Expressive Writing for Body Image Distress in Young Cancer Survivors

Overseen By Victoria Wytiaz, MD

Age: < 65

Sex: Any

Trial Phase: Academic

Sponsor: University of Michigan Rogel Cancer Center

Disqualifiers: Planned cancer treatment, Recent treatment changes, Limb-altering surgery, End-of-life care

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 4 weeks

30 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

Each year, about 89,500 adolescents and young adults (AYAs; 15-39 years old) are diagnosed with cancer and up to 60% experience body image (BI) distress. BI is largely developed in adolescence and young adulthood and has implications for self-identity and quality of life. Cancer itself and its associated treatments precipitate changes to appearance as well as body sensation and function, all of which can alter BI and lead to increased anxiety. An in-home BI-focused expressive writing (EW) program offers a promising outlet for addressing BI distress and anxiety in a way that eliminates constraints of clinical time and specialist availability. There are no recommended interventions to help AYA cancer survivors cope with BI distress. To address this knowledge gap, the objective of this this pilot randomized-controlled trial is to determine the feasibility of a four-week BI-focused EW intervention to decrease BI distress and anxiety among AYA cancer survivors with the hypothesis that this intervention will reduce BI distress and anxiety.

Do I have to stop taking my current medications for the trial?

The trial does not specify if you must stop taking your current medications. However, you can continue treatments for anxiety or body image distress if they started at least eight weeks before joining the trial and the dose hasn't changed.

Will I have to stop taking my current medications?

You can continue taking your current medications for anxiety or body image distress if you started them at least eight weeks before joining the study and haven't changed the dose. If you plan to start new treatments for these issues, you should wait until after the study.

What safety data exists for expressive writing in cancer survivors?

The studies reviewed indicate that expressive writing interventions, including self-compassion-based writing activities, are generally feasible and acceptable for cancer survivors, particularly those with breast cancer. Participants have reported positive responses and changes in their thoughts about their illness, which are associated with improved quality of life. No specific safety concerns were noted in the studies, suggesting that expressive writing is a safe intervention for this population. ^{1 2 3 4 5}

Is expressive writing safe for young cancer survivors?

Expressive writing has been used safely in various studies with cancer patients, including those with breast cancer, and participants generally reported positive experiences and improved quality of life. ^{1 2 3 4 5}

Is the treatment 'BI Focused writing, Control' a promising treatment for body image distress in young cancer survivors?

Yes, the treatment 'BI Focused writing, Control' is promising for young cancer survivors dealing with body image distress. Research shows that expressive writing can help reduce distress and improve quality of life by changing how patients think about their illness. This type of writing has been well-received by cancer patients and has shown positive effects in both clinical and non-clinical settings. ^{2 3 5 6 7}

How does the treatment 'Expressive Writing for Body Image Distress' differ from other treatments for body image distress in young cancer survivors?

This treatment is unique because it uses expressive writing, a form of journaling, to help young cancer survivors process their feelings about body image changes, which can lead to improved psychological well-being and quality of life. Unlike traditional therapies, it focuses on self-expression and reflection, which can be done independently and without medication. ^{2 3 5 6 7}

What data supports the idea that Expressive Writing for Body Image Distress in Young Cancer Survivors is an effective treatment?

The available research shows that expressive writing can be an effective treatment for body image distress in cancer survivors. In a study conducted in a cancer clinic, patients who participated in a writing program reported positive changes in their thoughts about their illness. About half of the participants noticed these changes immediately after writing, and similar results were observed three weeks later. These changes were linked to a better quality of life. This suggests that expressive writing can help improve how cancer patients feel about their bodies and their overall well-being. ^{2 3 5 7 8}

What data supports the effectiveness of the treatment Expressive Writing for Body Image Distress in Young Cancer Survivors?

Research shows that expressive writing can help cancer patients by changing how they think about their illness, leading to improved quality of life. Additionally, self-compassion-focused writing has been effective in reducing body image distress in breast cancer survivors. ^{2 3 5 7 8}

Who Is on the Research Team?

Victoria Wytiaz, MD

Principal Investigator

University of Michigan Rogel Cancer Center

Are You a Good Fit for This Trial?

This trial is for adolescent and young adult cancer survivors aged 15-39 who have finished cancer treatments at least 3 months prior. They must be experiencing body image distress but not planning any new cancer treatment or starting new therapies for body image issues during the study.

Inclusion Criteria

BIS ≥10 at time of screening

I finished all cancer treatments more than 3 months ago.

I am between 15 and 39 years old.

Exclusion Criteria

Currently receiving end-of-life care

I plan to undergo cancer treatment, including surgery or chemotherapy, during the study.

I have had surgery that significantly changed the shape or function of a limb.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants engage in a four-week, in-home Body Image-focused expressive writing intervention or a control writing program

4 weeks

Follow-up

Participants are monitored for feasibility and acceptability of the intervention, including completion of patient-reported measures

3 months

What Are the Treatments Tested in This Trial?

Interventions

• BI Focused writing
• Control

Trial Overview The trial tests a four-week in-home expressive writing program focused on body image (BI) to see if it can reduce BI distress and anxiety among participants. It's a pilot randomized-controlled trial, meaning some will use the writing program while others won't, to compare outcomes.

How Is the Trial Designed?

Group I: Expressive Writing (EW) Experimental Treatment 1 Intervention

four- week, in- home, Body Image (BI)- focused EW intervention

Group II: Attention Control Active Control 1 Intervention

four- week control writing program

Who Is Running the Clinical Trial?

University of Michigan Rogel Cancer Center

Lead Sponsor

Trials

303

Recruited

20,700+

Published Research Related to This Trial

The web-based self-compassion writing activity (MyCB) significantly increased state self-compassion and positive affect in breast cancer survivors compared to an expressive writing control, indicating its potential effectiveness in improving psychological outcomes.

