Expressive writing appears to change thoughts and feelings about cancer

Expressive writing --writing about one’s deepest thoughts and feelings—may help change the way cancer patients think and feel about their disease. In one of the first studies published in an oncology journal about the benefits of writing therapy, researchers say those who immediately reported changes in thoughts about their illness also reported a better physical quality of life three weeks later.

“Previous research suggests expressive writing may enhance physical and psychological well-being,” said Nancy P. Morgan, M.A., writing clinician and director of the Lombardi Comprehensive Cancer Center’s Arts and Humanities Program. “But most of those studies involved three to five writing sessions that were conducted in a controlled laboratory setting. Here, we found that just one writing session in a busy cancer clinic where the patients are frequently interrupted can still have a positive impact on patients.” The study appears in the February issue of The Oncologist.

Morgan and her colleagues conducted their study in the clinic waiting area of the Lombardi Comprehensive Cancer Center between July and November 2006. It included a pre-writing survey, twenty minutes of expressive writing, a post-writing survey, and an optional follow-up survey that was completed by telephone 3 weeks later. Seventy-one (71) adult leukemia or lymphoma patients (51 percent male, 49 percent female) attending an appointment with a medical oncologist for treatment or follow-up participated in the study.

All participants completed the pre-survey, while 63 (88 percent) completed the 20-minute expressive writing exercise, responding to prompts including: How has cancer changed you and how do you feel about those changes?

“We were interested in assessing psychological and social outcomes following the writing, including quality of life, benefit finding, and reports of whether the writing changed the way participants thought and felt about their cancer experience,” Morgan said. “Thoughts and feelings, or the cognitive processing and emotions related to cancer, are key writing elements associated with health benefits, according to previous studies. Writing about only the facts has shown no benefit.”

The post-survey indicated that 49 percent of participants who completed the writing exercise reported that writing changed their thoughts about their illness, while 35 percent reported writing changed they way they felt about their illness. At the three week follow-up, 54 percent of those completing all parts of the study reported writing changed their thoughts and 38 percent reported writing changed their feelings about their illness. Two factors -- younger age, and less time since diagnosis, were associated with more change in thoughts and feelings.

“In addition to the quantitative data highlighting participants’ responses that the writing changed the way they thought about their cancer experience, we were interested in whether participants indicated in their writing that cancer brought about meaningful changes in their lives,” Morgan said.

To analyze the impact of the writing exercise on patients, the researchers conducted initial content analyses of the compositions, examining each text for themes, words, and phrases indicative of the transformative nature of the cancer experience. Of the 63 texts, 60 contained evidence of transformation brought about by the cancer experience. Many of the changes expressed in the writing were positive and related to feelings about family, spirituality, work, and the future. As one patient wrote, “Don’t get me wrong, cancer isn’t a gift, it just showed me what the gifts in my life are.”

When people used a greater number of positive emotion words in their writing, they also reported more change in how the writing affected their thoughts and feelings about the illness. Greater reports of change in thoughts were significantly related to reports of better physical quality of life at follow-up.

“Waiting for your appointment in the clinic can be a time of anxiety and stress for cancer patients,” said Bruce D. Cheson, M.D., head of Hematology at Lombardi and a co-author on the study. “I’m pleased to see that so many of our patients were interested in this kind of therapy. Our study supports the benefit of an expressive writing program and the ability to integrate such a program into a busy clinic.”

Preliminary results from this study coincided with one of the largest gifts in the history of arts in healthcare and the Lombardi Arts and Humanities Program. Trustees of the Robert M. Fisher Foundation created a $1.5 million endowment fund in memory of Cecelia F. “Cookie” Rudman, a longtime volunteer at the cancer center. The Fund allows Morgan to expand her program to ensure all patients and caregivers at the Lombardi Comprehensive Cancer Center can participate in the arts programs offered. Each new patient receives a writing journal at the patient orientation.

“We’re grateful to the patients who assisted our research team in carrying out an innovative study,” Morgan said. “They enabled us to better understand the benefits of expressive writing.”

The Lombardi Comprehensive Cancer Center, part of Georgetown University Medical Center and Georgetown University Hospital, seeks to improve the diagnosis, treatment, and prevention of cancer through innovative basic and clinical research, patient care, community education and outreach, and the training of cancer specialists of the future. Lombardi is one of only 39 comprehensive cancer centers in the nation, as designated by the National Cancer Institute, and the only one in the Washington, DC, area. For more information, go to http://lombardi.georgetown.edu.

Georgetown University Medical Center is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through our partnership with MedStar Health). Our mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis -- or "care of the whole person." The Medical Center includes the School of Medicine and the School of Nursing and Health Studies, both nationally ranked, the world-renowned Lombardi Comprehensive Cancer Center and the Biomedical Graduate Research Organization (BGRO), home to 60 percent of the university’s sponsored research funding.