showing incredible benefits of LSD for cancer-associated pain, and you could still look up those data from Chicago and it was extraordinary. But those research efforts were stopped when psilocybin was rescheduled in the early 1970s, and now these studies have reemerged looking at more emotional and psychiatric endpoints without much discussion about the biological.

But, in the in the underground setting, there is ample and largely anecdotal but a lot of subjective evidence from people about how these have helped their their biology, their symptoms, their pain, how they relate to the cancer, and I've heard many remarkable stories.

Personally, I've had a lot of health benefits. My cholesterol went down. My EKG normalized. I had chronic back pain which disappeared. I lost about 20 pounds. There's a variety of things that that are unexpected that can happen biologically. But very often now people are using microdoing especially to try to help neuropathy, brain fog or chemo brain, fatigue, and just general wellness and to help with anxiety.

What essential safety screening protocols or contraindications or drug-drug interactions should oncology nurses and APPs keep in mind when counseling patients?

There's a lot. First off, I'll say that just understanding the dosing is really important. I mentioned microdoing, which is currently really not legally available almost anywhere in the U.S. except a few states, but those are doses that are either just barely perceptible or subperceptual and that people can take several times a week, generally to address either either anxiety or some body symptom that they're having. And those are pretty low doses, but still need professional input about how to how to use these. But it, for the most part, can be very safe, physically, medically. There's some very minor concern, almost a theoretical concern, some data emerging about potential heart valve problems for chronic long-term microdoing, and those data really need to be fleshed out. But somebody who has concerns about valvular issues probably doesn't want to be microdoing psilocybin, and there are other options that can spare the valves.

In terms of large macrodoses, the one major major contraindication is lithium, anybody on lithium should absolutely not take mushrooms. The other medications are psychiatric medications. There are a whole variety of them, most of which are not unsafe but can blunt the effects of a psychedelic experience. Recent data from Oregon and Colorado indicate that patients, by taking a larger dose, may not have a full deep experience in the same way but can actually have the same long-term benefits.

There are some contraindications that have nothing to do with medications but just a condition, and the major ones are a personal history of any psychotic disorder or psychotic tendency or mania, those are really important. Also, heart disease, uncontrolled hypertension, uncontrolled seizure disorders, those all need to be met with medical screening by an experienced person before undergoing this. But personal history of of schizophrenia is an absolute contration.

There are different degrees of all of this and it's good to be to be screened. The final thing that comes up a lot is having the personal, social, financial resources. A psychedelic journey can be destabilizing for somebody who maybe does not have a safe place to go after the experience. And it's really important to just assess what the person's internal and external resources are to be able to do this. And there is a financial component to this, but there's much more than that, social supports and internal scaffolding and stability are really important to assess.