***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: Why do people fail to engage in positive behaviors which will promote their health and well-being ? Research ers addressing this question adopt primarily one of two perspectives , drawing either on theories of health behavior , such as the Health Belief Model ( HBM ) , or on theories of risk perception , such as unrealistic optimism . To overcome this compartmentalization , two studies of cancer screening behavior assessed the extent to which unrealistic optimism occurred in relation to each of the elements of the HBM : severity and curability of cancer and the benefits of , and barriers to , having a screening test .  Data were collected using telephone interviews , dialing numbers r and omly selected from the telephone directory . In the first study 164 women aged 50 to 70 years responded to questions about breast cancer and screening mammography , while in the second study 200 men aged 45 to 60 years responded to questions about prostate cancer and screening using the prostate specific antigen test . Women had an optimistic bias in relation to breast cancer risk and severity and barriers to having a screening mammogram but not in relation to the benefits of screening . For prostate cancer , there was an optimistic bias for all HBM variables : risk and severity of prostate cancer and barriers to and benefits of screening . It was concluded that unrealistic optimism is broader than perceived risk , being evident for all elements of the HBM PURPOSE Single-variable analyses have associated physical activity , diet , and obesity with survival  after breast cancer . This report investigates interactions among these variables . PATIENTS AND METHODS A prospect i ve study was performed of 1,490 women diagnosed and treated for early-stage breast cancer between 1991 and 2000 . Enrollment was an average of 2 years postdiagnosis . Only seven women were lost to follow-up through December 2005 . RESULTS In univariate analysis , reduced mortality was weakly associated with higher vegetable-fruit consumption , increased physical activity , and a body mass index that was neither low weight nor obese . In a multivariate Cox model , only the combination of consuming five or more daily servings of vegetables-fruits , and accumulating 540 + metabolic equivalent tasks-min/wk ( equivalent to walking 30 minutes 6 d/wk ) , was associated with a significant survival advantage ( hazard ratio , 0.56 ; 95 % CI , 0.31 to 0.98 ) . The approximate 50 % reduction in risk associated with these healthy lifestyle behaviors was observed in both obese and nonobese women , although fewer obese women were physically active with a healthy dietary pattern ( 16 % v 30 % ) . Among those who adhered to this healthy lifestyle , there was no apparent effect of obesity on survival . The effect was stronger in women who had hormone receptor-positive cancers . CONCLUSION A minority of breast cancer survivors follow a healthy lifestyle that includes both recommended intakes of vegetables-fruits and moderate levels of physical activity . The strong protective effect observed suggests a need for additional investigation of the effect of the combined influence of diet and physical activity on breast cancer survival Advances in chemotherapy significantly prolong survival of patients with acute myeloid leukemia ( AML ) and may cure a significant percentage of patients . Therefore , the assessment of quality of life ( QL ) of patients undergoing chemotherapy  is of growing interest . This study was design ed to evaluate  QL  in patients with AML treated according to the protocol of the German AML-Cooperative Group ( Münster , FRG ) . Based on conceptual , method ological and practical criteria , the EORTC-QLQ C 30 question naire was used . In addition , patients ' coping strategies were assessed by the FQCI . Patients ' individual perception of their disease and therapy was evaluated by a semi-structured interview . Currently , 61 patients are enrolled in the protocol . For those patients having completed the course of inpatient treatment , individual assessment of Global Health Status and Subjective QL improves significantly . The content analysis of the interviews shows to what extent aspects of the inpatient setting influence patients ' QL . Although only a minority of patients with AML remain in continuous complete remission , the evaluation of QL in patients undergoing treatment shows that subjective benefit outweighs the effects of antileukemic therapy CONTEXT Although physicians ' communication skills have been found to be related to clinical outcomes and patient satisfaction , teaching of communication skills has not been fully integrated into many medical school curricula or adequately evaluated with large-scale controlled trials . OBJECTIVE To determine whether communications training for medical students improves specific competencies known