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Group-led creative writing and behavioural health in cancer: a randomised clinical trial
  1. Darya Nesterova1,
  2. Junjia Zhu2,
  3. Courtney Kramer3,
  4. Monali Vasekar4,
  5. Cristina Truica4,
  6. Aditya Joshi5,
  7. Michael Hayes4,5,
  8. Jolene Kessler4,
  9. Erika F H Saunders5,
  10. Joseph J Drabick4 and
  11. Monika Joshi4
  1. 1Neurosurgery, Penn State College of Medicine, Hershey, Pennsylvania, USA
  2. 2Public Health Sciences, Penn State Cancer Institute, Hershey, Pennsylvania, USA
  3. 3Penn State College of Medicine, Hershey, Pennsylvania, USA
  4. 4Medicine, Division of Hematology-Oncology, Penn State Cancer Institute, Hershey, Pennsylvania, USA
  5. 5Department of Psychiatry and Behavioral Health, Division of Adult Psychiatry, Pennsylvania Psychiatry Institute, Hershey, Pennsylvania, USA
  1. Correspondence to Dr Monika Joshi, Medicine, Penn State Cancer Institute, Hershey, PA 17033, USA; mjoshi{at}


Background Cancer diagnosis can adversely affect mental well-being and overall clinical outcome. We evaluated the efficacy of a group-led creative writing workshop (CWW) on mood in patients with cancer prospectively.

Methods We conducted a single-institution phase II study. Sixty adult patients with cancer (any type or stage) were randomised 2:1 to CWW (4×CWW sessions, bimonthly over 8 weeks) versus active control (AC) (independent writing at home with the help of a book, four sessions, bimonthly over 8 weeks). The total study duration was 6 months with a follow-up of up to 3 months. Primary objective: changes in overall mood, depression and anxiety symptoms before and after intervention in both arms. Emotional Thermometer Scale (ETS) was used to assess changes in patients’ mood. Additionally, the Patient Health Questionnaire (PHQ)-9 and General Anxiety Disorder Scale (GAD)-7 were used to evaluate depression and anxiety symptoms.

Results Of 50 evaluable patients (CWW 34, AC 17), 26 patients in the CWW arm attended at least one class and 19 attended at least four classes. Patients in CWW had significant immediate improvement in the overall ETS (post vs preclass scores; p<0.0001, 95% CI −4.31 to −2.47). Four of the five subscale ETS scores were significantly lower for the CWW arm: distress (p=0.0346, 95% CI −2.6 to −0.1), anxiety (p=0.0366, 95% CI −4.1 to −0.2), depression (p=0.0441, 95% CI −3.9 to −0.1) and anger (p=0.0494, 95% CI −3.3 to 0). No significant differences were seen in the AC arm. No significant differences were observed in the PHQ-9 or the GAD-7 scores.

Conclusion CWW had a positive effect on mood based on ETS scores, suggesting a potential therapeutic benefit among patients with cancer.

  • complementary therapy
  • cancer
  • psychological care

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  • Contributors DN and MJ participated in all aspects of the study: protocol writing, obtaining consent from patients, conducting the study, analyses of data, and manuscript writing and edits. JZ: study design, protocol writing, statistical analyses, manuscript writing and editing. CK: conduct of the study, manuscript writing and edits. MV, CT, AJ, MH, JJD and EFHS: study design, analyses and manuscript editing. JK: study conduct and editing. MJ was the Principal Investigator on the study and coordinated overall aspects of the study.

  • Funding The study was supported by institutional funds from Penn State Cancer Institute.

  • Competing interests Competing interest outside the submitted work: CT reports personal fees from Novartis, PUMA, Daiichi-Sanyo, Seagen, other from Gilead. MJ: Institutional research grant from AstraZeneca, research grant from Pfizer-EMD Serono for clinical study; free drug from Eisai for clinical study. Personal fees for advisory board for Sanofi.

  • Patient consent for publication Not required.

  • Ethics approval The study protocol was approved by the institutional review board, study number STUDY00008646.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Required data have been submitted to clinical Additional data are available upon request.

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