A digital media attention diversion improves mood and fear in patients receiving chemotherapy for recurrent gynecologic malignancies: results of a randomized trial

• Authors: Ryan J. Spencer, University of Wisconsin; Vinita Alexander, Emory University; Jens Eickhoff, University of Wisconsin; Kaitlin M. Woo, University of Wisconsin; Erin Costanzo, University of Wisconsin; Nick Marx, Colorado State University; Stephen L. Rose, University of Wisconsin
• Journal Title: International Journal of Gynecological Cancer
• Volume: Volume 30, Number 4
• Publisher: BMJ Publishing Group | 2020-03-01, Pages 525-532
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1136/ijgc-2019-001185
• Subjects: Health Sciences, Oncology; Health Sciences, Rehabilitation and Therapy; Health Sciences, Obstetrics and Gynecology; Biology, Biostatistics
• Keywords: Quality of life; cancer recurrence; attention diversion; chemotherapy

Abstract

Background: Recurrent gynecologic cancer patients experience symptoms that affect psychological, emotional, social and physical well-being. Chemotherapy can further exacerbate these symptoms. Poor mood, pain and fatigue are linked and are detrimental to quality of life. Interventions targeting these symptoms may improve patient-reported outcomes and performance status. Objectives: To determine the ability of a humorous digital media attention diversion to improve symptom domains of positive and negative mood during chemotherapy for patients with recurrent gynecologic cancers. Study design: This randomized, crossover clinical trial enrolled women with recurrent gynecologic cancers. Subjects participated over 3 cycles of chemotherapy. The primary outcome was the change in mood on the validated PANAS-X instrument, which measures positive and negative affect domains. All subjects completed the PANAS-X after receiving chemotherapy during cycle 1 on study. In Arm 1, subjects watched their choice of humorous movies on a digital media device while receiving chemotherapy during cycle 2 on study. They selected from non-humorous movies during cycle 3 on study. In Arm 2, the order of movies was reversed. After each cycle, mood, fatigue and other patient reported outcomes were assessed for comparison with baseline measurements. Results: The target enrollment of 66 subjects was achieved. Subjects watched humorous content for an average of 96.0 minutes and non-humorous content for an average of 62.5 minutes. Negative mood improved after exposure to humorous (p=0.017) and non-humorous content (p=0.001). Patient-reported fear also improved after exposure to both humorous (p=0.038) and non-humorous content (p=0.002). Subjects reported higher use of affiliating and self-effacing humor types. Conclusion: Offering patients a choice of digital media during chemotherapy significantly improved negative mood and fear. This was seen with both humorous and non-humorous content. This low-cost and low-risk intervention should be implemented as an attention diversion to improve negative mood and fear for patients receiving chemotherapy.