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’Stronger Together’ pilot in Vietnam shows promise; toolkit released to scale peer support
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Summary
An NCI-funded pilot of Stronger Together, a peer-mentor psychosocial support program piloted in four Vietnamese hospitals, enrolled 186 patients and found improved mental health component scores on the SF-12 and high acceptability; presenters released an implementation toolkit and announced funding to add an advocacy module for scale-up.
Zofira Ginsberg, senior scientific advisor for clinical research at the National Cancer Institute (NCI) Center for Global Health, opened an NCI seminar on a peer-support program designed for newly diagnosed cancer patients in low-resource settings.
The Stronger Together model, presented by Carolyn Taylor, founder and executive director of Global Focus on Cancer, and partners from Vietnam and Boston University, adapts a Mount Sinai–originated peer mentorship approach to local culture and clinical systems. Taylor said the program is intended to “provide emotional and navigational support, provide information to patients and their families, decrease distress, and increase adherence to treatment.” She added that “personal lived experience is a form of evidence” in designing supportive-care programs.
Dr. Tran Thi Thanh Hung, vice director of the Vietnam National Cancer Institute and chair of the Department of Bioethics and Health Psychology at Hanoi Medical University, framed the need for psychosocial services in Vietnam. Hung described high rates of distress, anxiety, and depression reported in national and team studies and noted workforce shortages for palliative care and mental health specialists. “Psychosocial care is an important part of the comprehensive care in cancer,” Hung said, stressing that limited human resources and budgets constrain services.
Dr. Phung Thao Le (PT), assistant professor at the Boston University School of Public Health, described the NCI-funded pilot’s design and measures. The trial ran at four sites in Vietnam (the Vietnam National Cancer Hospital in Hanoi, Hue Central Hospital, Humbul Women’s Hospital in Ho Chi Minh City, and Thumpul Oncology Hospital in the Mekong Delta) and enrolled 186 participants: 91 in the intervention arm and 95 in the usual-care arm. Eligibility included adults recently diagnosed with breast or gynecologic cancer who scored below a threshold on the NCCN distress thermometer; outcomes were measured at baseline and at 2, 4, and 6 months using the DAS-21 (depression, anxiety, stress) and the SF-12 (physical and mental health components).
PT reported that both arms showed declining scores on depression, anxiety, and stress over time. She said that “none of the subscales of depression, anxiety, and stress achieved statistical significance” for the total sample but that the SF-12 mental-health component showed a statistically significant improvement in the intervention group compared with control in preliminary analyses. PT cautioned that qualitative findings remain ongoing.
Qualitative interviews and focus groups identified three implementation themes: very high acceptability among newly diagnosed patients, the disruptive impact of COVID-19 on in-person mentor–mentee interactions leading to phone/virtual adaptations, and the need for ongoing mentor training and supportive supervision to sustain program quality. PT said adaptations—such as shifting 1:1 training to group-based training—were chosen to fit Vietnam’s collectivist culture and to integrate mentors within existing clinical leadership structures.
Taylor described an implementation-ready Stronger Together toolkit that includes modules for institutional readiness and program structure, program coordinator roles and competencies, and comprehensive peer-mentor training (confidentiality, boundaries, communication, role play, and monitoring). She said the team received funding to develop a fourth module focused on advocacy, policy, and health-system strengthening to support integration and sustainability.
Speakers noted plans to adapt or trial the model in other settings: in the U.S. (breast and gynecologic oncology outside New York City), Rwanda and Ethiopia (breast cancer trials), Malaysia (working with the Breast Cancer Welfare Association), and a collaboration with Western Sydney University to adapt the approach for immigrant populations. Carolyn emphasized that the model is designed to be low-cost and scalable because it uses trained volunteers with lived experience.
In audience questions, PT said the study was not randomized because the local ethical review considered randomization inappropriate; she reported the two arms had no statistically significant differences on baseline measures. Audience members asked about extending the model to other cancers, parents of pediatric patients, and caregiver-focused support; presenters agreed there is interest and that caregivers may have even higher distress and merit targeted support.
The presenters emphasized next steps: completing qualitative analyses, refining the toolkit, strengthening supervision and training components, and pursuing policy and system-level alignment to sustain peer-support services. The NCI Center for Global Health will make the recorded seminar and toolkit resources available on its events site and invited attendees to upcoming webinars.
