Two landmark psilocybin studies at Johns Hopkins and NYU focused on people confronting mortality in the most intimate and immediate way—fighting their way through a life-threatening cancer diagnosis. The results of these studies were remarkable: a single high-dose psilocybin session, combined with therapeutic support, produced substantial and sustained decreases in depression and anxiety. Six months later, approximately 80% of participants continued to show clinically significant improvement.

But here's what I've been thinking: there's another population—a much larger and rapidly growing one—that went through the fire of cancer and came out the other side. They survived. They're supposed to be celebrating. However, they are now in a different kind of fight. A fight to bring meaning to the experience. A fight to understand who they've become. A fight to quell the fear that the cancer might return. A fight that gets far less attention than their previous battle, but is no less devastating.  

They need help.

The Aftermath Population

As of 2025, there are 18.6 million cancer survivors in the United States—about one in every eighteen Americans. That number is projected to exceed 22 million by 2035. The five-year survival rate for all cancers combined has reached 70% for the first time, up from just 50% in the mid-1970s.

This is a triumph of medical science. But it creates a challenge we haven't fully reckoned with: what happens after?

About a quarter of cancer survivors experience persistent psychological distress—anxiety, depression, and difficulty returning to normal life. In some studies, more than half report high levels of psychological distress. And the prevalence of anxiety among long-term survivors remains significantly elevated compared to people who've never had cancer. This isn't a temporary adjustment period. For many, the distress persists for years.

The signature psychological challenge of survivorship isn't depression or generalized anxiety—it's fear of recurrence. Nearly three-quarters of survivors worry about getting cancer again. For about one in five, that fear rises to clinically significant levels. And unlike many forms of anxiety, fear of recurrence doesn't naturally fade with time. Research suggests it remains relatively stable throughout survivorship.

Here's what makes this particularly painful: everyone around the survivor expects them to be relieved, grateful, ready to move on. And they are—partly. But they're also changed in ways that are hard to articulate, haunted by an experience they haven't fully processed, and suddenly without the structure that organized their lives during treatment.

Why Survivors Are Ready for This Work

During active cancer treatment, there's a clear task: survive. Show up for appointments. Tolerate the chemotherapy. Get through the surgery. Manage the side effects. The structure is demanding but unambiguous. You know what you're supposed to do. You show up, and you do it.

During this period, while existential questions do arise and the distress is real, for most patients, there's no bandwidth for integration—the psychological work of making sense of the experience and weaving it into one's identity and worldview. An estimated 60-80% of cancer patients were ineligible for the Hopkins study. They were simply too medically fragile for a psychedelic journey due to their treatments, leaving the integration work unfinished. 

But even if they had been able to fully integrate the immediate existential challenge of facing death, once they survive, a different set of challenges emerges: What does this mean for my life? Who am I after this? How do I want to live now that I know at the foundation of being that I'm mortal? How do I live fully while carrying the memory of how close I came to dying, and how real the possibility is that the cancer might return? 

Research describes the first six months after treatment as an "in-between" period—survivors question their ability to return to normal life. At the same time, they feel lost without the enveloping support of healthcare services. Their identity as "cancer patient" is gone, but the pre-cancer identity doesn't fit anymore either. They went through something that changed them fundamentally, and now they have to figure out who they are on the other side.

What Integration Might Look Like

For cancer survivors, psilocybin-assisted integration work would likely center on several themes:

Learning to live with mortality awareness. Psilocybin can help survivors develop a relationship with mortality that doesn't involve constant terror—finding ways to live richly and meaningfully while acknowledging the reality of death.

Reconstructing identity across the liminal divide. Psilocybin can facilitate access to deeper sources of identity that transcend both worlds—pre-cancer and post-cancer—and help generate a coherent sense of self that integrates rather than chooses between them.

Finding meaning in what happened—and what's still happening. We're not talking about "everything happens for a reason" platitudes, but genuine meaning-making that acknowledges both the trauma and the transformation. 

Addressing fear of recurrence. This isn't about pretending the fear is irrational—recurrence is a real possibility, and the fear is appropriate. It's about developing a different relationship to the uncertainty. Psilocybin often helps people hold uncertainty with less terror and more acceptance.

