Expressive Writing for Cancer Stress Management

Overseen By Qian LU, MD,PHD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: M.D. Anderson Cancer Center

Disqualifiers: Inability to provide consent, others

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

Compensation: Varies

Number of Visits: 1

414 Participants Needed

Trial Summary

What is the purpose of this trial?

This clinical trial evaluates the effect of expressive writing for the management of stress in cancer survivors. Cancer diagnosis and treatment are associated with increased stress in cancer survivors related to concerns about family, career, relationships, finances, side effects of treatment, and death. This stress can be further exacerbated by social upheavals such as the COVID-19 pandemic. For safety reasons, many patients are isolated with restricted access to in-person health care and reduced social interaction with family and friends. Together with the economic uncertainties that come with this pandemic, these factors are likely to increase cancer survivors' stress levels. Expressive writing may provide a medium through which cancer survivors confront stressors and find meaning in their experience. The goal of this trial is to learn more about the experiences of cancer survivors during stressful times.

Do I need to stop my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications, so it's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment Expressive Writing for cancer stress management?

Research shows that expressive writing can help cancer patients by reducing distress and improving mood and emotional support perceptions. Studies have found benefits in psychological and physical health outcomes for cancer patients and survivors who engage in expressive writing. ^{1 2 3 4 5}

Is expressive writing safe for cancer patients?

Research on expressive writing for cancer patients does not report any safety concerns, suggesting it is generally safe for use in humans. ^{1 4 5 6 7}

How is the treatment Expressive Writing for Cancer Stress Management different from other treatments?

Expressive Writing is unique because it involves patients writing about their thoughts and feelings related to their cancer experience, which can help manage stress and emotional distress. Unlike other treatments that might involve medication or physical interventions, this approach focuses on emotional expression and processing through writing. ^{1 5 6 8 9}

Research Team

Qian Lu, MD

Principal Investigator

M.D. Anderson Cancer Center

Eligibility Criteria

This trial is for cancer survivors who are at least 18 years old, diagnosed within the last 3 years, and can read and speak English. Participants need internet access via a computer or smartphone. All types of cancers and stages are welcome, but those unable to consent or non-English speakers cannot join.

Inclusion Criteria

My cancer can be at any stage and in any part of my body.

Are able to speak and read in English

Have access to a computer or smart phone with internet connection

Exclusion Criteria

Inability to provide informed consent

Non-English speakers will be excluded because this is a feasibility study that will enroll only a limited number of participants

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants complete questionnaires and engage in expressive writing or neutral writing exercises weekly for 3 weeks

3 weeks

Virtual sessions once weekly

Follow-up

Participants are monitored for changes in psychological health, quality of life, physical health, and stress at baseline, 1, 3, and 6 months

6 months

Virtual assessments at baseline, 1, 3, and 6 months

Treatment Details

Interventions

• Expressive Writing

Trial Overview The study looks at how expressive writing might help manage stress in people who have survived cancer. It aims to understand their experiences during stressful events like the COVID-19 pandemic when isolation and economic uncertainty may increase stress levels.

Participant Groups

Group I: Arm I (questionnaires, messages, writing) Experimental Treatment 3 Interventions

Patients complete questionnaires over 30 minutes about their mood, health, and income at baseline, and 1, 3, and 6 months. Patients also read brief positive messages and write essays about their experiences over 30 minutes (non-stop) QW for 3 weeks.

Group II: Arm II (questionnaires, messages, writing) Active Control 3 Interventions

Patients complete questionnaires over 30 minutes about their mood, health, and income at baseline, and 1, 3, and 6 months. Patients also read brief neutral messages and write essays about neutral topics over 30 minutes (non-stop) QW for 3 weeks.

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+

Findings from Research

In a study of 112 breast cancer patients undergoing chemotherapy, higher emotional expressivity was linked to better quality of life, particularly for those using more positive or fewer negative words in their expressive writing, although it did not affect physical or psychological well-being.