Adding a meditation component (MyCB + M) further enhanced benefits, leading to greater increases in trait self-compassion and reductions in anxiety, suggesting that combining these interventions may optimize support for body image distress in breast cancer survivors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility and pilot study of a brief self-compassion intervention addressing body image distress in breast cancer survivors. Mifsud, A., Pehlivan, MJ., Fam, P., et al.[2022]

In a study of 419 young women diagnosed with stage 0-III breast cancer, those who underwent mastectomy (with or without reconstruction) reported significantly higher body image concerns compared to those who had a lumpectomy, with mean CARES scores of 1.87 and 1.52 versus 0.85, respectively.

Factors such as anxiety, depression, fatigue, and type of surgery were strongly associated with body image concerns, indicating that both physical and psychological aspects play a crucial role in how young women perceive their body image after breast cancer treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Body image in recently diagnosed young women with early breast cancer. Rosenberg, SM., Tamimi, RM., Gelber, S., et al.[2022]

The Dutch version of Hopwood's Body Image Scale (BIS) was validated for assessing body image changes in cancer patients, showing excellent psychometric properties with high internal consistency (α > 0.90) and test-retest reliability (P = 0.86).

The BIS effectively distinguished between body image distress in breast cancer patients after different treatments, with scores significantly lower for those who underwent breast-conserving therapy (4.56) compared to those who had a mastectomy (7.19), indicating its utility in clinical practice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reliability and validity of the Dutch-translated Body Image Scale. van Verschuer, VM., Vrijland, WW., Mares-Engelberts, I., et al.[2019]

The expressive writing intervention (EWI) did not show significant overall effects on cancer-related distress, depressive symptoms, or mood in a study of 507 Danish women treated for early-stage breast cancer, indicating that it may not be a universally effective intervention.

However, women who wrote about non-cancer topics experienced greater reductions in cancer-related avoidance, and those who wrote about their cancer reported fewer depressive symptoms and higher positive mood three months post-intervention, suggesting that the choice of writing topic can influence outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of an expressive writing intervention on cancer-related distress in Danish breast cancer survivors - results from a nationwide randomized clinical trial. Jensen-Johansen, MB., Christensen, S., Valdimarsdottir, H., et al.[2015]

A study involving 71 adult leukemia and lymphoma patients showed that a 20-minute expressive writing task was feasible and well-received in a clinical setting, with 88% of participants completing the task.

Participants reported positive changes in their thoughts about their illness, which were significantly associated with improved physical quality of life at a 3-week follow-up, suggesting that even brief writing exercises can enhance well-being in cancer patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementing an expressive writing study in a cancer clinic. Morgan, NP., Graves, KD., Poggi, EA., et al.[2019]

The expressive writing program developed for women with breast cancer significantly reduced stress related to physical symptoms and improved quality of life, as shown by a study involving 58 participants (29 in the experimental group and 29 in the control group).

While the program was effective in alleviating physical symptoms and enhancing quality of life, it did not show significant effects on cancer symptoms, anxiety, or depression, indicating a need for further research to explore its impact on emotional well-being.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Development and effectiveness of expressive writing program for women with breast cancer in Korea]. Park, EY., Yi, M.[2015]

The web-based self-compassion writing activity, 'My Changed Body,' received positive feedback from both breast cancer survivors (n=15) and health professionals (n=20), indicating high acceptability and satisfaction with its design and content.

Participants suggested improvements such as simplifying instructions and enabling the saving of written work, highlighting the potential for this self-administered intervention to effectively address body image issues post-breast cancer treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

My Changed Body: Background, development and acceptability of a self-compassion based writing activity for female survivors of breast cancer. Przezdziecki, A., Alcorso, J., Sherman, KA.[2017]

Among 3735 adolescent and young adult cancer survivors, 14.5% reported experiencing a negative body image, with higher prevalence in females and those with specific cancer types like breast cancer.

Factors such as higher Body Mass Index (BMI), advanced tumor stage, chemotherapy treatment, maladaptive coping strategies, and lower health-related quality of life were significantly associated with negative body image, highlighting the need for targeted supportive care in survivorship programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Negative Body Image among Adolescent and Young Adult (AYA) Cancer Survivors: Results from the Population-Based SURVAYA Study. Saris, LMH., Vlooswijk, C., Kaal, SEJ., et al.[2022]

Citations

1. England pubmed.ncbi.nlm.nih.gov

Feasibility and pilot study of a brief self-compassion intervention addressing body image distress in breast cancer survivors. [2022]

2. England pubmed.ncbi.nlm.nih.gov

Body image in recently diagnosed young women with early breast cancer. [2022]

3. Netherlands pubmed.ncbi.nlm.nih.gov

Reliability and validity of the Dutch-translated Body Image Scale. [2019]

4. England pubmed.ncbi.nlm.nih.gov

Effects of an expressive writing intervention on cancer-related distress in Danish breast cancer survivors - results from a nationwide randomized clinical trial. [2015]

5. England pubmed.ncbi.nlm.nih.gov

Implementing an expressive writing study in a cancer clinic. [2019]

6. Korea (South) pubmed.ncbi.nlm.nih.gov

[Development and effectiveness of expressive writing program for women with breast cancer in Korea]. [2015]

7. Ireland pubmed.ncbi.nlm.nih.gov

My Changed Body: Background, development and acceptability of a self-compassion based writing activity for female survivors of breast cancer. [2017]

8. Switzerland pubmed.ncbi.nlm.nih.gov

A Negative Body Image among Adolescent and Young Adult (AYA) Cancer Survivors: Results from the Population-Based SURVAYA Study. [2022]