***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: Introduction Hypothalamic-pituitary-adrenal ( HPA ) deregulation is commonly observed in cancer patients , but its clinical significance is not well understood . We prospect ively examined the association between HPA activity , tumor-associated inflammation , and survival in ovarian cancer patients prior to treatment . Material s and Methods Participants were 113 women with ovarian cancer who provided salivary cortisol for three days prior to treatment for calculation of cortisol slope , variability  , and  night cortisol . Cox proportional hazard regression analyses were used to examine associations between cortisol and survival in models adjusting for disease stage , tumor grade , cytoreduction and age . On a sub sample of 41 patients with advanced disease ascites fluid was assayed for levels of interleukin-6 ( IL-6 ) and correlated with cortisol variables . Results Each cortisol measure was associated with decreased survival time , adjusting for covariates ( all p<.041 ) . A one st and ard deviation increase in night cortisol was associated with a 46 % greater likelihood of death . Patients in the high night cortisol group survived an estimated average of 3.3 years compared to 7.3 years for those in the low night cortisol group . Elevated ascites IL-6 was associated with each cortisol measure ( all r > .36 , all p<.017 ) . Discussion Abnormal cortisol rhythms assessed prior to treatment are associated with decreased survival in ovarian cancer and increased inflammation in the vicinity of the tumor . HPA abnormalities may reflect poor endogenous control of inflammation , dysregulation caused by tumor-associated inflammation , broad circadian disruption , or some combination of these factors . Nocturnal cortisol may have utility as a non-invasive measure of HPA function and /or disease severity Naturalistic research methods have been developed to collect data in the daily environment , providing ecological valid measures . Recent reports suggest , however , that compliance with fixed time sampling protocol s may be problematic and can bias results . This study investigated compliance with an intensive , r and om time sampling protocol for salivary cortisol and effects of non-compliance on cortisol results . Twenty female twin pairs and nineteen of their sisters were instructed to take saliva sample s when signaled at ten unpredictable moments on each of five consecutive days . Subjects recorded collection times , unaware that compliance with the sampling protocol was being investigated by means of electronic monitoring devices . Sample s taken < or = 15 min after the signal , according to self-report , were defined as adherent to the protocol . Sample s taken < or = 10 min after the self-reported collection time , according to the monitor , were defined as accurate . Self-reported adherence to the sampling protocol was 96.4 % . Verified compliance was somewhat lower , with 81 % of all saliva sample s accurately timed . Contrary to previous reports , inclusion of non-compliant sample s in the analysis did not distort the cortisol diurnal profile .  Intensive , r and om time sampling appears to have advantages over fixed time sampling for obtaining valid cortisol profiles when research ers do not have devices to monitor compliance . Results indirectly support the validity of momentary self-report data about daily experiences obtained with the same sampling methods BACKGROUND Yoga is a popular mind-body therapy that has demonstrated beneficial effects on psychological , behavioral , and functional outcomes . However , few studies have investigated effects on inflammatory processes . This study tested the hypothesis that an Iyengar yoga intervention specifically design ed for fatigued breast cancer survivors would lead to decreases in inflammation-related gene expression and circulating markers of proinflammatory cytokine activity . METHODS Breast cancer survivors with persistent cancer-related fatigue were r and omized to a 12-week Iyengar yoga intervention  ( n=16 ) or a 12-week health education control condition  ( n=15 ) . Blood sample s were collected at baseline , post-intervention , and at a 3-month follow-up for genome-wide transcriptional profiling and bioinformatic analyses . Plasma inflammatory markers and salivary cortisol were also assessed . RESULTS In promoter-based bioinformatics analyses , the yoga group showed reduced activity of the pro-inflammatory transcription factor nuclear factor kappa B ( NF-κB ) , increased activity of the anti-inflammatory glucocorticoid receptor , and reduced activity of cAMP response element-binding protein ( CREB ) family transcription factors relative to controls ( all ps<.05 ) . There was also a significant intervention effect on the soluble tumor necrosis factor receptor type II ( sTNF-RII ) , a marker of TNF activity ; plasma levels of sTNF-RII remained stable in the yoga group , whereas levels of this marker increased in the health education group ( p=.028 ) . A similar , non-significant trend was observed for the interleukin 1 receptor antagonist ( p=.16 ) . No significant changes in C reactive protein ( CRP ) , interleukin 6 ( IL-6 ) , or diurnal cortisol measures were observed . CONCLUSIONS A 12-week restorative Iyengar yoga intervention reduced inflammation-related gene expression in breast cancer survivors with persistent fatigue . These findings suggest that a targeted yoga program may have beneficial effects on inflammatory activity in this patient population , with potential relevance for behavioral and physical health 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 Purpose Older cancer survivors are a vulnerable population due to an increased risk for chronic diseases ( e.g. , cardiovascular disease ) compounded with treatment late-effects and declines in physical functioning . Therefore , interventions that reduce chronic disease risk factors ( i.e. , blood pressure , chronic inflammation , and cortisol ) are important in this population . Tai chi chih ( TCC ) is a mind-body exercise associated with reductions in chronic disease risk factors , but has not been examined with older cancer survivors . In a feasibility r and omized controlled trial of TCC , we examined secondary outcomes of blood pressure , salivary cortisol , and inflammatory cytokines ( interleukin (IL)-6 , IL-12 , tumor necrosis factor-α , IL-10 , IL-4 ) due to their implication s in chronic diseases . Methods Sixty-three senior female cancer survivors ( M age = 67 years , SD = 7.15 ) with physical functioning limitations ( SF-12 