Randomized controlled trial of expressive writing for patients with renal cell carcinoma

Abstract

Purpose: This randomized controlled trial examined the quality-of-life benefits of an expressive writing (EW) intervention for patients with renal cell carcinoma (RCC) and identified a potential underlying mechanism of intervention efficacy.

Patients and methods: Patients (N = 277) with stage I to IV RCC were randomly assigned to write about their deepest thoughts and feelings regarding their cancer (EW) or about neutral topics (neutral writing [NW]) on four separate occasions. Patients completed the Center for Epidemiologic Studies Depression Scale (CES-D), MD Anderson Symptom Inventory (MDASI), Brief Fatigue Inventory (BFI), Pittsburgh Sleep Quality Index (PSQI), Medical Outcomes Study Short Form-36 (SF-36), and Impact of Event Scale (IES) at baseline and 1, 4, and 10 months after the intervention.

Results: The mean age of participants (28% stage IV; 41% female) was 58 years. Multilevel modeling analyses, using a Bonferroni-corrected α = .021 for six outcomes adjusted for the correlation among outcomes, revealed that, relative to the NW group, patients in the EW group reported significantly lower MDASI scores (P = .003) and higher physical component summary scores on the SF-36 (P = .019) at 10 months after the intervention. Mediation analyses revealed that significant group differences for MDASI scores at 10 months were mediated by lower IES scores at 1 month after the intervention in the EW group (P = .042). No significant group differences were observed in the BFI, CES-D, PSQI, and mental component summary of the SF-36.

Conclusion: EW may reduce cancer-related symptoms and improve physical functioning in patients with RCC. Evidence suggests that this effect may occur through short-term improvements in cognitive processing.

Trial registration: ClinicalTrials.gov NCT00505310.

Fig 1.

CONSORT flow diagram. EW, expressive writing; NW, neutral writing.

Fig 2.

Hypothesized intervention mediation model.

Fig 3.

Least square means for (A) cancer-related symptoms (MD Anderson Symptom Inventory [MDASI]); (B) fatigue (Brief Fatigue Inventory [BFI]); and (C) physical function aspects of quality of life (Medical Outcomes Study Short Form-36, Physical Component Summary [SF-36 PCS]). Higher scores represent greater symptoms (MDASI and BFI) or better quality of life (SF-36 PCS). Group mean difference: (*) P < .05; (†) P < .01. EW, expressive writing; NW, neutral writing.

Fig 4.

Baseline and 1-month (T2) postintervention group differences for intrusive thoughts and avoidance behaviors (Impact of Events Scale [IES]). At baseline, raw means are depicted. At T2, least square means controlling for baseline levels, stage, age, sex, and education are depicted. Group mean difference: (*) P = .53. EW, expressive writing; NW, neutral writing.