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Effect of prolonged expressive writing on health outcomes in breast cancer patients receiving chemotherapy: a multicenter randomized controlled trial

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Abstract

Purpose

This study aims to evaluate the effects of prolonged expressive writing on health outcomes in breast cancer patients undergoing chemotherapy to help understand how the dosage of an expressive writing intervention might moderate its effects.

Methods

A total of 112 breast cancer patients undergoing chemotherapy were randomly allocated to the expressive writing group (n = 56) or the prolonged expressive writing group (n = 56). The expressive writing group received the standard expressive writing intervention based on Pennebaker’s prompt to write for at least 20 min over four consecutive days (4 sessions). The prolonged expressive writing group used a modified prompt: write for at least 20 min 3 times a week over a 4-week period (12 sessions); patients could choose whether to write on consecutive days or not. All participants were required to write about their stressor-related upsetting or traumatic feelings about breast cancer. Outcomes were assessed and compared at baseline, as well as 1 month, 3 months, and 6 months postintervention.

Results

There was no significant difference in the patients’ quality of life, or physical and psychological wellbeing between the expressive writing group and the prolonged expressive writing group at any time point (all p > .05). The quality of life of breast cancer patients significantly decreased in the two groups over time (F = 40.64, p < .001).

Conclusion

Our findings suggest that the writing dosage does not moderate the effects of expressive writing on breast cancer patients undergoing chemotherapy.

Trial registration

ChiCTR1800016278

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Data availability

The corresponding author has full control of all primary data. Primary data are available on request.

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Acknowledgments

We express our sincere gratitude to all the study participants and clinic staff in the five tertiary hospitals for their support with the trial. We thank Pro. Shengli An from the Department of Biostatistics from Southern Medical University for her help with the statistical analysis of the manuscript.

Funding

The study was funded by the Medical Scientific Research Foundation of Guangdong Province, China (grant number A2018090). The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

Author notes

  1. Yanni Wu, Liping Liu, Wanting Zheng, Chunrao Zheng, Min Xu, Xiaohong Chen and Wenji Li contributed equally to this work.

Authors and Affiliations

  1. Nanfang Hospital, Southern Medical University, NO.1838 North Guangzhou Avenue, Baiyun District, Guangzhou City, Guangdong Province, China

    Yanni Wu, Liping Liu, Wenji Li & Chunlan Zhou

  2. Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, People’s Republic of China

    Wanting Zheng & Lijun Xie

  3. Shenzhen People’s Hospital, Shenzhen, Guangdong, People’s Republic of China

    Chunrao Zheng & Pengyan Zhang

  4. Cancer Center of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China

    Min Xu & Xiaoli Zhu

  5. The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, People’s Republic of China

    Xiaohong Chen & Chuanglian Zhan

Authors
  1. Yanni Wu
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Corresponding author

Correspondence to Chunlan Zhou.

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Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent statement

The trial was approved by the involved hospitals, including the Medical Ethics Committee of Nanfang Hospital (reference number: NFEC-2018-049), The Affiliated Hospital of Guangdong Medical University (reference number: PJ2018-029), The Cancer Center of Guangzhou Medical University (reference number: 2018-003), The First Affiliated Hospital of Shantou University Medical College (reference number: 2018-039), and Shenzhen People’s Hospital (reference number: 2018-029). Written informed consent was obtained from each participant prior to the study.

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Wu, Y., Liu, L., Zheng, W. et al. Effect of prolonged expressive writing on health outcomes in breast cancer patients receiving chemotherapy: a multicenter randomized controlled trial. Support Care Cancer 29, 1091–1101 (2021). https://doi.org/10.1007/s00520-020-05590-y

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  • DOI: https://doi.org/10.1007/s00520-020-05590-y

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