***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The psychological response to breast cancer , such as a fighting spirit or an attitude of helplessness and hopelessness toward the disease , has been suggested as a prognostic factor with an influence on survival . We have investigated the effect of psychological response on disease outcome in a large cohort of women with early-stage breast cancer . METHODS 578 women with early-stage breast cancer were enrolled in a prospect i ve survival study . Psychological response was measured by the  mental adjustment to cancer ( MAC ) scale , the Courtauld emotional control ( CEC ) scale  , and the  hospital anxiety and depression ( HAD ) scale 4 - 12 weeks and 12 months after diagnosis . The women were followed up for at least 5 years . Cox 's proportional-hazards regression was used to obtain the hazard ratios for the measures of psychological response , with adjustment for known clinical factors associated with survival . FINDINGS At 5 years , 395 women were alive and without relapse , 50 were alive with relapse , and 133 had died . There was a significantly increased risk of death from all causes by 5 years in women with a high score on the HAD scale category of depression ( hazard ratio 3.59 [ 95 % CI 1.39 - 9.24 ] ) . There was a significantly increased risk of relapse or death at 5 years in women with high scores on the helplessness and hopelessness category of the MAC scale compared with those with a low score in this category ( 1.55 [ 1.07 - 2.25 ] ) . There were no significant results found for the category of " fighting spirit " . INTERPRETATION For 5-year event-free survival a high helplessness/hopelessness score has a moderate but detrimental effect . A high score for depression is linked to a significantly reduced chance of survival ; however , this result is based on a small number of patients and should be interpreted with caution PURPOSE Evidence that psychosocial status and health-related quality of life ( HRQOL ) are associated with breast cancer ( BC ) outcomes is weak and inconsistent . We examined prognostic effects of these factors in a prospect i ve cohort study . PATIENTS AND METHODS Three hundred ninety-seven women with surgically resected T1 to T3 , N0/N1 , M0 BC completed the European Organization for Research and Treatment of Cancer Quality of Life Question naire ( Core 30 items ) , Profile of Mood States , Psychosocial Adjustment to Illness Scale , Impact of Events Scale , Mental Adjustment to Cancer Scale  , and the  Courtauld Emotional Control Scale 2 months after diagnosis and 1 year later . Data on tumor-related factors , treatment , and outcomes were obtained prospect ively from medical records , and Cox survival analyses were performed . RESULTS Mean age was 52.0 + /- 9.9 years . Two hundred twenty-five women had T1 , 136 women had T2 , 16 women had T3 , and 20 women had TX tumors ; 127 were N1 . One hundred thirteen women received adjuvant chemotherapy , 130 received hormone therapy , 45 received both , and 109 received neither . We investigated 140 prognostic associations ; four were found to be statistically significant at a P value of < /= .05 ( three fewer than expected by chance ) . Two were in the hypothesized direction of effect , and two were in the opposite direction . All arose from measurements 1 year after diagnosis , which were most susceptible to confounding by treatment . There was no evidence of consistency of associations across outcomes or question naires . These results are in keeping with chance as the explanation for our statistically significant findings . CONCLUSION HRQOL and psychosocial status at diagnosis and 1 year later are not associated with medical outcome in women with early-stage BC The current study assessed main effects and moderators ( including emotional expressiveness , emotional processing , and ambivalence over emotional expression ) of the effects of expressive writing in a sample of healthy adults . Young adult participants ( N=116 ) were r and omly assigned to write for 20 minutes on four occasions about deepest thoughts and feelings regarding their most stressful/traumatic event in the past five years ( expressive writing ) or about a control topic ( control ) . Dependent variables were indicators of anxiety , depression , and physical symptoms . No significant effects of writing condition were evident on anxiety , depressive symptoms , or physical symptoms . Emotional expressiveness emerged as a significant moderator of anxiety outcomes , however . Within the expressive writing group , participants high in expressiveness evidence d a significant reduction in anxiety at three-month follow-up , and participants low in expressiveness showed a significant increase in anxiety . Expressiveness did not predict change in anxiety in the control group . These findings on anxiety are consistent with the matching hypothesis , which suggests that matching a person 's naturally elected coping approach with an assigned intervention is beneficial . These findings also suggest that expressive