Psilocybin-assisted psychotherapy for psycho-existential distress in advanced cancer: a narrative review

Feb 18, 2026BMJ supportive & palliative care

Psilocybin-assisted therapy for mental and existential distress in advanced cancer

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Abstract

Psilocybin-assisted psychotherapy may alleviate anxiety, depression, and psycho-existential distress in patients with advanced cancer.

Psycho-existential disorders in cancer are often complex and resistant to conventional treatments.
High doses of psilocybin, when administered within a structured therapeutic framework, appear to be safe and effective.
Important factors for psilocybin efficacy include the therapeutic setting, patient mindset, and peak experiences.
Integrated approaches that combine psychotherapy with psilocybin may enhance therapeutic value.
The review highlights palliative care as a particularly suitable context for psilocybin-assisted psychotherapy.

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INTRODUCTION: This article presents a narrative review of psilocybin-assisted psychotherapy as a promising intervention for addressing anxiety, depression and psycho-existential distress in patients with advanced cancer. This group of disorders, often resistant to conventional treatments, significantly impacts patients' quality of life and autonomy, as well as illness trajectories. Psilocybin, when administered in high doses within a structured therapeutic framework, seems to alleviate these symptoms safely and effectively, with potential additional benefits on pain and systemic inflammation.

METHODS AND ANALYSIS: A targeted literature search was conducted across major scientific databases-including PubMed, Scopus, PsycINFO, Cochrane Library and Embase-supervised by experts from various relevant disciplines to identify sources of particular importance.

RESULTS: The process also led to the acquisition of highly cited scientific works to compose a coherent theoretical framework through which to interpret the evidence initially collected. Emerged key themes include: the complex and treatment-resistant nature of psycho-existential disorders in cancer; the importance of set, setting and peak experiences for psilocybin efficacy, as well as the consequent therapeutic value of integrated approaches that include psychotherapy; and the methodological limitations in more recent experimental trials. The article also identifies palliative care as a uniquely appropriate context for psilocybin-assisted psychotherapy.

CONCLUSION: psilocybin-assisted psychotherapy is a compelling therapeutic option warranting further investigation through rigorous, interdisciplinary research to promote an anthropologically/ethically grounded implementation in palliative settings, even beyond the oncology field.

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Psilocybin-assisted psychotherapy for psycho-existential distress in advanced cancer: a narrative review

Abstract

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