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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether a four-week, at-home writing program can help young cancer survivors improve body image and reduce anxiety. The researchers aim to determine if writing about body image can alleviate the distress many young people experience after cancer treatment. Participants will either engage in the expressive writing program focused on body image (BI Focused writing) or join a control group with a general writing task. This trial is suitable for cancer survivors aged 15-39 who have completed treatment and are experiencing significant body image distress. As an unphased trial, it offers participants a unique opportunity to contribute to innovative research that could enhance emotional well-being after cancer treatment.

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 prior data suggests that this expressive writing intervention is safe for young cancer survivors?

Research has shown that expressive writing (EW) is well-tolerated by young adult cancer survivors. In one study with 306 breast cancer survivors, participants engaged in expressive writing without significant side effects, suggesting it could improve mental health. Another trial with young adult breast cancer survivors found the online EW program practical and well-received.

Although expressive writing is not a medication, it has shown potential in alleviating body image distress. Participants in these studies did not report major negative effects. Therefore, expressive writing appears to be a safe way for young cancer survivors to manage body image distress and anxiety. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the expressive writing treatment for body image distress in young cancer survivors because it offers a non-pharmacological approach to improving mental health. Unlike traditional therapies that might involve medication or in-person counseling, this method allows individuals to engage in a structured, in-home writing exercise focused on body image, which can be more accessible and less intimidating. The unique aspect of this treatment is its potential to empower survivors to process their experiences and emotions creatively and privately, which could lead to significant emotional relief and improved self-image.

What evidence suggests that this trial's treatments could be effective for body image distress in young cancer survivors?

Research has shown that writing about feelings and experiences can help reduce worries about body image. In this trial, participants will engage in a four-week, in-home Body Image (BI)-focused Expressive Writing (EW) intervention. A study with women who survived breast cancer found that this type of writing program greatly improved their body image and reduced distress. This suggests that expressing thoughts and feelings about body image can be beneficial. The program can be completed at home, eliminating the need for clinic visits. Early results are encouraging, indicating it might also lower anxiety and boost self-esteem related to body image. ^{1 2 3 6 7}

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+

American Society of Clinical Oncology

Collaborator

Trials

40

Recruited

148,000+

Published Research Related to This Trial

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]

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]

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 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]

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]

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]

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]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8410700/

A structured expressive writing activity targeting body image ... A randomized controlled trial (RCT) among 306 breast cancer survivors demonstrated that MyCB was significantly more effective in reducing body image-related ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT06046014

Feasibility of Expressive Writing for Body Image Distress ... 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 ...

3. sciencedirect.com sciencedirect.com/science/article/pii/S0738399124002234

Testing the efficacy of a brief online writing intervention on ... Outcomes assessed at baseline and one-week follow-up included body appreciation, body dissatisfaction, and distress. In study 2 (1 session version of EYH), ...

4. researchnow.flinders.edu.au researchnow.flinders.edu.au/files/125645967/Brkic_Testing_P2024.pdf

Testing the efficacy of a brief online writing intervention on ... Outcomes assessed at baseline and one-week follow-up included body appreciation, body dissatisfaction, and distress. In study 2 (1 session ...

5. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/39466058/

Feasibility Trial of an Online Expressive Writing ... Purpose: Many young adult (YA) breast cancer survivors (BCS) experience psychosocial distress during and after treatment, but do not utilize ...

6. journals.sagepub.com journals.sagepub.com/doi/abs/10.1089/jayao.2023.0187

Feasibility Trial of an Online Expressive Writing ... The online EW pilot intervention demonstrated evidence of feasibility and acceptability to YA BCS; its potential to improve health outcomes should be evaluated ...

7. researchgate.net researchgate.net/publication/385308761_Feasibility_Trial_of_an_Online_Expressive_Writing_Intervention_for_Young_Adult_Cancer_Survivors

(PDF) Feasibility Trial of an Online Expressive Writing ... Feasibility Trial of an Online Expressive Writing Intervention for Young Adult Cancer Survivors. October 2024; Journal of Adolescent and Young Adult Oncology ...