More Research Needed to Assess the Efficacy of Peer-to-Peer Support for Cancer Survivors

TON - June 2023 Vol 16, No 3

Peer-to-peer (PTP) support is an important aspect of nonprofessional patient care that improves cancer-specific quality of life. However, PTP research is sorely lacking, with very few randomized controlled trials (RCTs) being conducted in this space, as well as a lack of standardized quality parameters for what constitutes successful and efficient PTP support, according to newly published research (Kiemen A, et al. J Clin Res Clin Oncol. 2023 Apr 30. Epub ahead of print).

Core components of PTP support for cancer survivors include informational, emotional, and psychosocial aspects, and many survivors seek out this unique type of support from others who have shared and understand their experience with cancer and its treatment. Some studies show that peer support may improve quality of life by supporting active coping behaviors, reducing anxiety, cultivating hope, and helping patients cope with the fear of cancer recurrence or progression. Effective social support, especially through peer support groups, has even been shown to be an influencing factor for cancer outcomes in general.

According to the study investigators, “the special feature of peer support is that those personally affected provide each other with psychosocial support, which is not the same as psychosocial care by professionals.”

However, despite its apparent benefits, outcomes of PTP support are difficult to determine. Voluntary PTP support programs have received little scientific research compared with professionally led programs, and an RCT design is often not realistic when it comes to evaluating the psychosocial benefits of PTP support activities, as randomization contradicts the basic principle of voluntary participation in PTP groups. Since blinding is not feasible, many patients may decline to participate if they are not assigned to the intervention group.

“Recent research suggests that it might be the unique position of peer supporters with the nonhierarchical, reciprocal relationship between patients and peers that complement formal psychosocial support,” the researchers explained. “Nevertheless, only a few studies are addressing the effectiveness of patients’ peer support.”

The investigators sought to summarize studies that have been conducted on the effects of nonprofessionally led PTP support in adult cancer survivors. They conducted a systematic literature review, including all studies with a precise definition of PTP support published from January 2000 to March 2023 in peer-reviewed journals (in English or German), and compared outcomes of PTP support against any controls.

Only 18 RCTs fulfilled the study’s inclusion criteria, in which PTP support was conducted either face-to-face, via telephone, or online (mainly one-on-one); the majority of the trials were conducted in breast cancer populations, followed by prostate cancer populations.

Due to the heterogeneity of study designs, measures, and PTP interventions, the researchers were not able to pool data for meta-analysis, so results should be interpreted with caution, they noted. But overall, small effects on depression/anxiety, coping, and sexual functioning were associated with PTP support, and were particularly apparent in patients with breast cancer, in face-to-face settings, and in assessments of cancer-specific quality-of-life outcomes (covering aspects relevant to the daily lives of patients with cancer). Most of these benefits were sustained for a short period, lasting anywhere from 4 weeks to 3 months, highlighting the need for more research into measures that can help sustain these short-term effects.

“This review shows that there are a few RCTs investigating the effect of PTP support with short-term effects,” the investigators asserted. “Overall, there is a need for more RCTs with high methodological standards to evaluate the effectiveness of PTP support.”

For future research, they recommended designing RCTs with clearly defined control groups, including long-term follow-up, as well as exploring the effects of peer support in patients by using multilevel approaches and cancer-specific instruments.

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