to affect outcomes of care . DESIGN AND SETTING A communications curriculum instituted in 2000 - 2001 at 3 US medical schools was evaluated with objective structured clinical examinations ( OSCEs ) . The same OSCEs were administered to a comparison cohort of students in the year before the intervention . PARTICIPANTS One hundred thirty-eight r and omly selected medical students ( 38 % of eligible students ) in the comparison cohort , tested at the beginning and end of their third year ( 1999 - 2000 ) , and 155 students in the intervention cohort ( 42 % of eligible students ) , tested at the beginning and end of their third year ( 2000 - 2001 ) . INTERVENTION Comprehensive communications curricula were developed at each school using an established educational model for teaching and practicing core communication skills and engaging students in self-reflection on their performance . Communications teaching was integrated with clinical material during the third year , required clerkships , and was supported by formal faculty development . MAIN OUTCOME MEASURES St and ardized patients assessed student performance in OSCEs on 21 skills related to 5 key patient care tasks : relationship development and maintenance , patient assessment , education and counseling , negotiation and shared decision making , and organization and time management . Scores were calculated as percentage of maximum possible performance . RESULTS Adjusting for baseline differences , students exposed to the intervention significantly outperformed those in the comparison cohort on the overall OSCE ( 65.4 % vs 60.4 % ; 5.1 % difference ; 95 % confidence interval [ CI ] , 3.9%-6.3 % ; P<.001 ) , relationship development and maintenance ( 5.3 % difference ; 95 % CI , 3.8%-6.7 % ; P<.001 ) , organization and time management ( 1.8 % difference ; 95 % CI , 1.0%-2.7 % ; P<.001 ) , and subsets of cases addressing patient assessment ( 6.7 % difference ; 95 % CI , 5.9%-7.8 % ; P<.001 ) and negotiation and shared decision making ( 5.7 % difference ; 95 % CI , 4.5%-6.9 % ; P<.001 ) . Similar effects were found at each of the 3 schools , though they differed in magnitude . CONCLUSIONS Communications curricula using an established educational model significantly improved third-year students ' overall communications competence as well as their skills in relationship building , organization and time management , patient assessment , and negotiation and shared decision making-tasks that are important to positive patient outcomes . Improvements were observed at each of the 3 schools despite adaptation of the intervention to the local curriculum and culture PURPOSE Regular physical activity reduces the risk of developing colon cancer , however , its influence on patients with established disease is unknown . PATIENTS AND METHODS We conducted a prospect i ve observational study of 832 patients with stage III colon cancer enrolled in a r and omized adjuvant chemotherapy trial . Patients reported on various recreational physical activities approximately 6 months after completion of therapy and were observed for recurrence or death . To minimize bias by occult recurrence , we excluded patients who experienced recurrence or died within 90 days of their physical activity assessment . RESULTS Compared with patients engaged in less than three metabolic equivalent task ( MET ) -hours per week of physical activity , the adjusted hazard ratio for disease-free survival was 0.51 ( 95 % CI , 0.26 to 0.97 ) for 18 to 26.9 MET-hours per week and 0.55 ( 95 % CI , 0.33 to 0.91 ) for 27 or more MET-hours per week . The adjusted P for trend was .01 . Postdiagnosis activity was associated with similar improvements in recurrence-free survival ( P for trend = .03 ) and overall survival ( P for trend = .01 ) . The benefit associated with physical activity was not significantly modified by sex , body mass index , number of positive lymph nodes , age , baseline performance status , or chemotherapy received . Moreover , the benefit remained unchanged even after excluding participants who developed cancer recurrence or died within 6 months of activity assessment . CONCLUSION Beyond surgical resection and postoperative adjuvant chemotherapy for stage III colon cancer , for patients who survive and are recurrence free approximately 6 months after adjuvant chemotherapy , physical activity appears to reduce the risk of cancer recurrence and mortality In anticipation of a consortium study of methotrexate ( MTX ) therapy provided to patients with primary central nervous system lymphoma ( PCNSL ) we have provided intravenous MTX without irradiation therapy to 31 non-immunosuppressed individuals . Twenty ( 65 % ) achieved complete response and 11 ( 35 % ) partial response to therapy . For the 31 patients the median survival was 30.43 months with an actuarial median follow up time of 30.69 months . The 2 + year survival was 63 % for all patients and 