Effects of expressive helping writing during stem cell transplant: Randomized controlled trial

Most cancer patients undergoing hematopoietic stem cell transplant report elevated symptoms and reduced health-related quality of life during peritransplant. These concerns can become persistent. A prior randomized controlled trial showed that expressive helping-a low-burden, brief intervention combining expressive writing with a novel peer support writing exercise-reduced psychological distress and physical symptoms in long-term transplant survivors with moderate/high persistent symptoms. The Writing for Insight, Strength, and Ease trial evaluated the use of expressive helping during peritransplant, when symptoms peak and early intervention could prevent the development of persistent symptoms.

Three hundred sixty-six adult blood cancer patients (44.3% female, 74.6% White, 13.4% Black, 11.5% Hispanic/Latinx) scheduled for allogeneic (33.9%) or autologous (66.1%) transplant were randomized to complete either expressive helping or a neutral writing task in four writing sessions beginning pretransplant and ending 4 weeks posthospital discharge. Symptom severity (primary outcome), distress (depressive symptoms, generalized and cancer-specific anxiety), health-related quality of life, and fatigue were measured in multiple assessments from prerandomization to 12 months postintervention. Primary endpoints at 3 and 12 months postintervention estimated short- and long-term intervention effects. Moderation analyses explored subgroup differences in intervention efficacy.

Mixed models with repeated measures analyses revealed no statistically or clinically significant intervention effects on primary or secondary outcomes. Moderation analyses did not identify subgroups of participants who benefitted from the intervention.

Findings do not support use of expressive helping during peritransplant. We recommend that survivors with persistent symptoms complete expressive helping at least 9 months posttransplant, consistent with evidence from a prior trial. (PsycInfo Database Record (c) 2025 APA, all rights reserved).