The study suggests that while emotional expressivity and word patterns in expressive writing can influence quality of life, they do not mediate the overall health outcomes, indicating that these factors may help identify patients who could benefit most from expressive writing interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Can emotional expressivity and writing content predict beneficial effects of expressive writing among breast cancer patients receiving chemotherapy? A secondary analysis of randomized controlled trial data from China. Wu, Y., Yang, D., Jian, B., et al.[2023]

The expressive writing (EW) intervention significantly improved women's perceptions of emotional support after treatment for early-stage breast cancer, with participants reporting greater satisfaction compared to the control group.

While EW did not show significant effects on mood, quality of life, or healthcare utilization, most participants found the writing experience valuable and reported no long-term negative effects, suggesting it could be a beneficial and cost-effective addition to cancer care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Narrowing the gap: the effects of an expressive writing intervention on perceptions of actual and ideal emotional support in women who have completed treatment for early stage breast cancer. Gellaitry, G., Peters, K., Bloomfield, D., et al.[2009]

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 systematic review of 16 randomized controlled trials involving cancer patients and survivors found no significant overall benefits of expressive writing intervention (EWI) on psychological or physical health outcomes.

While EWI did not show general effectiveness, there may be potential benefits for individuals with low emotional support, suggesting that future research should explore specific subgroups that might respond better to this intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of expressive writing intervention on psychological and physical health outcomes in cancer patients--a systematic review and meta-analysis. Zachariae, R., O'Toole, MS.[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]

Expressive writing significantly reduces emotional distress in early-stage cancer patients compared to neutral writing, as shown in a review of 7 randomized controlled trials.

While expressive writing helps improve mood and sleep quality in early-stage cancer patients, it does not significantly benefit those with long-term metastatic disease or in palliative care, indicating its effectiveness may be limited to specific patient groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[The use of expressive writing in the course of care for cancer patients to reduce emotional distress: analysis of the literature]. Gallo, I., Garrino, L., Di Monte, V.[2018]

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 (EW) did not significantly reduce distress, perceived stress, sleep disturbance, or pain in breast cancer patients undergoing treatment, based on a study of 49 women who participated in four writing sessions over a week.

The effectiveness of EW varied with social constraints; women with high social constraints reported lower pain levels with EW, while those with low social constraints experienced higher pain levels, indicating that EW may not be a universally effective stress management strategy for all patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Expressive writing as a presurgical stress management intervention for breast cancer patients. de Moor, JS., Moyé, L., Low, MD., et al.[2015]

Expressive writing (EW) significantly reduces negative somatic symptoms in breast cancer patients within a 3-month follow-up period, based on a meta-analysis of 11 randomized controlled trials involving 1,178 participants.

However, EW does not show a significant impact on psychological health outcomes at any follow-up time, indicating that while it may help with physical symptoms, its benefits may be limited and short-lived.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Expressive Writing Intervention on Health Outcomes in Breast Cancer Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Zhou, C., Wu, Y., An, S., et al.[2023]

References

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

Can emotional expressivity and writing content predict beneficial effects of expressive writing among breast cancer patients receiving chemotherapy? A secondary analysis of randomized controlled trial data from China. [2023]

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

Narrowing the gap: the effects of an expressive writing intervention on perceptions of actual and ideal emotional support in women who have completed treatment for early stage breast cancer. [2009]

3. 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]

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

The effect of expressive writing intervention on psychological and physical health outcomes in cancer patients--a systematic review and meta-analysis. [2022]

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

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

6. Italy pubmed.ncbi.nlm.nih.gov

[The use of expressive writing in the course of care for cancer patients to reduce emotional distress: analysis of the literature]. [2018]

7. Germany 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. [2021]

8. Canada pubmed.ncbi.nlm.nih.gov

Expressive writing as a presurgical stress management intervention for breast cancer patients. [2015]

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

Effect of Expressive Writing Intervention on Health Outcomes in Breast Cancer Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. [2023]