90 % for complete responders . Of 375 drug cycles , grade 3 leukopenia was identified in 3 cycles , mucositis in 6 cycles and delayed drug clearance in 47 cycles . Recurrences included brain ( 9/20 ) and /or spinal fluid ( 2/20 ) . The median Karnofsky scale improved from 40 ( 10–80 ) prior to therapy to 90 after treatment . Eleven patients , in complete response for a median of 22 + months after diagnosis were evaluated using 4 instruments that assess Quality of Life Functional Assessment of Cancer Therapy – Brain ( FACT-BR ) modified , Symptom Question naire , Social Adjustment Scale-Self-Report and Problem Solving Inventory . Their psychosocial adjustment , well-being and stress coping abilities were comparable to the normative groups . Further there was no evidence of any MTX-induced , Magnetic Resonance Imaging (MRI)-detected encephalopathy in these individuals and there was preservation of clinical cognition and memory . We conclude that therapy with MTX , without radiation can be used in PCNSL patients without limitations of age or pretreatment Karnofsky scores . Further rates of response and median survival approach those of therapies using multiple drugs and radiation , but with a less likely risk of dementia Ninety women with recently diagnosed stage I or stage II breast cancer who had been admitted to the NIH Clinical Center and were participating in a r and omized trial were entered onto this behavioral immunology protocol . Patients were immunologically and psychosocially assessed at baseline ( approximately 5 days after surgery ) and again at 3 and 15 months post surgery . All of the patients were followed up for a minimum of 5 years , and 60 % of the patients were followed for 7 years or longer . Twenty-nine women in the study group reported disease recurrences over the entire follow-up period . Causal path modeling statistical techniques showed that natural killer ( NK ) cell activity was a strong predictor of disease outcome when the outcome variable was defined as recurrence v nonrecurrence of disease ( chi 2 = 6.9 , p less than .001 ) . Higher NK cell activity at follow-up predicted disease-free survival over the follow-up period . When the disease outcome variable was operationally defined as time to recurrent disease , the psychosocial factors were more strongly predictive of the rate of disease progression for those who had a recurrence ( chi 2 = -4.1 , p less than .01 ) , but NK cell activity was seemingly less relevant in this latter case . Overall , these findings suggest that including mood and potentially relevant immunological variables , along with important biological prognostic variables , in multivariate and prospect i ve models such as those examined in this study , potentially contributes more to the explanation of greater outcome variance of early-stage breast cancer than has been believed in the past In a prospect i ve controlled clinical trial , 102 patients with inoperable non-small cell lung cancer ( NSCLC ) , limited disease , stage II and III were treated with  combination chemotherapy , cisplatin 70 mg/m2 i.v . on day one and etoposide 100 mg/m2 i.v . on day one , and etoposide 200 mg/m2 orally on days 2 and 3 , or radiotherapy given in 15 fractions of 2.8 Gy with two anterior/posterior fields during a period of three weeks . The patients completed a vali date d self-administered question naire before the start of treatment that assessed their psychosocial well-being , disease-related symptoms , personal functioning , and everyday activity . These subjective variables were evaluated together with treatment modality , WHO performance status , weight loss , and stage of disease , with regard to their value in predicting survival . Univariate survival analyses were undertaken for each individual factor , median survival was calculated according to life-table analyses . A step-wise multiple regression analysis was used to measure the prognostic value of the various factors . In the univariate analysis , general symptoms ( p = 0.0006 ) psycho-social well-being ( p = 0.0002 ) and stage of disease ( p = 0.007 ) were the best predictive factors . In the multiple regression analyses the subjective variables , general symptoms ( p less than 0.01 ) and psychosocial well-being ( p less than 0.05 ) were shown to have the best predictive value for the patients ' survival A question naire has been developed for use as 
    Output:
    
We conclude that a subjective-individual regulation of patient 's mental stability during a cytotoxic chemotherapy is important .
Successful coping strategies develop not only based on objective , but also subjective evaluation mechanisms .
We deduce consequences for doctor-patient communication and psychosocial care in haematology .
The newly developed process model of subjective regulation in cancer patients , in general , views the oncological treatment process as a procedural mental evaluation