“Women with ovarian cancer experience an average of 14 concurrent symptoms, so symptom management is very complex. It can be overwhelming for patients and challenging for providers, who may not have time to address these symptoms in a typical 15-minute appointment,” said lead author Heidi Donovan, PhD, RN, professor of health and community systems in Pitt’s School of Nursing and Obstetrics, Gynecology and Reproductive Services in the School of Medicine. “That’s why we developed a symptom management approach outside of a normal clinical setting, from the comfort of a woman’s own home.”
Ovarian cancer is a “low incidence, high impact cancer,” according to her. In 2022, about 20,000 women will be diagnosed with ovarian cancer in the United States, and more than 12,000 will die. For many patients, the cancer recurs after two to three years who have been treated successfully.
“There’s a vast difference in quality of life between patients who manage symptoms successfully and those who don’t, both throughout chemotherapy and afterwards,” said Donovan, who is also director of the Gynecologic Oncology Family CARE Center at UPMC Magee-Womens Hospital. “Effective symptom management requires that patients follow directions from providers but also be willing to communicate, make adjustments and try new strategies.”
She and her team had developed a new symptom management approach called “Written Representational Intervention to Ease Symptoms, or WRITE Symptoms,” which guides patients to reflect on how they experience a symptom: what causes it, what makes it worse, how it feels, how it impacts their daily life, and how they’ve tried to manage it.
“The WRITE approach blends health psychology with educational principles,” explained Donovan. “The process of talking or writing about a symptom in a systematic way can help women understand which management strategies work and which don’t. Using evidence-based symptom management techniques, we then help patients develop strategies for addressing target symptoms. Later, patients review the strategies and assess if changes need to be made. It’s a very iterative process.”
The researchers recruited 497 patients with recurrent or persistent ovarian, fallopian tube, or primary peritoneal cancers. After participants had completed surveys on symptom load, control, and quality of life, they were assigned to approximately one of three groups, after selecting the three target symptoms they preferred for best control.
One group completed a nurse-led WRITE intervention in which nurses guided patients through an asynchronous web-based message board. The second group guided themselves through the full computer-mediated version of WRITE. The third, or improved routine maintenance team, did not finish writing and acted as a controller.
The analysis found that both WRITE interventions improved a woman’s symptom control after eight weeks, and these measures were significantly higher compared to advanced routine care.
“To see the same benefits in both the nurse-led and fully computer-mediated versions of the program is really powerful,” said Donovan. “We also found that the self-led program was much more efficient: people were able to develop a symptom management plan in about 30 minutes compared to a few weeks with the asynchronous, nurse-led version.”
Researchers are now developing a mobile health app that will help family members and other caregivers better manage their symptoms for those with ovarian cancer. Based on the computer-mediated version of WRITE, the application will guide users through questionnaires and problem-solving exercises, as well as disease-specific modules and key modules. For patients who need additional support, there may also be an option to partner with providers. According to Donovan, this application may be offered to families of gynecological cancer outpatients next year or so.
This research was funded by the National Institute of Nursing Research (R01NR010735/NRG GOG-259) and the National Cancer Institute (U10CA180822, U10CA180868, and UG1CA189867).