Expressive writing reduces cancer-related symptoms and improves quality of life

In the largest expressive writing trial conducted on an oncology population, researchers from MD Anderson found those patients who recorded their deepest thoughts and emotions saw improved physical functioning and quality of life.

A cancer diagnosis may be experienced as a traumatic event causing depressive symptoms, sleep disturbance, fatigue and intrusive thoughts for patients. Managing the response to these thoughts and symptoms is an important aspect of patient care because they affect quality of life.

Additionally, research has shown the poor management of these symptoms has the potential to elevate inflammation in the body, which can contribute to tumor progression. The study, published in the Journal of Clinical Oncology, and led by Lorenzo Cohen, Ph.D., enrolled 284 patients diagnosed with stage I - IV renal cell carcinoma from 2006 - 2009.

Patients were randomly assigned to either an expressive writing group (EW) or neutral writing group (NW). Neutral writing included general thoughts about dietary behaviors, sleep and attitudes toward smoking, whereas expressive writing focused on a patient's deepest most personal thoughts. Patients in both groups were prompted to write on just four separate occasions.

Participants in both groups completed a series of questionnaires measuring intrusive thoughts, cancer-related symptoms (MDASI), fatigue (BFI), depressive symptoms (CES-D), sleep disturbances (PSQI) and overall quality of life (SF-36).

Ten months after the intervention, where the most pronounced group differences occurred, MDASI scores were significantly lower for those in the EW group than NW group and the EW group reported better physical functioning aspects of quality of life.

Fatigue levels were also moderately lower for those in the EW group compared to the NW group. At the one-month follow-up point, the data revealed patients in the EW group reported fewer intrusive thoughts compared to patients in the NW group, and this is what led to improvements in cancer-related symptoms and fatigue levels at 10 months.

The authors note previous research on this subject primarily focused on women with breast cancer, however the findings suggest expressive writing could benefit men and women with different forms of disease. They also note that considering the findings in light of an entirely self-administered, brief, safe, and virtually no-cost intervention, EW seems to be a promising supportive care approach.

Additional work is needed to evaluate subgroups of patients, such as those lacking social support, who might see increased benefits. Cohen said upcoming work related to the study will evaluate biologic markers including saliva and blood, to potentially establish bio-behavioral processes behind the outcomes.

For more information on other integrative medicine research and therapies benefiting physical, psycho-spiritual and social health, visit MD Anderson's Integrative Medicine Program.