Writing Therapy for Cancer Survivors

Overseen By Qian Lu, MD, PHD

Age: 18+

Sex: Any

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)

Compensation: Varies

Number of Visits: 10

Duration: 3 months

192 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to understand how writing about personal experiences affects the health of Asian American immigrant breast cancer survivors. Participants will be divided into two groups: one will write about facts related to their cancer, while the other will explore emotions, stress, coping strategies, and positive thoughts about their cancer journey. Ideal participants are Asian or Asian American individuals who have completed primary cancer treatment within the last five years and are comfortable reading in English or Chinese. As an unphased study, this trial offers participants a unique opportunity to contribute to research that may enhance emotional well-being for future cancer survivors.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that Writing Therapy is safe for cancer survivors?

Research has shown that writing therapy, such as expressive writing, is generally safe for cancer patients. Studies indicate that this therapy does not cause harm.

Expressive writing involves writing about personal thoughts and feelings. For cancer patients, it includes writing about their cancer experience. This therapy has been studied in many cancer patients and is associated with improved quality of life and health outcomes.

Participants who have tried expressive writing have not reported serious side effects. It is well-tolerated, meaning most people manage it without problems.

In this trial, participants will write about their cancer experiences, including stress, emotions, and positive thoughts. No evidence suggests that writing therapy is unsafe. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about writing therapy for cancer survivors because it offers a unique, non-medical approach to emotional healing. Unlike traditional treatments that primarily focus on the physical aspects of cancer recovery, such as chemotherapy or radiation, writing therapy targets emotional well-being. This therapy allows participants to explore their feelings, cope with stress, and find positive aspects of their journey through structured writing sessions. By encouraging emotional expression and reflection, writing therapy aims to improve mental health, potentially leading to better overall recovery outcomes for cancer survivors.

What evidence suggests that writing therapy could be effective for cancer survivors?

This trial will compare different writing therapy approaches for cancer survivors. Research has shown that writing therapy, especially expressive writing, can benefit cancer patients. Studies have found that expressive writing can enhance both mental and physical health for people with cancer. For example, it can improve quality of life and reduce stress by allowing patients to express their deepest feelings about their cancer journey. Additionally, a review found that expressive writing is linked to better health, including improved mental well-being and overall quality of life. These findings suggest that writing therapy might be a helpful tool for cancer survivors. ^{1 2 6 7 8}

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 Asian American breast cancer survivors who have immigrated to the United States. It's designed to understand their experiences and how writing about these experiences can impact their health.

Inclusion Criteria

Self-identified as Asian, Asian Americans, any Asian or Asian American subgroup (Chinese, Vietnamese, Indian, Korean, etc.) ethnic/cultural background

Comfortable reading in English or in Chinese

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 writing therapy sessions focusing on stress, emotional disclosure, and positive thoughts

3 months

3 writing sessions

Follow-up

Participants are monitored for quality of life and perceived stress at 6- and 12-month follow-ups

12 months

Follow-up assessments at 6 and 12 months

Booster Session

Participants engage in a booster writing session focusing on positive thoughts and feelings

9 months

1 booster session

What Are the Treatments Tested in This Trial?

Interventions

• Writing Therapy

Trial Overview Participants will be asked to complete questionnaires and write essays as a form of therapy. The study aims to evaluate if this writing therapy can provide health benefits for cancer survivors.

How Is the Trial Designed?

Group I: Intervention Condition Experimental Treatment 2 Interventions

Participants will be asked to write about different topics regarding their cancer experience. During session 1, participants will be asked to write about the stress of having cancer and their strategies for coping with stressors associated with their cancer (i.e., stress and coping). During session 2, participants will be asked to write about their deepest feelings regarding their cancer experience (i.e., emotional disclosure). During session 3 and the booster session (at 9-month follow-up), participants will be asked to write about positive thoughts and feelings regarding their experience with cancer.

Group II: Control condition Experimental Treatment 2 Interventions

Participants will be asked to write about facts regarding their cancer diagnosis and treatment in writing sessions.

Who Is Running the Clinical Trial?

M.D. Anderson Cancer Center

Lead Sponsor

Trials

3,107

Recruited

1,813,000+

Published Research Related to This Trial

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]

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]

A study analyzing therapeutic texts from 51 PTSD patients revealed that writing about trauma exposure led to a significant increase in the use of negative emotional words like fear and depression compared to writing about biographical experiences.