writing about a stressful event may be contraindicated for individuals who do not typically express emotions This investigation examined relationships between breast cancer patients ' psychosocial characteristics ( impact of the illness , traumatic stress symptoms , emotional self-efficacy , and social support ) and problems they perceived in their medical interactions and their satisfaction with their physicians . Participants were 352 women enrolled in a multicenter trial of the effects of group therapy for women with recently diagnosed primary breast cancer . The findings reported here are from a cross-sectional analysis of baseline data gathered prior to r and omization . Problems interacting with physicians and nurses were associated with greater levels of cancer-related traumatic stress ( p < 0.01 ) , less emotional self-efficacy for cancer ( p < 0.05 ) , less satisfaction with informational support from family , friends , and spouse , and a tendency to perceive those sources of support as more aversive ( p < 0.05 ) . Women who were less satisfied with emotional support from their family , friends and spouse were less likely to feel satisfied with their physicians ( p < 0.05 ) . These patient characteristics identify women with primary breast cancer who are likely to experience difficulty in their interactions with nurses and physicians and to be less satisfied with their physicians OBJECTIVE The purpose was to examine whether social-cognitive variables would moderate the efficacy of a couple-focused group intervention ( CG ) for women diagnosed with early stage breast cancer . DESIGN Participants ( N = 238 ) were r and omly assigned to 6 sessions of a couple-focused group versus usual care . Intent to treat growth curve modeling analyses indicated that emotional expression and emotional processing moderated CG effects on depression . MAIN OUTCOME MEASURES The primary outcome measures for this study were psychological distress and psychological well-being . RESULTS Treatment attrition analyses separating out participants assigned to but not attending CG indicated that emotional expression , emotional processing , and protective buffering moderated the effects of CG among those who attended CG with the most consistent effects noted for emotional processing on indicators of distress and well-being . CONCLUSION The CG intervention may be more effective for patients who begin the group experience using emotional approach coping strategies to deal with cancer Abstract This study aim ed to investigate the psychophysiological outcomes of different psychosocial interventions for breast cancer patients . Participants were r and omly assigned into 3 intervention groups , namely , Body-Mind-Spirit ( BMS ) , Supportive-Expressive ( SE ) , and Social Support Self-Help ( SS ) groups ; a no-intervention group was used as control .  Salivary cortisol was used as the physiological stress marker . Distress level , mental adjustment , emotional control , and social support were measured . Data were collected at baseline , 4 month , and 8 month . Preliminary results indicated that BMS intervention produced the greatest and the most sustained effects . It enhanced positive social support , reduced psychological distress , emotional control , and negative mental adjustment . Total salivary cortisol was lowered after 8 months . Most participants in SE groups indicated the treatment helpful , but changes in psychophysiological outcomes were not statistically significant . Participants in SS groups seemed less likely to benefit from the intervention . The no intervention control group indicated a reduction in social support . These outcomes suggest that active professional intervention is more likely to yield therapeutic effects . In particular , psychosocial intervention attending to the spiritual dimension contributes to positive outcomes Women with breast cancer express the greatest need for counseling at the time of diagnosis and report that the intervention they want is to be able to speak with someone who has the same cancer , but has lived through the crisis of treatment and is leading a ' normal ' life . We conducted an observational study of a 6-month peer-counseling intervention testing outcomes for both newly diagnosed women ( Sojourners ) and peer counselors ( Navigators )  as a first step toward the goal of validating a peer navigator program . Significant improvement in the Sojourners was observed in trauma symptoms , emotional well-being , cancer self-efficacy , and desire for information on breast cancer re sources . Navigators maintained baseline levels of the outcome variables , but increased in dissatisfaction with their interactions with their medical team and increased emotional suppression . Our findings indicate that peer navigation may halt a decline in quality of life that is commonly found in the first year following breast cancer diagnosis . In addition , Navigators were not adversely affected by their experience ; however , careful training and supervision of Navigators is crucial to overall success . R and omized clinical trials are needed to demonstrate the efficacy of peer navigator programs Purpose . To testthe relative effectiveness of a mindfulness-based stress reduction program ( MBSR ) compared with a nutrition education intervention ( NEP ) and usual care ( UC ) in women with newly diagnosed early-stage breast cancer (BrCA)undergoing radiotherapy .  