Expressive Writing Therapy for Breast Cancer Survivors

Age: 18+

Sex: Female

Trial Phase: Academic

Sponsor: M.D. Anderson Cancer Center

Disqualifiers: Inability to provide informed consent

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

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 6

Duration: 3 weeks

285 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how expressive writing can improve the health of Chinese immigrant women who have survived stage 0-III breast cancer. Participants will engage in writing sessions focusing on factual details about their cancer, stress and coping strategies, or positive reflections on their experience. The goal is to determine how writing might impact their well-being and recovery journey. Suitable candidates for this trial are women who completed their main cancer treatments in the last five years and have lived in the U.S. for at least six months. As an unphased study, this trial offers a unique opportunity to explore innovative ways to enhance recovery and well-being.

Do I need to stop taking my current medications to join the trial?

The trial information does not specify whether you need to stop taking your current medications. It focuses on expressive writing therapy for breast cancer survivors.

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

Research has shown that expressive writing is generally safe and well-tolerated by cancer patients. One study found it improved both mental and physical health without causing harm. Another study found that breast cancer survivors who tried expressive writing did not report any major negative effects. Overall, this approach is considered low-risk and involves writing about personal experiences, feelings, and ways to manage stress. This suggests that expressive writing is a safe option for those looking to improve their well-being during cancer recovery. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the expressive writing therapies for breast cancer survivors because they offer a novel, non-medical approach to emotional healing. Unlike standard treatments, which often focus on physical recovery, these writing interventions aim to support mental and emotional well-being. The self-regulation writing encourages patients to explore stress and emotional coping, potentially enhancing psychological resilience. The self-cultivation writing focuses on fostering positive thoughts, which might improve quality of life by shifting patients' perspectives on their experiences. These interventions are simple, cost-effective, and can be self-administered, making them accessible options for long-term emotional support.

What evidence suggests that this trial's treatments could be effective for breast cancer survivors?

Research has shown that expressive writing therapy can improve both mental and physical well-being in cancer patients. In this trial, participants will engage in different writing interventions. Arm I involves control writing, where patients write about facts regarding their cancer diagnosis and treatment. Arm II focuses on self-regulation writing, emphasizing stress and coping, emotional disclosure, and benefit finding. Arm III involves self-cultivation writing, where patients express positive thoughts and feelings about their breast cancer experience. Previous studies have indicated that breast cancer patients who engaged in expressive writing felt less stressed and experienced better emotional health. Another study found that it improved the quality of life for breast cancer survivors. However, not all studies agree, and some found no major benefits. Overall, expressive writing might help some people by providing an outlet to share their thoughts and feelings about their cancer journey. ^{1 3 4 6 7}

Who Is on the Research Team?

Qian Lu, MD

Principal Investigator

M.D. Anderson Cancer Center

Are You a Good Fit for This Trial?

This trial is for foreign-born Chinese women, aged 18 or older, who have been living in the U.S. for at least six months and were diagnosed with stage 0-III breast cancer. Participants should have completed primary treatments like surgery or chemotherapy within the last five years.

Inclusion Criteria

I am a Chinese woman, over 18, who has lived in the U.S. for at least six months.

My breast cancer is at an early to mid-stage (0-III).

I finished my main cancer treatment within the last 5 years.

Exclusion Criteria

Inability to provide informed consent

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants engage in expressive writing sessions, writing about their cancer experiences for 3 weekly 30-minute sessions

3 weeks

3 visits (virtual or in-person)

Follow-up

Participants are monitored for quality of life and stress biomarkers at 6 weeks, 6 months, and 12 months

12 months

3 visits (in-person or virtual)

What Are the Treatments Tested in This Trial?

Interventions

• Culturally Based Brief Expressive Writing Intervention

Trial Overview The study is testing a culturally tailored brief expressive writing intervention to see if it improves health outcomes for Chinese immigrant breast cancer survivors by having them write about their experiences.

How Is the Trial Designed?

Group I: Arm III (self-cultivation writing) Experimental Treatment 3 Interventions

Patients write about positive thoughts and feelings regarding their breast cancer experience for 3 weekly 30-minute sessions.

Group II: Arm II (self-regulation writing) Experimental Treatment 3 Interventions

Patients write about stress and coping, emotional disclosure, and benefit finding for 3 weekly 30-minute sessions.

Group III: Arm I (control writing) Active Control 3 Interventions

Patients write about facts regarding their cancer diagnosis and treatment for 3 weekly 30-minute sessions.

Culturally Based Brief Expressive Writing Intervention is already approved in United States for the following indications:

Approved in United States as Expressive Writing Intervention for:

• Improvement of health in Chinese immigrant stage 0-III breast cancer survivors

Who Is Running the Clinical Trial?

M.D. Anderson Cancer Center

Lead Sponsor

Trials

3,107

Recruited

1,813,000+

National Cancer Institute (NCI)

Collaborator

Trials

14,080

Recruited

41,180,000+

Published Research Related to This Trial

A study involving 96 Chinese-speaking breast cancer survivors found that a writing intervention focusing on cancer facts led to the highest reported quality of life at the 6-month follow-up, challenging previous assumptions about the effectiveness of emotional writing for this population.

