Expressive writing improves quality of life for breast cancer survivors

Receiving a cancer diagnosis is a life-changing event, and the path through treatment can be among the hardest things a person goes through in life. Survivors can face a variety of physical and emotional effects, both during and after their treatment that can significantly lower their quality of life.

There are many options available to help patients cope with these effects, including spiritual support, counseling and cancer support groups. According to a study from researchers at MD Anderson Cancer Center, expressive writing also may be a beneficial approach.

The results of the randomized controlled trial, published in the November issue of Annals of Behavioral Medicine, reveal this guided writing intervention to significantly improve quality of life (QOL) for Chinese-American breast cancer survivors. Lead author Qian Lu, M.D., Ph.D., associate professor of Health Disparities Research, long has been interested in writing as a tool for cancer survivors.

Writing helps patients share struggles

“When I first worked with cancer survivors, I realized they weren’t telling us much about what was going on in their lives, so we tried having them write about their experiences,” Lu said. “In reading through their writing, I found they revealed so much about the troubles and struggles they had gone through.”

Expressive writing is similar to journaling, but gives participants specific writing instructions and evaluates progress after a period of time. Past studies have shown expressive-writing interventions to improve psychological and physical health outcomes in a variety of settings, but few, if any, have shown a QOL improvement in cancer survivors.

Lu has conducted research in this area for many years to understand both the feasibility of this approach and the most effective expressive-writing instructions.

“I felt that expressive writing would be really good for cancer patients because we know they often go through many struggles during diagnosis, treatment and survivorship,” Lu said. “I thought it could be very helpful to them.”

Quality of life evaluated in three groups

In the current randomized controlled trial, 138 Chinese-American breast cancer survivors were assigned to one of three groups, each with different writing instructions. Each group wrote three 30-minute weekly essays based on their instructions.

The first, a control group, was asked to write about the facts relevant to their cancer experience each week. The remaining groups, termed self-regulation (SR) and enhanced self-regulation (ERS), tested specific expressive-writing instructions. Participants in the SR group wrote first about their deepest feelings, then stress and coping, and finally about the positive aspects of their cancer journey. The ESR group mirrored the SR, but reversed the order of the first two weeks.

QOL was evaluated by the Functional Assessment of Cancer Therapy questionnaire at baseline, as well as one, three and six months following intervention.

At the conclusion of the study, the researchers found that the intervention increased QOL in the participants from baseline to the six-month follow-up. Both groups reported an improved QOL relative to the control group, with the largest and most statistically significant effects in the ESR group.

The essays vary in their content, but many express profound feelings of struggle and pain as well as joy and gratitude.

“I found a new self and new sense of confidence after I experienced cancer, and I feel more motivated to live a more purposeful and meaningful life,” wrote one participant. “Gratitude is the best gift to ourselves, and I hope I can share this love and joy with others, and hope that everyone around me can feel my purest form of love.”

Potential to help other groups of patients

Going forward, Lu is very interested in determining how to best implement this for a variety of patient populations that need such interventions. The current study was focused specifically on Chinese-Americans, for whom cancer is the leading cause of death; very few studies have looked at ways to improve quality of life in this population.

However, several other cultural or ethnic groups may not be comfortable sharing their feelings verbally and expressive writing may be of use to them. Even in mainstream culture, explained Lu, women are encouraged to talk about their emotions, whereas men are not.

“Expressive writing may be a very good avenue for those uncomfortable with sharing their feelings. That way they can disclose to themselves rather than having to do so with other people,” Lu said. “We’re very interested in learning how we can deliver this intervention to those who need it.”