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


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.


CONCLUSIONS
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.
All authors: The University of Texas MD Anderson Cancer Center, Houston, TX.
Kathrin
K
Milbury
Amy
A
Spelman
Christopher
C
Wood
Surena F
SF
Matin
Nizar
N
Tannir
Eric
E
Jonasch
Louis
L
Pisters
Qi
Q
Wei
Lorenzo
L
Cohen
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000523:psychology*; D003071:Cognition; D003863:Depression / Q000209:etiology; D004644:Emotions; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012893:Sleep Wake Disorders / Q000209:etiology; D013315:Stress, Psychological / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D016896:Treatment Outcome; D014956:Writing