Mindfulness-Based Psilocybin-Assisted Therapy (MB-PAT) for cancer-related demoralization in Canada: The case for a hybrid group-based delivery model

Demoralization syndrome (DS) - a distinct clinical entity characterized by helplessness, hopelessness, and a persistent loss of meaning - affects approximately one in five Canadians with advanced cancer and is associated with increased desire for hastened death, negative clinical outcomes, and higher economic burden, yet recognition and treatment of DS remains suboptimal in modern oncology. While current pharmacological treatments fail to address demoralization's existential dimensions, and despite the potential effectiveness of a number of psychosocial interventions, not everyone responds to behavioral therapies and they remain chronically underfunded in mainstream oncology. Mindfulness-Based Psilocybin-Assisted Therapy (MB-PAT) offers enhanced therapeutic potential by synergistically integrating evidence-based mindfulness training with psilocybin's neuroplastic effects; however, the traditional dyadic delivery model limits scalability within healthcare settings. This viewpoint opines that MB-PAT delivered in a group format represents a potentially optimal solution to this evidence-implementation gap. Our contention is that MB-PAT may harness synergistic biopsychosocial mechanisms that directly counter the isolation of demoralization through an integrative approach. We finish by highlighting the Canadian Network for Psychedelic-Assisted Cancer Therapy (CAN-PACT) as a pioneering initiative poised to generate critical evidence, infrastructure and capacity through its planned multi-phase initiatives and projects. By leveraging existing group-therapy infrastructure and therapist familiarity with mindfulness-based interventions as the basis for multi-site national clinical trials, and developing a scalable, equity-focused delivery model, MB-PAT offers a pragmatic pathway to integrate potentially transformative existential care into publicly funded Canadian oncology practice.