A Virtual, Group-Based Expressive Writing Intervention for Survivors of Adolescent and Young Adult Cancer: Protocol for a Single-Arm Feasibility Study

Background: 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. Objective: 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. Methods: 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. Results: 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. Conclusions: 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.