Expressive Writing Improves Symptoms and Physical Function in Patients With Renal Cell Carcinoma


Key Points

  • An expressive writing intervention was associated with significantly better outcomes in symptoms and physical functioning at 10 months.
  • Reduced intrusive thoughts and avoidance behavior at 1 month appeared to mediate the improvement in symptoms at 10 months.

In a trial reported in the Journal of Clinical Oncology, Milbury et al compared cancer symptoms, physical and mental function, depressive symptoms, fatigue, and sleep outcomes after sessions of expressive writing about cancer vs writing about neutral topics in patients with renal cell carcinoma. They found that expressive writing was associated with reduced cancer-related symptoms and improved physical functioning; the improvement in symptoms appeared to be mediated by an early reduction in intrusive thoughts and avoidance behaviors.

Study Details

In the trial, 277 patients with stage I to IV renal cell carcinoma were randomly assigned to write about their deepest thoughts and feelings regarding their cancer (expressive writing group, n = 138) or about neutral topics (neutral writing group, n = 139) in four separate sessions. Patients completed the Center for Epidemiologic Studies Depression Scale, MD Anderson Symptom Inventory, Brief Fatigue Inventory, Pittsburgh Sleep Quality Index, Medical Outcomes Study Short Form-36 (SF-36), and Impact of Event Scale at baseline and at 1, 4, and 10 months after the intervention.

The expressive writing group and neutral writing group were generally balanced for age (mean, 58 years in both), sex (60% and 62% male), race/ethnicity (76% and 81% white), proportion married (71% in both), proportion with some college or higher (73% and 79%), income (≥ $50,000 per year for 62% and 64%), employment status (59% and 50% full-time, 28% and 36% retired), cancer stage (I in 36% and 35%, II in 13% in both, III in 19% and 18%, IV in 29% and 30%), surgical treatment (71% and 70%), systemic treatment (38% and 37%), and proportion with clear cell histology (80% and 81%).

Improved Symptoms and Physical Function

Primary comparisons between groups included age, sex, and stage at diagnosis as a priori covariates and were subject to Bonferroni correction for multiple comparisons (α = .021 for significance). On multilevel modeling analysis, there were no significant differences between groups in fatigue (Brief Fatigue Inventory), depressive symptoms (Center for Epidemiologic Studies Depression Scale), sleep disturbance (Pittsburgh Sleep Quality Index), or mental functioning as measured by the SF-36 Mental Component Summary score.

However, the expressive writing group had significantly better outcomes in cancer-related symptoms on the MD Anderson Symptom Inventory (P = .003) and significantly better physical functioning as measured by the SF-36 Physical Component Summary score (P = .003) at 10 months. The improvement in symptoms appeared to be mediated by a significantly lower Impact of Event Scale score, indicating fewer intrusive thoughts and avoidance behaviors, at 1 month in the expressive writing group (P = .042). Mediation analysis also indicated that lower early scores on the Impact of Event Scale were associated with significantly better Brief Fatigue Inventory scores.

The investigators concluded, “[Expressive writing] may reduce cancer-related symptoms and improve physical functioning in patients with [renal cell carcinoma]. Evidence suggests that this effect may occur through short-term improvements in cognitive processing.”

Lorenzo Cohen, PhD, of The University of Texas MD Anderson Cancer Center, is the corresponding author for the Journal of Clinical Oncology article.

The study was supported by a National Cancer Institute grant.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.