Psychedelic Oncology: Naming the Elephant in Cancer Care

Names matter.

Take your name, for instance. Every time someone uses it, they're referring to a specific person with a specific history, specific relationships, a specific way of moving through the world. Your name evokes the essential thing that is you.

Names matter in oncology too. The field is divided into subspecialties, each named for the specific tool it wields against cancer. Medical oncology specializes in chemotherapy, targeted therapies and other medical interventions. Surgical oncology specializes in removing tumors surgically. Radiation oncology specializes in (you guessed it) radiation.

Naming these groups matters because it enables the healthcare system to focus expertise. The name identifies the challenge and the appropriate tool. Naming is the first step in addressing something.

So here's my question: if you receive a cancer diagnosis and your challenge is existential terror, what kind of doctor treats that? If your struggle is spiritual crisis in the face of mortality, who addresses it? If you're experiencing the demoralization and depression and general malaise that accompanies survivorship, which specialist do you see?

These are the elephants in the room for cancer care. They are the huge elephants we are forced to ignore because we simply don’t have good tools for addressing the emotional, social and spiritual impacts of cancer. Why acknowledge the elephant when we know that we can’t shoo it from the room? Alas. 

During my recent podcast with Jason Konner, an oncologist who practiced for over twenty years, he described how these issues are often ignored because the medical system simply doesn't have named expertise for treating psychosocial suffering.

"What became clear is we weren't really trained how to talk about the things that were the most relevant in the room," Jason told me. "When you have cancer and you walk in, yeah, you want to talk about treatment, side effects and prognosis. But the other things that come up are questions like: Why did this happen to me? What am I going to do with my family? What's the meaning of life? I don't want to die. And believe it or not, nobody really talks about that in training."

Nobody talks about it. The most important questions. The ones that keep patients awake at night. Unaddressed.

But psychedelic medicines may be pointing toward an answer. The evidence is not conclusive, but exciting signals suggest psychedelics may help address existential distress and demoralization in people living with cancer. If that's true, what type of healthcare provider will wield these powerful tools?

Jason has a name for this emerging field: Psychedelic Oncology. He's encouraging us to embrace psychedelic oncology as a medical discipline alongside medical oncology, surgical oncology, and radiation oncology.

The Mixed Blessing of Overall Survival

Jason and I discussed ‘overall survival’ which is the metric that pharmaceutical companies, the FDA and many oncologists use to determine whether cancer treatment is ‘successful’. Let me be the first to acknowledge that surviving cancer matters. No one wants to die, and it's good that our medical system measures overall survival in cancer treatments.

But the singular obsession with survival can distract from outcomes that matter deeply to people living with cancer: joy, love, meaning, connection. Yes, we want to survive. But if survival only means a heartbeat and brainwaves without beauty and awe and love . . . if survival is just an extension of suffering and pain . . . well. That kind of survival doesn't sound good to me.

Jason described the Kaplan-Meier survival curves that are often the focus at oncology conferences. Everyone celebrates when one curve shows even a small survival improvement. "There's a Kaplan-Meier curve and everybody goes bananas," he said. But what happens in the space between those curves? What is the lived experience inside that black-and-white graph?

The singular obsession with survival has implicitly taught many oncologists and patients and families: survival at any cost is good; death in any instance is bad. While this is true at some level, it can overshadow the day-to-day experiences of people suffering from cancer. 

I've experienced this firsthand.

After receiving my terminal prognosis, I remember emphasizing to my oncologist that my goal was no longer survival, but reduction of suffering. I recall his reaction, his reluctance to feel like he was ‘giving up’, his sense that maintaining ‘hope’ meant continuing to fight for survival.

(And I want to be clear: this is not a criticism of my doctor. He is a medical oncologist. His field is using medicines to shrink tumors. His metric of success is patient survival. The system shaped his response. The system that never named suffering as something worth treating in its own right.)

My response to my oncologist was simple: suffering is the enemy, not death. Sometimes death is natural and inevitable. Unnecessary suffering is the real adversary. 

Yes, we need medical oncology to extend survival. But we also need something more. Something that understands suffering and offers tools to alleviate it. Maybe psychedelic oncology is that something.

The Invisible Work

Jason pointed out a reality that surprised me: so much of oncology practice is actually managing anxiety, fear, existential distress. "If all we would do is write chemo," he told me, "we'd be out of there in an hour."

The real work is psychosocial and spiritual. But no one names it.

"The cancer experience brings up spiritual, emotional, psychological issues," Jason explained. "And the current medical oncology model does not address those adequately. Nowhere near adequately."

And just because it goes unnamed doesn't mean it doesn't exist. These unaddressed emotional and social needs overwhelm our medical system. Oncologists forced to become psychiatrists. ICUs filled with terminal patients kept alive with medical technology. Administrative staff fielding endless patient phone calls about scan anxiety. Maybe the system would function better if it addressed what it currently ignores?

The reality is that oncologists are forced to treat these emotional, social and spiritual symptoms without proper tools or training. This isn't their expertise. They are medical oncologists or surgical oncologists, not therapists or chaplains. Yet here they are, fielding questions about the meaning of life. Untrained. Unequipped. Expected to address the elephant no one named.

Enter psychedelic oncology. A subspecialty that might help address what currently remains invisible: existential distress, meaning-making, relationship with mortality.

Building the Container

Jason posed a thought experiment: if federal rescheduling of psychedelics happened tomorrow, would hospitals start offering psychedelic therapy?

No. "We don't have the container," he said. "We don't have the culture. We don't have the education. We don't have the acceptance." Legal access alone means nothing without provider buy-in. Rescheduling psychedelics is meaningless if we don’t have the system to use those tools. 

‘Psychedelic oncology’ is less than a nascent field of medicine. It's still a concept taking shape. But you can begin to see rough outlines of what it might become.

It would start with psychedelic literacy in medical education. "We get no education about this in medical school," Jason noted. "None. Which is shocking and astounding."

Psychedelic oncology would certainly include offering psychedelic medicines to people living with cancer. Jason described caring for patients who had found psychedelics on their own. Their experience was completely different. "Their energetic presence was just generally more relaxed," he observed. "There's more of a relaxed presence with reality and less of a compulsive focusing on what's going to come next."

Psychedelic oncology might also include psychedelic retreats for healthcare providers themselves. Jason’s organization is planning retreats specifically designed for healthcare professionals, creating spaces where they can address their own burnout before bringing these medicines to patients. Building the container the system never built.

The benefits could be profound for patients, providers and the healthcare system. And the cancer care system could benefit as well: Less anxiety about scans. Fewer panicked phone calls. More capacity for providers to be present. Patients who exist in the moment rather than perpetually bracing for the next shoe to drop.

Naming What Matters

Jason talked about creating a container. And that container needs a name.

Psychedelic oncology feels like a good start. It remains to be determined what this container ultimately looks like or what fills it. We're at the very beginning.

But names matter. Calling this an emerging field in oncology, placing it alongside medical oncology and surgical oncology and radiation oncology, gives it legitimacy. Gives it focus. Gives it a chance to develop expertise around the challenges that currently go unnamed.

The elephants in cancer care have been ignored long enough. Maybe it's time we named them. Maybe it's time we developed tools to address them. Maybe psychedelic oncology is where we begin.

Let's journey together.