Expressive Writing Program May Help Advanced Breast Cancer Patients

Cancer Training Branch

Often patients with advanced breast cancer receive relatively little support in dealing with the serious psycho-social concerns they face from their growing dependence on others, cognitive and physical decline, and issues related to the end-of-life. Teaching these patients to write expressively and disclose their deepest thoughts and feelings about their condition may reduce their emotional and physical distress by providing them opportunities to share their cancer experiences and find meaning in their situations.

Clinical psychologist Catherine E. Mosher, Ph.D., was awarded an NIH fellowship grant* to study the impact of an expressive writing program on women with metastatic breast cancer. “There was a study in metastatic, renal-cell carcinoma patients where they found expressive writing had sleep-related health benefits,” noted Dr. Mosher, a postdoctoral research fellow at Memorial Sloan-Kettering Cancer Center Department of Psychiatry & Behavioral Sciences. “I wondered if I could replicate that finding in breast cancer patients.”

She is well on the way to enrolling 98 patients in the study, which will compare the expressive writing method against a control group of patients who will write only about their daily activities. Dr. Mosher conducts four weekly phone sessions with each patient. “I call them on the phone and ask them to write about their moods,” she reported. Women in the expressive writing group use a workbook to “write about their deepest thoughts and feelings regarding their cancer experience,” she explained.

“I strongly believe that home-based interventions like this are needed, particularly for advanced cancer patients,” Dr. Mosher added. “Not all of them can travel to hospitals for group or individual therapy sessions.”

The study will primarily assess the impact of expressive writing on the patients’ levels of distress (i.e., depressive symptoms and feeling disheartened). It will also monitor effects on other outcomes, including a sense of meaning in life and peace, pain severity, sleep disturbance, fatigue, and functional impairment.

Dr. Mosher heard about the NIH fellowship program during her doctoral health psychology internship at Duke University Medical School. She successfully applied to the program and has found it “a tremendous opportunity to collaborate with multiple laboratories, to mentor student volunteers who help with my study, and to write grant proposals. It’s been a really good two years.”