Reconnecting after isolation. Cancer can be profoundly isolating, even when surrounded by support. The experience is ultimately yours alone. Psilocybin's capacity to produce experiences of connection—to others, to nature, to something larger—can help bridge the isolation that lingers after treatment.

We Know Enough to Act

Ideally, we'd have research specifically focused on this population, but we don't. And we won't anytime soon. The need, however, is present and growing.

However, I don't think we need that research to offer psilocybin assistance to this population. Despite over 50 years of the War on Drugs claiming otherwise, we now have considerable evidence of the safety of psychedelics. In the Hopkins and NYU studies, there were no long-term severe adverse effects. With proper screening, there have been no long-term severe adverse effects for any of the thousands of participants in the hundreds of studies of psychedelic-assisted therapies for anxiety, depression, OCD, PTSD, substance use disorders, stroke victim recovery, and the list goes on. In Oregon's non-medicalized approach, in which properly screened individuals can access psilocybin sessions for any reason without a doctor's or mental health professional's approval, approximately 0.13% of 10,000+ administrations have required emergency services, putting psilocybin administrations on par with colonoscopies. 

And, as the Hopkins and NYU studies on existential distress demonstrated, the effectiveness of psilocybin when combined with other supports is striking. Perhaps the only real question for any individual struggling through the aftermath of cancer is what support do they need?

Therapy or Coaching?

If you're struggling with clinical symptoms—PTSD with intrusive flashbacks, severe depression with functional impairment, suicidal ideation, or active substance abuse—you need to be working with a licensed therapist. These are clinical conditions that require professional diagnosis and treatment.

But if you're fundamentally functional and working to integrate a profound experience, coaching can help.

Many cancer survivors aren't mentally ill—they're existentially disrupted. They went through something that changed them fundamentally, and they're trying to figure out how to live in its aftermath. They're asking questions like: *Who am I now? What does my life mean after this? How do I live with the fear that it could come back? What matters to me now that didn't before?*

These aren't clinical questions. They're life questions.

Life coaching supports individuals who are fundamentally functional but facing transitions, seeking direction, or working to align their lives with their values. Cancer survivorship is exactly this kind of transition—perhaps the most significant one many people will ever face. The work isn't about treating pathology; it's about integration, meaning-making, and building a life on the other side of a transformative experience.

Psilocybin-assisted life coaching, then, is appropriate for survivors who:

• Are medically stable and cleared by their oncologist

• Are not experiencing severe psychiatric symptoms that would require clinical treatment

• Are struggling with existential questions rather than clinical disorders

• Want support with integration, meaning-making, and life direction

• Are looking for a collaborative, forward-focused relationship rather than treatment for a diagnosis

The distinction matters because it affects how the work unfolds. Therapy often focuses on what's wrong and how to fix it. Coaching focuses on where you want to go and how to get there. For many survivors, the latter frame is more accurate to their situation—and more empowering.

This doesn't mean coaches work in isolation. Good coaches know their scope and refer when clinical issues arise. In my practice, I maintain relationships with therapists who specialize in trauma and cancer-related distress, and I don't hesitate to refer when someone needs more than coaching can provide. The goal is to get people the support they need.

The Fire and Its Aftermath

The fire changes everyone who goes through it. We've gotten good at helping people survive the fire. It's time to get better at helping them live in its aftermath.

For some survivors, that help will come through therapy—processing trauma, treating depression, working through clinical anxiety. For others, it will come through coaching—finding meaning, clarifying values, and building a life that honors their experiences.

Either way, psilocybin offers something valuable: a way to address the existential challenge of learning to live fully while carrying mortality awareness, to engage with the profound questions that arise after survival, and to emerge with a clearer sense of who you are and how you want to live in the aftermath of facing death.

The Hopkins and NYU studies showed that psilocybin can help people face death. The logical extension is that it can help people learn to live after they've faced death and survived.

The research will come. In the meantime, the survivors are here. And many of them are ready for this work.

Michael Kelly is a licensed psilocybin facilitator and life coach based in Portland, Oregon. He works with people at significant life thresholds, including those facing life-altering illness and their caregivers.