Methods . Data were available from a r and omized controlled trialof 172 women , 20 to 65 years old , with stage I or II BrCA . Data from women completing the 8-week MBSR program plus 3 additional sessions focuses on special needs associated with BrCA were compared to women receiving attention control NEP and UC . Follow-up was performed at 3 post-intervention points : 4 months , and 1 and 2 years . St and ardized , vali date d self-administered question naires were used to assess psychosocial variables . Descriptive analyses compared women by r and omization assignment . Regression analyses , incorporating both intention-to-treat and post hoc multivariable approaches , were used to control for potential confounding variables . Results . A subset of 120 women underwent radiotherapy ;  77 completed treatment prior to the study , and 40 had radiotherapy during the MBSR intervention . Women who actively received radiotherapy ( art ) while participating in the MBSR intervention ( MBSR-art ) experienced a significant ( P < .05 ) improvement in 16 psychosocial variables compared with the NEP-art , UC-art , or both at 4 months . These included health-related , BrCA-specific quality of life and psychosocial coping , which were the primary outcomes , and secondary measures , including meaningfulness , helplessness , cognitive avoidance , depression , paranoid ideation , hostility , anxiety , global severity , anxious preoccupation , and emotional control . Conclusions . MBSR appears to facilitate psychosocial adjustment in BrCA patients receiving radiotherapy , suggesting applicability for MBSR as adjunctive therapy in oncological practice A r and omized trial ( n = 60 ; A. L. Stanton , S. Danoff-Burg , L. A. Sworowski , et al. , 2002 ) revealed that 4 sessions of written expressive disclosure or benefit finding produced lower physical symptom reports and medical appointments for cancer-related morbidities at 3-month follow-up among breast cancer patients relative to a fact-control condition . The goal of this article is to investigate mechanisms underlying these effects . Within-session heart rate habituation mediated effects of expressive disclosure on physical symptoms , and greater use of negative emotion words in essays predicted a decline in physical symptoms . Postwriting mood and use of positive emotion and cognitive mechanism words in essays were not significant mediators , although greater cognitive mechanism word use was related to greater heart rate habituation and negative emotion word use Background : Previous studies of cancer patients investigated the effect of psychological treatment on basal endocrine and immune values . Using a r and omized experiment , we explored the effect of a 13-week experiential-existential group psychotherapy ( EEGP ) program on the reactivity to a speech task in breast cancer patients . We explored whether changes in cardiovascular and immune reactivity to a speech task over the 3-month period correlated with changes in psychological distress and emotional expression . Methods : Patients who had been treated for early-stage breast cancer and who were diagnosed as having either positive axillary lymph nodes or distant metastases were r and omly assigned to either EEGP or a waiting list control ( WLC ) condition . We continuously recorded heart rate ( HR ) , diastolic ( DBP ) and systolic blood pressure ( SBP ) in response to the speech task before and after treatment . We also measured lymphocyte proliferation to pokeweed ( PWM ) and phytohemagglutinin ( PHA ) , and natural killer cell activity ( NKCA ) as well as peripheral blood lymphocyte distributions in blood sample s that were drawn before , during and after the speech task . Results : Patients in EEGP had smaller increases in natural killer ( NK ) cells induced by the speech task after treatment versus task-induced values observed at study entry and greater than pre-/posttreatment changes seen in patients r and omized to the WLC . A similar pattern emerged with respect to NKCA over the intervention period , which was independent of the changes in NK cells . There were no differences between patients assigned to EEGP and WLC in HR , DBP and SBP responses as well as in changes in PWM- and PHA-induced lymphocyte proliferation in response to the speech task measured before and after the 3-month intervention period . Individual differences in pre-/posttreatment increases in emotional expression but not in psychological distress were significantly associated with smaller changes in the number and function of NK cells over the 3-month period . Conclusions : These 
    Output:
    
The most frequently employed instrument was the  Courtauld Emotional Control Scale .