Self-affirmation intervention for patients newly diagnosed with advanced cancer: a preliminary efficacy trial

Abstract

Objective: Cancer diagnosis represents a life crisis. It remains unclear whether/what psychosocial intervention may enhance cancer patients' quality of life (QoL) during existential plight. This study aimed to examine preliminary efficacy of a brief writing intervention for patients newly diagnosed with advanced cancer with a focus on affirming personally important values and beliefs.

Methods: This is a single-arm pilot study testing effect of a 4-week home-based self-affirmation writing intervention for patients newly diagnosed with advanced cancer using interrupted time series design (NCT05235750). Patients were eligible if they were newly diagnosed (within 8 weeks) with advanced stage (III or IV) or recurrent cancer. Longitudinal analyses were performed using generalized linear mixed model incorporating the correlation of repeated measures. All statistical analyses were performed at 5% significance level using SAS^® (version 9.4).

Results: Fifty-seven patients newly diagnosed with advanced stage cancer with a mean age of 63 years balanced in gender were enrolled. Intent-to-treat analysis revealed significant post-intervention change for Faith as measured by the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being 12 item scale (FACIT-Sp-12) (ES 0.23, p = .05) and Ge6 "I worry that my condition will get worse" as measured by the Functional Assessment of Cancer Therapy - General (FACT-G) (ES 0.26, p = .10). When comparing changes pre- and post-intervention, Ge6 remained clinically significant (ES_Δ 0.36, p = .27).

Conclusions: Self-affirmation via writing showed initial short-term efficacy in relieving cancer-specific existential concerns (Ge6 "I worry that my condition will get worse") and may be a promising innovative intervention approach that warrant randomized experiments to verify. Further research is also needed to find out who may most likely benefit from this intervention.

Keywords: Advanced cancer; Self-affirmation; existential plight; psychological adaptation; quality of life; writing intervention.