A Virtual, Group-Based Expressive Writing Intervention for Survivors of Adolescent and Young Adult Cancer: Protocol...

Survivors of adolescent and young adult (AYA) cancer (ages 15-39 y at diagnosis) face persistent psychosocial challenges, including isolation from peers, identity disruption, and unmet supportive care needs. Approximately 90,000 AYAs are diagnosed with cancer annually in the United States, and 86% survive at least 5 years. However, few age-appropriate, scalable, and developmentally tailored online psychosocial interventions exist for this population. Expressive writing (EW) shows promise for improving psychological well-being in survivors of AYA cancer, but traditional individual approaches do not address the preference of AYAs for peer support. A virtual, group-based EW intervention combining private emotional processing with facilitated peer discussion may address multiple unmet needs.

The primary objective is to evaluate the feasibility and acceptability of a virtual, group-based EW intervention tailored for survivors of AYA cancer. Secondary objectives are to explore preliminary changes in quality of life and psychosocial outcomes, including perceived stress, coping self-efficacy, cancer-related intrusive thoughts, self-compassion, and posttraumatic growth.

This single-arm feasibility study enrolls 30 survivors of AYA cancer who were diagnosed at ages 15 to 39 years; are 18 to 39 years old at study entry; are 1 to 5 years postdiagnosis; can speak, read, and write in English; and have regular internet access. Participants are assigned to 1 of 3 groups of 10 on the basis of developmental-stage preferences: emerging adults (18-25 y), young adults (26-39 y), or a mixed-age group (18-39 y). The 8-week intervention consists of 4 private writing sessions of 20 minutes each (odd-numbered weeks), alternating with 4 facilitated group discussions on a closed Facebook platform (even-numbered weeks). All procedures are conducted online, with questionnaires and private writings delivered via REDCap (Research Electronic Data Capture). Primary outcomes include feasibility (success criteria: ≥75% of participants complete assessments; ≥75% complete ≥1 private writing sessions; ≥70% complete all private writing sessions; ≥75% complete ≥1 group discussions; ≥70% complete all group discussions) and acceptability (success criterion: mean score ≥3 on a 0-4 scale). Secondary and exploratory outcomes are assessed at baseline and at 1-month and 3-month follow-ups. Qualitative data are collected through semistructured interviews, open-ended responses, private essays, and group posts or comments and analyzed using the constant comparative method.

This study was funded in September 2024. Recruitment was completed between June 25 and July 7, 2025. Participants are currently completing 3-month follow-up assessments. Data management is expected to be completed by May 2026, and the results will be submitted for publication by the end of 2026.

This study provides critical feasibility and acceptability data for the first developmentally adapted, virtual, group-based EW intervention for survivors of AYA cancer. The findings will inform the optimization and design of a randomized controlled trial to evaluate the intervention's efficacy in improving outcomes for this population.