Purpose <p>‘Pay It Forward’ is a voluntary, anonymous peer-to-peer support initiative. During chemoradiotherapy (CRT) treatment for head and neck cancer, participants receive a handwritten card of support from someone who has completed the same treatment. After recovery, individuals write their own card to assist a future person undergoing CRT. This study examined participants’ experience of the initiative and explored potential psychological benefits.</p> Methods <p>This single-centre prospective study used convenience sampling and mixed methods. Structured questionnaires were completed after receiving and writing cards. Semi-structured interviews were conducted at 12&#xa0;weeks following completion of CRT. Interviews were audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis.</p> Results <p>Thirteen individuals were recruited (12 male, median age 66&#xa0;years). Twelve reported it was positive to receive support from another patient. From thirteen interviews (mean 15&#xa0;min), two main themes encapsulating the core aspects of participants’ perspectives were identified. Firstly, the therapeutic benefit and value of the card including subthemes of: instillment of hope and encouragement, personal reflection, and keeping the card safe and rereading it. The second theme described the perception that the card gave a sense of connectivity with subthemes about camaraderie, sharing with family and duty of care to future peers.</p> Conclusion <p>Preliminary analysis indicates that this initiative supports patients when receiving a card during CRT, offering hope and solidarity, and when writing a card after treatment with benefits of reflection and altruism. Further research will evaluate the effectiveness and scalability of Pay It Forward across different clinical settings.</p>