The self-regulation writing group showed improved emotional well-being compared to the emotional disclosure group, suggesting that cognitive-focused writing may be more beneficial for Asian American cancer survivors than purely emotional expression.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Expressive writing among Chinese American breast cancer survivors: A randomized controlled trial. Lu, Q., Wong, CC., Gallagher, MW., et al.[2022]

A study involving 118 mainland Chinese breast cancer patients found that expressive writing interventions significantly improved quality of life (QoL) over 6 months, particularly for those in the cancer-facts and emotional disclosure writing groups compared to a neutral control group.

The emotional disclosure writing group reported the highest QoL, while the cancer-facts group showed better physical well-being than the self-regulation writing group, highlighting the varying effectiveness of writing interventions based on the type of writing and the patients' cultural context.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The benefits of expressive writing among newly diagnosed mainland Chinese breast cancer patients. Ji, LL., Lu, Q., Wang, LJ., et al.[2022]

A pilot study involving 19 Chinese-speaking breast cancer survivors found that an expressive writing intervention significantly improved health outcomes, including quality of life and reduced posttraumatic stress, with medium to large effect sizes over a 6-month follow-up period.

The study demonstrated high compliance and perceived value among participants, highlighting the feasibility and cultural sensitivity of using expressive writing as a supportive strategy for minority cancer survivors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A pilot study of expressive writing intervention among Chinese-speaking breast cancer survivors. Lu, Q., Zheng, D., Young, L., et al.[2022]

A study involving 90 Chinese breast cancer survivors showed that expressive writing interventions, particularly writing about cancer facts, significantly improved quality of life (QOL) compared to writing about stress and coping efforts.

Writing about positive aspects of the cancer experience also improved QOL, but not as effectively as writing about cancer facts, indicating that both approaches can be beneficial for patients undergoing chemotherapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The impact of an expressive writing intervention on quality of life among Chinese breast cancer patients undergoing chemotherapy. Lu, Q., Dong, L., Wu, IHC., et al.[2022]

Expressive writing, involving four 20-minute sessions focused on emotional disclosure, significantly improved the quality of life for breast cancer patients undergoing chemotherapy, with noticeable effects observed two weeks after the intervention.

The study, which included 82 participants, also indicated that expressive writing positively influenced self-care self-efficacy over time, suggesting it is a beneficial and low-cost psychological intervention for patients lacking emotional support.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of Structured Expressive Writing on Quality of Life and Perceived Self-Care Self-Efficacy of Breast Cancer Patients Undergoing Chemotherapy in Central China: A Randomized Controlled Trial. Wang, R., Li, L., Xu, J., et al.[2023]

Expressive writing is a beneficial intervention for women with breast cancer, helping them process emotions and experiences related to their illness, as shown in a study with seven participants who engaged in four writing sessions.

The study identified three key themes: writing as a process, writing as therapeutic, and writing as a means to help others, suggesting that this method can be effectively integrated into care plans for breast cancer patients and potentially other cancer groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Capturing the Experience: Reflections of Women With Breast Cancer Engaged in an Expressive Writing Intervention. Gripsrud, BH., Brassil, KJ., Summers, B., et al.[2018]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6680178/

The effect of expressive writing intervention on ... This study aimed to evaluate the effectiveness of expressive writing intervention (EWI) for improving psychological and physical health in cancer patients ...

2. sciencedirect.com sciencedirect.com/science/article/abs/pii/S1462388924000760

Using expressive writing to improve cancer caregiver and ... Most relevant to our focus on ICs, one study found that remote EW with breast cancer patients improved mental health and physical health (e.g., decreased ...

3. clinicaltrials.gov clinicaltrials.gov/study/NCT00679185

Expressive Writing in Improving Quality of Life in Patients ... To determine if expressive writing improves quality of life (QOL) relative to the control condition in breast cancer survivors with chronic stage II lymphedema.

4. ijmio.com ijmio.com/the-effects-of-expressive-writing-intervention-in-cancer-patients-and-survivors-a-rapid-umbrella-review/

The effects of expressive writing intervention in cancer ... In terms of expressive writing's overall effectiveness, 40% (n = 2) demonstrated no overall effectiveness, while 40% (n = 2) demonstrated only ...

5. mdpi.com mdpi.com/2227-9032/10/9/1762

Effects of Structured Expressive Writing on Quality of Life ... This study explored the effectiveness of an expressive writing intervention among patients with breast cancer undergoing chemotherapy in central China.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5571730/

A Randomized Controlled Trial of Expressive Writing in ... Effects of an expressive writing intervention on cancer‐related distress in Danish breast cancer survivors—Results from a nationwide randomized clinical trial.

7. journals.plos.org journals.plos.org/plosone/article?id=10.1371/journal.pone.0192729

Expressive writing intervention and self-reported physical ... Expressive writing intervention and self-reported physical health out-comes – Results from a nationwide randomized controlled trial with breast cancer patients.