physical functioning ≤80 or role-physical ≤72 ) were r and omized to 12-weeks ( 60-min , three times a week ) of TCC or Health Education control ( HEC ) classes . Resting blood pressure , 1-day salivary cortisol sample s , and fasting plasma sample s for cytokine multiplex assays were collected at baseline and 1-week post-intervention . Results Controlling for baseline values , the TCC group had significantly lower systolic blood pressure ( SBP , p = 0.002 ) and cortisol area-under-curve ( AUC , p = 0.02 ) at post-intervention than the HEC group . There was no intervention effect on inflammatory cytokines ( p ’s > 0.05 ) . Conclusions This TCC feasibility trial was associated with significant reductions in SBP and cortisol AUC in senior female cancer survivors . Larger , definitive trials are needed to confirm these findings . Implication s for Cancer SurvivorsSenior survivors ’ have an increased risk for chronic diseases ; however , TCC interventions may help reduce associated risk factors The purpose of this study was to evaluate a woman 's psychological and immunological response to  breast biopsy  before and after the procedure . Women were enrolled into the study when notified of the need for breast biopsy .  Psychological and immunological assessment s were made at enrollment , on the day of breast biopsy , as well as 1 month and 4 months after notification of biopsy results . Psychological assessment s demonstrated that perceived stress , anxiety , and mood disturbance were heightened before biopsy and remained elevated after biopsy regardless of the diagnosis . Immunologically , the women exhibited reduced natural killer cell activity and INF gamma production before biopsy with reductions significant 1 month after the procedure . In contrast , IL-4 , IL-6 , and IL-10 production were increased before and after the procedure with most significant increases prior to the procedure and continuing 1 month after the procedure . These results demonstrate that undergoing biopsy of the breast for cancer diagnosis is an emotional experience , characterized by increased perceived stress , anxiety , and mood disturbance . This emotional distress is accompanied by reduced NK cell activity and cytokine dysregulation . The psychological and immunological impact of breast biopsy is not transient , but persists well beyond the actual experience of the biopsy procedure . Noteworthy is the observation that women with benign or malignant biopsy results experienced similar psycho-immune consequences . Hence , these observations are of relevance not only to women diagnosed with malignancy , who face the challenges of cancer treatment and adaptation to illness , but also to women with benign biopsy findings BACKGROUND Changes in the cortisol awakening response ( CAR ) were studied in women participating in a Mindfulness-Based Stress Reduction ( MBSR ) program after completion of their medical treatment for breast cancer . METHOD Thirty-three women completed question naires pre- and post-MBSR  pertaining to : stress , depressive symptomatology , and medical symptoms . The CAR was assessed on 3 days pre- and 3 days post-MBSR as a biological marker of stress . RESULTS A significant effect on the CAR was found , with cortisol levels showing a prolonged increase after awakening at the post-MBSR assessment period . This was accompanied by significant improvements in self-reported stress levels , depressive symptomatology , and medical symptoms . Furthermore , the change in medical symptoms was negatively correlated with the area under the curve ( AUC ) at study onset ( r = -.52 , p < .002 ) ; i.e. , the greater the AUC of the CAR before MBSR , the greater the reduction in medical symptoms after the program . CONCLUSIONS These results suggest the potential usefulness of employing the CAR as a biological marker in women with breast cancer participating in an MBSR program Background : Neuroendocrine dysregulation influenced by psychosocial stress is related to breast cancer recurrence . Very few studies examine the impacts of psychotherapy on diurnal cortisol patterns among breast cancer survivors . Methods : Forty-eight breast cancer patients who completed active cancer treatment were r and omly assigned to receive either 8 weekly body-mind-spirit ( BMS ) group therapy sessions or 1 educational ( EDU ) session . Self-report measures included the Beck Depression Inventory-II ( BDI-II ) , and the Meaning in Life question naire ( MLQ ) including two subscales : MLQ-Presence and MLQ- Search . Salivary cortisol levels were collected by the subjects in their homes at the time of awakening , 30 and 45 min after awakening , and at 12.00 , 17.00 , and 21.00 h. Measurement time points include baseline , the 2nd month ( completion of BMS therapy ) , the 5th month , and the 8th month . Results : There were no significant differences in BDI-II scores ( p>0.05 ) and MLQ-Presence scores ( p > 0.05 ) between BMS and EDU groups at baseline or across the three follow-ups . Nevertheless , greater MLQ- Search scores were found in the BMS group compared to the EDU group during the 5th month of follow-up ( p < 0.01 ) . The higher level of cortisol at 21.00 h ( p < 0.01 ) and a flatter diurnal cortisol pattern were more likely to occur in EDU than in BMS participants ( p < 0.05 ) at the 8th month of follow-up . Conclusion : BMS group therapy likely contributed to enhancing an active search for meaning in life toward more opportunities for personal growth and to maintaining stable cortisol responses to everyday life stress for breast cancer survivors Our group has shown in a r and omized clinical trial that psychological intervention to reduce stress in patients with stages II and III breast cancer led to enhanced immune function , fewer recurrences and improved overall survival . We hypothesized that patients with high levels of stress would have alterations in myeloid-derived suppressor cells ( MDSC ) compared to patients with lower stress . P BMC from 16 patients with high stress ( n = 8) or with low stress ( n = 8) after surgery as measured by the  Impact of Event Scale ( IES ) question naire were evaluated for the presence of MDSC . Patients with higher  IES scores had significantly elevated salivary cortisol levels ( P = 0.013 ; 13 μg/dl vs. 
    Output:
    
Diurnal cortisol slope and cortisol awakening response ( CAR ) were the most commonly reported parameters associated with clinical outcomes .
Flattened cortisol slopes , blunted CARs , and elevated evening cortisol concentrations were associated with poorer psychosocial and physiological outcomes .