Effects of Structured Expressive Writing on Quality of Life and Perceived Self-Care Self-Efficacy of Breast Cancer Patients Undergoing Chemotherapy in Central China: A Randomized Controlled Trial

Effects of WeChat-based EPIC training on health-related quality of life, attribution and life attitude in women newly diagnosed with breast cancer: a clinical randomized controlled trial

PURPOSE

When confronted with healthy functional impairments, the attribution of disease-induced distress plays a key role in the prognosis of health outcomes. This study examined the effects of an attribution-related intervention, namely WeChat-based EPIC (enter, practice, intensify, consolidate) training, on health-related quality of life (HRQoL), attribution, and life attitude in women newly diagnosed with breast cancer.

METHODS

Eligible patients were recruited using convenience sampling and randomly assigned to the intervention or control group via stratified block randomization. The former received WeChat-based EPIC training plus routine nursing care for 6 months. The latter received only routine nursing care. HRQoL (primary indicator), attribution and life attitude (secondary indicators) were measured using the Functional Assessment of Cancer Therapy-Breast version 4.0 (FACT-Bv4.0), Attributional Style Questionnaire (ASQ) and Life Attitude Self-rating Questionnaire for Breast Cancer (LASQ-BC), respectively. A linear mixed model was used to examine the score fluctuations at the 1-, 3-, and 6-month intervals relative to the baseline.

RESULTS

After 6 months, the intervention group (n = 84) showed statistically significant higher total scores in the FACT-Bv4.0 [mean difference: - 15.01; 95% confidence interval: - 17.96, - 12.07; p < 0.001], ASQ [- 4.16 (- 4.45, - 3.86); p < 0.001], and LASQ-BC [- 6.77 (- 8.27, - 5.27); p < 0.001] than that of the control group (n = 82). The total scores of the three indicators also showed significant group, time, and group-by-time interaction effects (p < 0.001).

CONCLUSION

The WeChat-based EPIC training was an effective intervention for improving HRQoL and psychological health in women newly diagnosed with breast cancer.

TRIAL REGISTRATION

Chinese Clinical Trial Registry www.chictr.org.cn , prospectively registered on 11 April 2020, ChiCTR2000031827.

Effects of expressive writing of positive emotions on mental health among patients with ovarian cancer undergoing postoperative chemotherapy

PURPOSE

Patients with ovarian cancer often experience significant psychological distress during postoperative chemotherapy, including anxiety and depression. Expressive writing of positive emotions has shown potential in improving psychological health and fostering post-traumatic growth (PTG) in cancer patients. However, its application to ovarian cancer patients undergoing chemotherapy remains under-explored.

METHODS

A quasi-experimental study was conducted with 82 ovarian cancer patients undergoing postoperative chemotherapy at a tertiary hospital in Changchun, China. Patients were divided into an experimental group (n = 40) receiving expressive writing intervention and a control group (n = 42) receiving routine care. Outcomes were assessed using the Post-Traumatic Growth Inventory (PTGI), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) at baseline and after a 6-week intervention.

RESULTS

After the intervention, the experimental group exhibited significantly higher PTGI scores (mean ± SD: 73.43 ± 6.95) compared to the control group (63.19 ± 5.91, P < 0.001), with improvements observed across all five PTG dimensions (P < 0.05). The experimental group also showed a greater reduction in SAS (mean ± SD: 38.25 ± 4.31 vs. 45.12 ± 5.17, P < 0.001) and SDS scores (mean ± SD: 42.10 ± 3.86 vs. 48.75 ± 4.62, P < 0.001).

CONCLUSIONS

Expressive writing of positive emotions significantly enhances PTG and reduces anxiety and depression in ovarian cancer patients undergoing chemotherapy. This intervention offers a cost-effective and feasible approach for psychological support in clinical settings.

The Effect of Expressive Writing on the Experiences of Head and Neck Cancer Patients Undergoing Radiotherapy: A Randomized Controlled Trial

BACKGROUND

Expressive writing (EW) has emerged as an innovative strategy for improving mood and quality of life. Nevertheless, insufficient research has been conducted on the impact of offering EW to patients with HNC. Therefore, the purpose of this study was to investigate the effects of two forms of EW on anxiety, depression, nutrition, and sleep quality in HNC patients undergoing radiotherapy.

METHODS

We conducted a single-blind, pretest, posttest, three-group randomized controlled trial. A total of 147 patients with HNC were randomly assigned to a benefit-finding writing group, neutral writing group, or control group. The intervention group patients performed EW during radiotherapy, with each writing session lasting 20 min, once a week for 4 consecutive weeks. Patient anxiety, depression, nutritional status, and sleep quality were measured at baseline (T0) and at the end of radiotherapy (T1).

RESULTS

After 4 weeks of intervention, patients in the BF and NW groups experienced improvements in anxiety, depression, and sleep (p < 0.05) compared with those in the CG group, but the intervention did not significantly affect patients' nutritional status (p > 0.05). Compared with those in the CG, anxiety in the BF and NW groups slowed down the trend of increasing anxiety, and repeated measures analysis revealed a significant group × time interaction (p = 0.017, F = 4.205, η2 = 0.059). Compared with those in the CG, the depression levels in the BF and NW groups were lower than those at baseline, and repeated measurement analysis revealed that the interaction effect between group × time was significant (p = 0.000, F = 16.262, η2 = 0.194). The sleep quality in the CG progressively worsened from T0 to T1 (p < 0.01), whereas in the BF, it progressively improved (p < 0.01).

CONCLUSIONS

This study provides preliminary evidence that two forms of EW are effective in alleviating anxiety and depression and improving sleep in patients with HNC but are not effective in improving their nutritional status.

TRIAL REGISTRATION

ChiCTR2400084964.

Systematic review and meta-analysis of the effectiveness of expressive writing disclosure on cancer and palliative care patients' health-related outcomes

OBJECTIVES

This review aimed to synthesize the available evidence on the effectiveness of expressive writing (EW) on health outcomes of patients with cancer.

METHODS

A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Six databases were searched from 1986 to 9 July 2022. The searches were updated on 3 October 2023. Methodological quality was assessed using the Cochrane Risk of Bias tool for randomized controlled trials (RCTs) and ROBINS-I tool for non-RCTs Mixed Methods Appraisal Tool. Narrative synthesis of outcomes was performed where meta-analysis was not appropriate.

RESULTS

Thirty-four studies with 4316 participants were identified, including 31 RCTs and three non-RCTs. Twenty-one studies focused on women with breast cancer; the remainder recruited people with various cancer types. There was a significant improvement in fatigue (SMD =  - 0.3, 95% CI - 0.55 to - 0.66, P = .002), passive mood (MD =  - 3.26, 95% CI =  - 5.83 to - 0.69, P = 0.001), and the physical dimension of quality of life (MD = 3.21, 95% CI 0.18 to 6.25, P = 0.04) but not for anxiety, depression, and global quality of life among patients who participated in EW when compared with control groups.

CONCLUSION

Findings showed some benefits of EW for people with cancer, but not necessarily in anxiety or depression. Heterogeneity in the delivery of interventions and their content, and shortcomings in the methodologies used highlight the need for stronger evidence in the field through high-quality trials and consistencies in the protocol, focusing on outcomes that this review highlighted as potential outcome targets.