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.

Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

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.