Supporting others brings healing to breast cancer survivors

A new study finds that survivors of hematopoietic stem cell transplant, an aggressive treatment for blood cancers, benefited from a two-part peer support process. The authors called this peer support process “expressive helping.”

The process has two main steps. Step 1 is writing for oneself in emotionally expressive ways about the trauma of the cancer and transplant experience. It is followed by Step 2, which is peer helping. Peer helping includes writing as if speaking to a person ready to undergo the transplant procedure about the survivor's experience while offering advice and encouragement.

The study was led by Christine Rini, PhD, research associate professor of health behavior at the University of North Carolina (UNC) Gillings School of Global Public Health and member of the UNC Lineberger Comprehensive Cancer Center in Chapel Hill. The study was published in Health Psychology (2013; doi:10.1037/hea0000024).

The benefits of receiving peer support when in ill health are recognized widely. Although fewer studies have focused on the effect of an ill person's giving support to a peer, prior research has established that cancer survivors who help others face treatment tend to experience a range of psychosocial and health-related benefits as a result of peer helping. The current study shows that cancer survivors that preceded the peer helping with emotionally expressive writing about his or her own experiences increased their own health benefits.

Rini and colleagues designed a four-part trial that compared expressive helping with neutral writing for oneself, expressive writing for oneself, and peer helping (writing as if speaking to a person ready to undergo transplant, without first doing expressive writing for oneself).

Postintervention, the survivor participants were evaluated for levels of general psychological distress, physical symptoms, and health-related quality of life. These measures were chosen specifically because the toxicity of hematopoietic stem cell transplant causes fatigue, cognitive problems, and psychological distress that can last for months or years, diminishing quality of life. The researchers wanted to determine which interventions might benefit those survivors who had surpassed acute treatment but were still suffering moderate to severe survivorship problems.

Among survivors with moderate to severe survivorship problems, the expressive-helping process, which combined expressive writing for oneself and peer helping by writing for others, reduced distress and improved physical symptoms and quality of life when compared with the helping or writing processes alone.

“We think that expressive helping helps transplant survivors translate their experience into language so they can develop a more coherent narrative of their experience and greater insight into its meaning,” Rini said. “Research shows that expressive writing has those kinds of benefits. In turn, that should help prepare survivors to communicate their experience to others in a way that provides more meaningful peer support.”

The study sample included 178 women and 137 men, at an average of 20 months posttransplant, recruited between 2008 and 2011 from survivors at Mount Sinai Hospital in New York, New York, and at Hackensack University Medical Center, in Hackensack, New Jersey. Consistent with the population receiving stem cell transplants in the United States, most were white, partnered, college-educated, and with moderately high income.

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