A randomized controlled trial of expressive writing in breast cancer survivors with lymphedema

Abstract

Objective: Breast cancer survivors who develop lymphedema report poorer quality of life (QoL) than those without lymphedema. Expressive writing is a potential intervention to address QoL.

Design: Adult women (N = 107) with breast cancer and chronic Stage II lymphedema were randomised to writing about thoughts and feelings specific to lymphedema and its treatment (intervention) or about daily activities (control) for four, 20-min sessions.

Main outcome measures: Outcome measures were several indicators of QoL assessed at baseline, one, three, and six months post-intervention (total scores and subscales of Upper Limb Lymphedema 27 and Functional Assessment of Cancer Therapy-Breast). Hypothesised moderators of change in QoL were dispositional optimism, avoidant behaviours, and time since lymphedema diagnosis.

Results: There was no statistically significant intent-to-treat main effects of expressive writing on QoL. Statistically significant moderating effects on change in different indicators of QoL were observed for all three moderators. Expressive writing was more effective for improving QoL in women who were higher on optimism, lower on avoidance and had less time since a lymphedema diagnosis.

Conclusion: These results provide further evidence that there are subsets of individuals for whom expressive writing is more effective. Future research may investigate targeting expressive writing based on identified moderators.

Keywords: breast cancer; lymphedema; oncology; psychology; quality of life; writing.

Figure 1

Study Flow Diagram

Figure 2a

Interaction of baseline levels of optimism with study group on change in quality of life (Upper Limb Lymphedema-27; ULL-27) from baseline to 3-months on study.

Figure 2b

Interaction of baseline levels of avoidant behavior and study group on change in quality of life (Functional Assessment of Cancer Therapy–Breast; FACT-B) from baseline to 1-month on study.

Figure 2c

Interaction of time since lymphedema diagnosis and study group on change in quality of life (Upper Limb Lymphedema-27; ULL-27) from baseline to 3-months on study.