Randomized Controlled Trial of Expressive Writing for Patients With Renal Cell Carcinoma
Randomized Controlled Trial of Expressive Writing for Patients With Renal Cell Carcinoma
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DOI：
10.1200/jco.2013.50.3532
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发表时间：
2014-03-01
影响因子：
45.3
通讯作者：
Cohen, Lorenzo
中科院分区：
文献类型：
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作者：
Milbury, Kathrin;Spelman, Amy;Cohen, Lorenzo
目的本随机对照试验研究了表达性书写（EW）干预对肾细胞癌（RCC）患者生活质量的益处，并确定了干预有效性的潜在潜在机制。患者和方法I至IV期RCC患者（N = 277）被随机分配写下他们对癌症（EW）或中性话题的最深想法和感受（Neutral Writing [NW]）在四个不同的场合。患者在基线和干预后1、4和10个月完成流行病学研究中心抑郁量表（CES-D）、MD安德森症状量表（MDASI）、简明疲劳量表（BFI）、匹兹堡睡眠质量指数（PSQI）、医学结局研究简表-36（SF-36）和事件影响量表（IES）。（28% IV期; 41%女性）为58岁。使用Bonferroni校正= 0.021对6个结局进行多水平建模分析，调整结局之间的相关性，结果显示，相对于NW组，EW组患者在干预后10个月时报告的MDASI评分显著降低（P = 0.003），SF-36的身体成分总分显著升高（P = 0.019）。中介分析显示，10个月时MDASI评分的显著组间差异由EW组干预后1个月时较低的IES评分介导（P = .042）。两组患者的BFI、CES-D、PSQI、SF-36的心理健康量表总分无显著性差异。结论西医治疗肾细胞癌可减轻患者的癌症相关症状，改善患者的躯体功能。有证据表明，这种效果可能通过认知过程的短期改善而发生。
Purpose 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.Patients and 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 = .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.Conclusion 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.