Expressive writing for body image distress and anxiety in adolescent and young adult cancer survivors: A pilot, randomized controlled trial.

Abstract

12082 Background: Up to 60% of adolescent and young adult cancer survivors (ages 15-39) experience body image distress but this is not well-managed due to multiple factors, including lack of provider expertise and patient hesitancy. Expressive writing invites participants to write openly about their thoughts and feelings related to a traumatic event, such as the cancer experience, to facilitate cognitive and emotional processing of the event. Expressive writing has not been explored in the AYA survivorship population with body image distress. The purpose of this pilot study is to determine the feasibility of implementing a four-week, in-home body image-focused expressive writing intervention for AYA cancer survivors with clinically significant body image distress. Methods: AYA cancer survivors with body image distress were recruited from oncology clinics at the University of Michigan and through institutional social media campaigns. Participants were randomized (1:1) to either a 4-week body image-focused expressive writing intervention or a control writing condition. Feasibility was based on recruitment and adherence, defined as completing 75% of writing sessions. Pre- and post-intervention, participants self-reported body image distress and anxiety utilizing the ten-item Body Image Scale (BIS) and the Generalized Anxiety Disorder 7 Scale (GAD-7). Changes in patient-reported outcomes were analyzed using linear mixed-effects models. Results: 27 participants were randomized (n=14 expressive writing, n=13 control) and were mainly female (96%) with locally advanced or metastatic cancer (60%). 26/27 (96.3%) completed all writing prompts outcome measures. Both groups demonstrated improvement in body image distress over the 4-week period. Expressive writing participants showed a numerically greater reduction (estimated change −5.57, 95% CI [−8.34, −2.8]). The difference-in-change between groups was −2.77 (time × treatment interaction, not significant). Results in Table 1. Conclusions: A four-week, in-home body image-focused expressive writing intervention demonstrated feasibility among AYA cancer survivors with body image distress. AYA cancer survivors face persistent body image distress that can affect quality of life. This intervention can offer a feasible, accessible, and low-cost approach to help mitigate these concerns. Further research is needed to determine the efficacy of the intervention to reduce body image distress among AYA cancer survivors. Clinical trial information: NCT06046014 . Estimated change in BIS and GAD-7 from baseline to week 4 by group. Outcome Group Estimated Change 95% CI p-value BIS score Expressive Writing -5.57 [-8.34, 2.8] <0.001 BIS score Control Writing -2.77 [-5.75, 0.22] 0.0676 GAD-7 score Expressive Writing -0.93 [-3.34, 1.48] 0.435 GAD-7 score Control Writing -4.67 [-7.26, 2.08] 0.001