Expressive Writing for Young Cancer Patients

Overseen By Trisha K. Paul, MD

Age: < 65

Sex: Any

Trial Phase: Academic

Sponsor: St. Jude Children's Research Hospital

Disqualifiers: Not meeting inclusion criteria, others

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

Compensation: Varies

Number of Visits: 2

26 Participants Needed

Trial Summary

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

The trial information does not specify whether you need to stop taking your current medications. It seems focused on a writing exercise, so it's unlikely that your medications will be affected.

What data supports the effectiveness of the treatment Expressive Writing Therapy for young cancer patients?

Research shows that expressive writing can help young cancer patients by improving their understanding of their condition and reducing feelings of depression and anxiety, leading to a better quality of life. Studies also suggest that expressive writing is a valuable and inexpensive tool for self-expression and finding meaning in the cancer experience. ^{1 2 3 4 5}

Is expressive writing safe for young cancer patients?

Expressive writing is generally considered safe for young cancer patients and has been found to be a valuable and acceptable tool for self-expression and improving quality of life. ^{2 4 6 7 8}

How is the treatment Expressive Writing Therapy different from other treatments for young cancer patients?

Expressive Writing Therapy is unique because it involves patients writing about their thoughts and feelings, which can help them process emotions and reduce stress, unlike traditional treatments that focus on physical symptoms or medication. ^{9 10 11 12 13}

What is the purpose of this trial?

Young people with cancer have difficult experiences and writing exercises may help improve their well-being. However, very few studies have examined how a creative writing activity might be useful for young people with cancer. In this pilot study, researchers at St. Jude Children's Research Hospital hope to explore whether teenagers and young adults with cancer want to participate in a writing exercise and whether they find it to be valuable. Primary Objective To assess the feasibility and acceptability of a writing-based narrative medicine intervention for adolescent and young adult patients with cancer.

Research Team

Trisha K. Paul, MD

Principal Investigator

St. Jude Children's Research Hospital

Eligibility Criteria

This trial is for young people aged 15-25 who are currently being treated for cancer at St. Jude Children's Research Hospital. It aims to see if they're interested in and benefit from a writing exercise designed to help with their experiences.

Inclusion Criteria

Active patient at St. Jude Children's Research Hospital

I am currently undergoing treatment for my cancer.

I am between 15 and 25 years old.

Exclusion Criteria

Does not meet the inclusion criteria

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Narrative Exercise

Participants engage in a writing-based narrative medicine intervention with support from an expert writer

2 months

1-4 visits (in-person or virtual)

Post-intervention Interview

Participants share their thoughts on the writing exercise in an informal interview

1 month

1 visit (in-person or virtual)

Follow-up Interview

Participants may participate in a second informal semi-structured interview 6 to 12 months after the first interview

6-12 months

Treatment Details

Interventions

• Writing Intervention

Trial Overview The study tests the impact of creative writing activities on adolescents and young adults with cancer. Participants will engage in writing exercises, and researchers will evaluate how feasible and valuable this narrative medicine intervention is.

Participant Groups

Group I: Participants Experimental Treatment 2 Interventions

Adolescents and young adults (AYA) patients aged 15-25 years currently receiving cancer-directed therapy at St. Jude Children's Research Hospital

Who Is Running the Clinical Trial?

St. Jude Children's Research Hospital

Lead Sponsor

Trials

451

Recruited

5,326,000+

Findings from Research

Expressive writing (EW) interventions showed a small but significant effect in relieving cancer symptoms among 1,718 patients, based on a meta-analysis of 14 trials.

While EW did not significantly improve psychological and cognitive outcomes, it did enhance health-related quality of life compared to usual care, suggesting potential benefits that may require further investigation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effects of Expressive Writing Interventions for Patients With Cancer: A Meta-Analysis. Oh, PJ., Kim, SH.[2017]

Expressive writing can positively influence health outcomes, particularly in parents of children with leukemia, by helping them process their traumatic experiences.

The study analyzed writings from 23 parents and found that those with better psychological outcomes used specific meaning-making processes, such as reordering events and connecting emotions, differently than those with poorer outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Health and writing: meaning-making processes in the narratives of parents of children with leukemia. Freda, MF., Martino, ML.[2016]

Facilitated writing activities led by a writing coach were found to be feasible and acceptable for patients with advanced incurable cancer, with 82% of participants completing at least three months of the intervention.

The study reported no increase in anxiety or depression among participants, and most patients expressed a desire for the intervention to continue, indicating a positive reception of the writing activities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Getting Creative: Pilot Study of a Coached Writing Intervention in Patients with Advanced Cancer at a Rural Academic Medical Center. Vergo, MT., Klassen-Landis, M., Li, Z., et al.[2022]

Talking and writing about their cancer experience can significantly help pediatric patients and survivors by improving their understanding of their condition and reducing symptoms like depression and anxiety.

Expressive writing, video narratives, and bibliotherapy are effective and accessible therapeutic methods that can enhance the quality of life for young cancer patients, and further research is encouraged to explore these benefits more deeply.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Utility of Verbal Therapy for Pediatric Cancer Patients and Survivors: Expressive Writing, Video Narratives, and Bibliotherapy Exercises. Jones, JK., Evans, JF., Barfield, RC.[2021]

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]

In a systematic review of 24 randomized controlled trials involving 1558 participants, positive writing (PW) was found to improve mood more effectively than expressive writing (EW) in the general population.