Cognitive restructuring texts showed the highest emotional intensity, containing both negative and positive affective words, indicating that this component of writing therapy may be particularly effective in addressing a range of emotions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Courses of affects in an internet-based writing therapy for elderly war trauma survivors. A content analytic approach]. Böttche, M., Berth, H., Knaevelsrud, C., et al.[2021]

A qualitative study involving 12 women highlighted the emotional challenges faced during the transition to breast cancer survivorship, revealing unmet needs for support and expression.

Community-based writing workshops were found to provide safe spaces for emotional sharing, which can enhance well-being and help participants create positive narratives about their experiences.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Writing toward well-being: A qualitative study of community-based workshops with breast cancer survivors. Thomas, R., Gifford, W., Hammond, C.[2020]

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]

The home-based expressive writing (EW) intervention was feasible for colorectal cancer patients, with 81% completing all assignments, but it did not significantly improve quality of life, depressive symptoms, or sleep problems compared to the control writing group.

The study found no differences in effectiveness based on sex or perceived social constraints, indicating that while EW allows for emotional expression, it may not serve as an effective standalone therapy for this patient population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Randomised controlled trial of expressive writing and quality of life in men and women treated for colon or rectal cancer. Lepore, SJ., Revenson, TA., Roberts, KJ., et al.[2021]

Writing Therapy (WT) is an effective tool for promoting self-healing and psychological well-being, showing therapeutic effects on symptoms of mental disorders like PTSD and depression, as well as enhancing positive emotions such as forgiveness and gratitude.

WT can be used as a standalone treatment or integrated into various psychotherapeutic approaches, making it a versatile option for clinicians to help clients achieve personal growth and insight.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Writing Technique Across Psychotherapies-From Traditional Expressive Writing to New Positive Psychology Interventions: A Narrative Review. Ruini, C., Mortara, CC.[2022]

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]

The WISE trial is a randomized controlled study designed to evaluate the efficacy of a brief psychological intervention called expressive helping for adult hematological cancer patients undergoing hematopoietic stem cell transplant, aiming to reduce physical and psychological symptoms during and after the transplant process.

Expressive helping combines emotionally expressive writing and peer support, and is expected to improve health-related quality of life and reduce distress and fatigue, potentially preventing long-term survivorship issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of expressive helping in adult hematologic cancer patients undergoing stem cell transplant: protocol for the Writing for Insight, Strength, and Ease (WISE) study's two-arm randomized controlled trial. Whitmore, L., Schulte, T., Bovbjerg, K., et al.[2021]

In a randomized clinical trial with 71 cancer patients, Pennebaker's expressive writing intervention (EWI) significantly reduced global psychiatric symptoms, indicating its efficacy in improving mental health after a cancer diagnosis.

The EWI also led to a reduction in alexithymia levels and an improvement in the mental component of quality of life, suggesting that this intervention can enhance emotional processing and overall well-being in cancer patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of Pennebaker's expressive writing intervention in reducing psychiatric symptoms among patients with first-time cancer diagnosis: a randomized clinical trial. La Marca, L., Maniscalco, E., Fabbiano, F., et al.[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]

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. 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 ... The purpose of this review was to assess the effects of EWI on health outcomes in cancer patients using systematic reviews with or without meta-analyses.

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

Using expressive writing to improve cancer caregiver and ... This study examined the feasibility and preliminary efficacy of Expressive Writing (EW) in improving informal cancer caregiver (IC) and patient health.

4. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/40686255/

Expressive writing interventions in patients with cancer Twenty-one of the quantitative studies found that EWIs were positively associated with cancer patients' QOL and/or physical health outcomes. Of ...

5. clinicaltrials.gov clinicaltrials.gov/study/NCT00679185

Expressive Writing in Improving Quality of Life in Patients ... RATIONALE: Expressive writing may help relieve symptoms and improve quality of life in breast cancer survivors with chronic lymphedema. PURPOSE: This clinical ...

6. cambridge.org cambridge.org/core/journals/palliative-and-supportive-care/article/expressive-writing-interventions-in-patients-with-cancer-a-scoping-literature-review/32C03C3461A4BECB9AE7A6B6796DF538

Expressive writing interventions in patients with cancer Twenty-one of the quantitative studies found that EWIs were positively associated with cancer patients' QOL and/or physical health outcomes. Of ...

7. clinicaltrials.gov clinicaltrials.gov/study/NCT05859880

Expressive Writing for Caregivers of Persons With Cancer The goal of this clinical trial is to test the effects of an expressive writing intervention for caregivers of persons with cancer.

8. withpower.com withpower.com/trial/phase-malignancies-6-2023-9d2b0

Writing Therapy for Cancer Survivors Writing therapy, including expressive writing, has been studied in cancer patients and is generally considered safe. Studies show that it does not cause ...