Patients with ovarian cancer are faced with a variety of stressors including diagnosis, treatment decisions, treatment side-effects, and disruption of their normal daily lives including their professional, family, and social lives. It has been suggested that these patients may be prone to increased anxiety, depression, sexual problems, fear of recurrence, and uncertainty about the future. This may lead to poor quality of life in these patients. In addition, spouses of patients may experience psychological distress and diminished quality of life. This is of concern because spouses/partners often provide emotional support to the patient, but may be too overwhelmed by their own fears and therefore feel unable to provide adequate support to their partner. This may lead to poor communication and relationship difficulties in the couple. This suggests that psychological interventions are needed for both patients and their spouses/partners in order to help them deal with the psychological issues brought about by the diagnosis and treatment of ovarian cancer.

The proposed study will examine the effects of a psychological intervention that encourages emotional expression in ovarian cancer patients and their partners. The intervention will follow the well-established emotional disclosure paradigm published by Pennebaker, in which participants are asked to write about their thoughts and emotions regarding a stressful or traumatic experience (in this case their experience with cancer). This proposal is based on ample research evidence regarding the importance of emotional expression in health; during times of stress people tend to have a need to express their emotions, which is thought to be a healthy process that helps people deal with stressful experiences. Research has shown that the expression of emotions has mental and physical health benefits in a variety of populations including cancer patients. Our own research has shown the beneficial psychological effects in gynecological cancer patients. However, individuals with cancer often are unable to express their emotions because of fears of stigmatization or lack of support. In addition, ovarian cancer patients may have to deal with intensely personal issues (e.g., sexual problems) that are not easily discussed in a social setting. This suggests that these patients may be particularly prone to inhibiting their emotions, which may have detrimental psychological and health effects. The expressive writing intervention that will be used in the proposed study has been successful in evoking disclosure of very personal topics even ones that subjects had not previously discussed with others. Most importantly, this intervention has caused long-term improvements in physical health, psychological well-being, and physiological functioning in a number of randomized controlled studies. In our pilot study, we have obtained a 100% completion rate among patients enrolled in the study, supporting the idea that the minimal burden that this intervention poses for participants may help to maximize compliance rates as compared to more complex interventions.

The aims of the study are as follows: (1) to assess the effectiveness of a brief expressive writing intervention on quality of life and psychological symptoms in ovarian cancer patients and their partners and on physical symptoms in patients; (2) to test possible mechanisms for these effects; (3) to identify those patients and partners who may be most likely to benefit from this type of intervention by examining various moderators of the effects, including pre-existing sources of emotional expression, social support, and disease characteristics (e.g., disease stage, time since diagnosis). Ovarian cancer patients (n=130) and their partners will be randomly assigned to an intervention or a control group. Following Pennebaker¿s model, subjects in the intervention group will be asked to write about their deepest thoughts and feelings regarding their cancer experience for 20 minutes each day for three consecutive days. The control group will be asked to write about trivial nonemotional topics. Outcome variables including psychological distress, quality of life, and physical symptoms will be assessed at baseline and over a period of nine months after the intervention (1 week, 3, 6, and 9 months).