For patients, while PW was better at generating positive emotions, EW was more effective in stimulating cognitive changes, suggesting that both writing techniques can be beneficial depending on the population's needs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of expressive writing versus positive writing in different populations: Systematic review and meta-analysis. Lai, J., Song, H., Wang, Y., et al.[2023]

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]

In a study involving 507 Danish women treated for primary breast cancer, Expressive Writing Intervention (EWI) did not show significant overall benefits in reducing physical symptoms or healthcare utilization compared to a control group.

However, women with low alexithymia who engaged in EWI and wrote about their cancer experienced a notable decrease in healthcare contacts, suggesting that EWI may be beneficial for specific individuals rather than as a universal treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Expressive writing intervention and self-reported physical health out-comes - Results from a nationwide randomized controlled trial with breast cancer patients. Jensen-Johansen, MB., O'Toole, MS., Christensen, S., et al.[2018]

In a patient with small cell lung cancer presenting with Eaton-Lambert syndrome, primary therapy for the cancer effectively reversed the syndrome's symptoms.

Anticholinesterase agents, which are often used to treat similar symptoms, were ineffective in this case, highlighting the importance of addressing the underlying tumor rather than relying solely on symptomatic treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Primary therapy for small cell lung cancer reversing the Eaton-Lambert syndrome. Kalter, S., Dhingra, HM., Farha, P.[2019]

Prophylactic cranial irradiation (PCI) can significantly reduce the risk of brain metastases and may improve survival in patients with small-cell lung cancer, but it also has potential negative effects on cognition and quality of life.

The study emphasizes the importance of addressing physician bias in treatment recommendations and introduces a patient decision aid to help patients make informed choices based on their values and priorities regarding PCI.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prophylactic Cranial Irradiation Versus Surveillance: Physician Bias and Patient-centered Decision-making. Johnson, SB., Decker, RH.[2019]

The addition of PD-L1 inhibitors, such as atezolizumab and durvalumab, to first-line chemotherapy (carboplatin and etoposide) has significantly improved overall survival and progression-free survival in patients with small-cell lung cancer (SCLC).

Despite initial challenges in developing effective biomarkers, the successful integration of these immunotherapies into treatment regimens has established them as new standards of care for SCLC, marking a significant advancement in therapy for this aggressive cancer.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Chemo-immunotherapy as first-line treatment for small-cell lung cancer. Farid, S., Liu, SV.[2021]

In two cases of cancer-associated Eaton-Lambert myasthenic syndrome, treatment involving plasma exchange, steroids, immunosuppressants, and chemotherapy led to significant clinical improvement.

The treatment not only improved symptoms but also resulted in marked electrophysiological improvements, particularly in the abductor digiti minimi and trapezius muscles compared to the extensor digitorum brevis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cancer-associated myasthenic (Eaton-Lambert) syndrome: distribution of abnormality and effect of treatment. Ingram, DA., Davis, GR., Schwartz, MS., et al.[2019]

A 70-year-old man with Eaton-Lambert syndrome, associated with small cell lung cancer, showed significant improvement in muscle strength and disappearance of symptoms after chemotherapy.

This case is notable as it demonstrates that chemotherapy for small cell lung cancer can lead to remission of both the cancer and the associated Eaton-Lambert syndrome, which has not been previously reported.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Remission by chemotherapy of the Eaton-Lambert myasthenic syndrome in a patient with small cell bronchogenic carcinoma. Berglund, S., Eriksson, M., von Eyben, FE., et al.[2019]

References

1. United States pubmed.ncbi.nlm.nih.gov

The Effects of Expressive Writing Interventions for Patients With Cancer: A Meta-Analysis. [2017]

2. United States pubmed.ncbi.nlm.nih.gov

Health and writing: meaning-making processes in the narratives of parents of children with leukemia. [2016]

3. United States pubmed.ncbi.nlm.nih.gov

Getting Creative: Pilot Study of a Coached Writing Intervention in Patients with Advanced Cancer at a Rural Academic Medical Center. [2022]

4. Switzerland pubmed.ncbi.nlm.nih.gov

The Utility of Verbal Therapy for Pediatric Cancer Patients and Survivors: Expressive Writing, Video Narratives, and Bibliotherapy Exercises. [2021]

5. Switzerland 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. [2023]

6. United States pubmed.ncbi.nlm.nih.gov

Efficacy of expressive writing versus positive writing in different populations: Systematic review and meta-analysis. [2023]

7. Germany pubmed.ncbi.nlm.nih.gov

The impact of an expressive writing intervention on quality of life among Chinese breast cancer patients undergoing chemotherapy. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Expressive writing intervention and self-reported physical health out-comes - Results from a nationwide randomized controlled trial with breast cancer patients. [2018]

9. United States pubmed.ncbi.nlm.nih.gov

Primary therapy for small cell lung cancer reversing the Eaton-Lambert syndrome. [2019]

10. United States pubmed.ncbi.nlm.nih.gov

Prophylactic Cranial Irradiation Versus Surveillance: Physician Bias and Patient-centered Decision-making. [2019]

11. England pubmed.ncbi.nlm.nih.gov

Chemo-immunotherapy as first-line treatment for small-cell lung cancer. [2021]

12. England pubmed.ncbi.nlm.nih.gov

Cancer-associated myasthenic (Eaton-Lambert) syndrome: distribution of abnormality and effect of treatment. [2019]

13. Sweden pubmed.ncbi.nlm.nih.gov

Remission by chemotherapy of the Eaton-Lambert myasthenic syndrome in a patient with small cell bronchogenic carcinoma. [2019]