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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how expressive writing might help cancer survivors manage stress. Participants write about their experiences to determine if it can reduce worries about family, work, or health, especially during challenging times like the COVID-19 pandemic. The study involves two groups: one reads positive messages and writes about their feelings, while the other focuses on neutral topics. Ideal participants are cancer survivors diagnosed within the last three years, who speak English and have internet access.

As an unphased trial, this study offers a unique opportunity for participants to explore personal growth and stress relief through writing.

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

Research has shown that expressive writing is generally safe for cancer patients. In several studies, participants in expressive writing reported no serious side effects. This activity typically involves writing about personal experiences and feelings, which can help reduce stress.

Twenty-one studies found that expressive writing improved quality of life and physical health for cancer patients. Some participants experienced less distress and fewer symptoms of depression. This indicates that expressive writing is not only safe but also beneficial for mental health.

For those considering joining a trial, expressive writing is well-tolerated and has helped many people feel better emotionally. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about using expressive writing for cancer stress management because it offers a non-pharmaceutical approach to help patients manage their emotional and psychological burden. Unlike standard treatments that might involve medication or therapy sessions, this method empowers patients to process their feelings through writing, which can be both therapeutic and accessible. The trial is exploring whether writing about personal experiences and emotions can alleviate stress more effectively than writing about neutral topics, potentially offering a simple and cost-effective tool for improving mental well-being during cancer treatment.

What evidence suggests that expressive writing is effective for managing stress in cancer survivors?

Research has shown that expressive writing can help cancer patients manage stress and improve their mental and physical health. In this trial, participants in one arm will engage in expressive writing, which studies have found often leads to reduced stress and an enhanced sense of well-being. For example, this type of writing is linked to better mood, less anxiety, and even a stronger immune system in cancer patients. It allows patients to express their feelings and find meaning in their cancer experience. This approach also helps caregivers and patients feel more supported and understood, leading to better health outcomes. ^{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 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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

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 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]

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]

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]

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. 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 Expressive writing interventions (EWIs) are associated with important psychological and physical outcomes in patients with cancer.

5. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/18544285/

Expressive Writing as a Presurgical Stress Management ... This study evaluated whether expressive writing (EW) was an effective stress management intervention for breast cancer patients. Women were recruited at the ...

6. clinicaltrials.gov clinicaltrials.gov/study/NCT04776941

Expressive Writing for the Management of Stress in Cancer ... This clinical trial evaluates the effect of expressive writing for the management of stress in cancer survivors. Cancer diagnosis and treatment are ...

7. onlinelibrary.wiley.com onlinelibrary.wiley.com/doi/10.1002/pon.3193

Effects of an expressive writing intervention on cancer ... To examine the effects of an expressive writing intervention (EWI) on cancer-related distress, depressive symptoms, and mood in women treated ...