From Receiving to Giving: Developing a Model of Helping Behavior Trajectories Among Cancer Survivors and Caregivers

Background and Purpose: With advances in cancer treatment, survivorship is increasing, yet the psychosocial impact of cancer extends beyond treatment for both patients and their families. Survivors and caregivers must navigate complex healthcare systems, manage uncertainty, and reconstruct their sense of self. In this process, many develop self-advocacy capacities reflecting a shift from dependency to agency, such as acquiring illness-related knowledge and asserting needs. Some subsequently transition into helping roles, supporting others with similar experiences. However, the relationship between self-advocacy and altruistic engagement remains insufficiently theorized. Guided by symbolic interactionism, this study sought to develop a theoretical model explaining how helping behavior emerges through self-advocacy and altruistic processes.

Methods: This longitudinal qualitative study, guided by constructivist grounded theory, explored helping trajectories among cancer survivors and family caregivers engaged in peer-support roles, using data collected between 2022 and 2026. We purposively sampled cancer survivors (n = 5) and family caregivers (n = 15) across online (social media–based peer-support communities) and offline (hospital and community-based) contexts. Eligible participants were adult survivors or caregivers with at least one year of helping experience, recruited through community organizations and online networks. Data were collected through in-depth semi-structured interviews (Zoom or in person; ~60 minutes), focusing on treatment trajectories, helping experiences, motivations, and role transitions. Concurrent field observations documented helping interactions across contexts. Data were analyzed using constant comparative methods, including iterative line-by-line coding and memoing to develop a preliminary process model. Analyses examined both shared and distinct patterns across groups. Additional strategies for rigor were used, including peer debriefing, audit trails, and triangulation.

Findings: Participant experiences provided insight into how helping behavior develops as a staged trajectory embedded in the cancer experience. First, cancer diagnosis functions as a biographical disruption that reshapes identity and life trajectories. Second, participants enter a self-advocacy phase, which involves developing capacities to navigate healthcare systems, acquiring knowledge, and asserting needs, marking a shift toward agency. Third, individuals transition into an altruistic phase, translating lived experience into helping behaviors (e.g., peer support, advocacy). Helping behavior further evolves through stages of formation, conflict, and stabilization, with increasing role specialization. Finally, helping generates both positive (e.g., meaning-making, identity reconstruction) and negative (e.g., emotional burden, role strain) outcomes, forming a recursive feedback loop.

Conclusion and Implications: These findings informed the proposed Self-Advocacy–Altruistic (SAA) model, conceptualizing helping as a process from self-advocacy to altruistic engagement, functioning as both social contribution and adaptive self-care. By positioning helping as a mechanism in post-illness adaptation, the model will advance understanding of how altruistic engagement supports others while reinforcing recovery, identity reconstruction, and meaning-making. It also offers actionable implications by reframing helping not as a prescribed intervention, but as an emergent and potentially unmet need. Practitioners should attend to clients’ desires for connection and contribution, and create flexible, voluntary pathways for engagement. These may, drawing on principles analogous to peer specialist models in behavioral health, include peer connection or community involvement aligned with individuals’ readiness.