***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: Sleep disturbance is a common clinical complaint of oncology patients and contributes to substantial morbidity . However , because most sleep studies have been cross‐sectional , associations between sleep quality and distress in patients with ovarian cancer over time remain unclear . This prospect i ve longitudinal study examined rates of sleep disturbance ; contributions of depression , anxiety , and medication use in sleep disturbance ; and associations between sleep quality and quality of life ( QOL ) during the first year after diagnosis among women with ovarian cancer 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 Ovarian cancer patients may experience  psychological disorders  due to the aggressive nature of the illness and treatment . We investigated the presence of psychological disorders longitudinally in women with a new diagnosis of ovarian cancer and the factors that predicted development and maintenance of these disorders . Patients were assessed in a prospect i ve longitudinal study at the beginning of chemotherapy treatment , mid-treatment , end of treatment and 3 months follow-up for depression , anxiety , perceived social support , neuroticism and cognitive strategies to control unwanted thoughts .  A total of 121 patients were recruited and 85 patients were assessed at all four time points . Three different longitudinal profiles of anxiety and depression caseness were found : non-cases ( never cases ) , occasional cases ( cases on at least one but not all four occasions ) and stable cases ( cases on all four occasions ) . Most of the women were occasional cases of anxiety ( 52 % , 44 ) , whereas for depression , the majority of women were non-cases ( 55 % , 47 ) . A subset of patients were stable cases of anxiety ( 22 % , 19 ) . Neuroticism and marital status were significant independent predictors of anxiety caseness profile . Neuroticism and use of anti-depressants  were independent predictors of depression caseness profile . Social support was not related to psychological morbidity Ovarian cancer is a life-threatening diagnosis which poses multiple challenges . The purpose of this study is to describe the quality of life ( QOL ) concerns and survivorship sequelae of long-term ( > 5 yr ) early-stage ovarian cancer survivors accrued through the clinical cooperative Gynecologic Oncology Group . Forty-nine ovarian cancer survivors with a mean age at diagnosis of 55.9 yr ( range 30 - 76 ) completed a telephone interview assessing QOL , psychosocial status , sexual functioning and late-effects of treatment .  Results indicate that this disease-free early-stage sample enjoys a good QOL , with physical , emotional , and social well-being comparable to other survivors and same-aged noncancer cohorts . However , 20 % of survivors indicated the presence of long-term treatment side effects , with a subset reporting problems related to abdominal and gynecologic symptoms , and neurotoxicity . Spiritual well-being was significantly positively associated with personal growth and mental health , and negatively associated with a declining health status . Lingering psychological survivorship sequelae included fear of follow-up diagnostic tests and fear of recurrence . Forty-three percent of respondents expressed that they would likely participate in a counseling program today to discuss psychosocial issues raised by having had ovarian cancer , and 56 % stated that they would have attended a support program during the initial treatment if it had been offered . This information provides some insight into the complex survivorship relationships between quality of life , long-term physical and sexual sequelae , and factors of resilience and growth which appear to promote a sense of well-being as a result of the cancer experience OBJECTIVES We aim ed to describe the levels of  anxiety and depression  in patients during the 3 month period following the end of chemotherapy treatment and to identify factors that predict psychological morbidity . METHOD We performed a prospect i ve study in women with ovarian cancer to determine the changes in psychological status in the 3 months following completion of chemotherapy .  Sixty-three consecutive patients were assessed at the completion of chemotherapy ( Time 1 ) and 57 at 3 months follow-up ( Time 2 ) . Relevant disease and patient characteristics were recorded and patients were assessed at Time 1 for anxiety , depression and their perception of emotional support , an index of their psychosocial environment .  Anxiety and depression were re-assessed at Time 2 . RESULTS The results indicate significant initial psychological morbidity , with clinical caseness for anxiety ( 38 % ) and depression ( 33 % ) being common . Follow-up at Time 2 shows that patients undergo a significant reduction in cases ( 19 % ) and symptoms of depression but an increase in cases of anxiety ( 47 % ) . The principal factors associated with symptoms of anxiety at Time 2 were poor perceived social support , increased intrusive thoughts and , to a lesser extent , younger age . Medical parameters , such as the stage of disease , response of the cancer to treatment , Ca125 ( a tumour glycoprotein ) and Karnofsky Performance status ( a measure of how well the patients is ) were not associated with worse psychological outcome . CONCLUSION These data show for the first time that social support and intrusive thoughts , rather than physical parameters , are the principal determinants of psychological morbidity in patients with ovarian cancer OBJECTIVES To assess the prevalence and predictors of depression and anxiety in women with ovarian cancer and their caregivers , to compare levels of depression and anxiety with community norms , and to explore the relationship between patients and their nominated caregivers . DESIGN , SETTING AND PARTICIPANTS Prospect i ve cohort study of 798 women with invasive ovarian cancer recruited between 1 January 2002 and 30 June 2006 through the nationwide Australian Ovarian Cancer Study , and 373 of their caregivers . MAIN OUTCOME MEASURES Depression and anxiety as assessed with the  Hospital Anxiety and Depression Scale  , and the role of demographic variables , disease and treatment variables , psychosocial variables , and use of mental health and support services as potential predictors . RESULTS Rates of anxiety and depression among patients were significantly lower than in previous reports , although clinical depression rates ( 5.9 % ) were significantly higher than community norms ( 3.0 % ; chi2 = 24.0 ; P < 0.001 ) . Caregivers also reported higher levels of depression ( chi2 = 21.1 ; P < 0.001 ) and anxiety ( chi2 = 17.6 ; P < 0.001 ) compared with norms . There was no difference within patient-caregiver pairs for depression ( P = 0.1 ) , while caregivers reported significantly higher anxiety than patients ( P < 0.01 ) . In patients , higher symptom burden , lower optimism and current specialist mental health treatment all significantly predicted both depression and anxiety , while lower social support was a significant predictor of patient anxiety only . In caregivers , lower social support and lower optimism were significant predictors of depression and anxiety . Patients being treated for mental health was also a predictor of their caregiver 's depression . CONCLUSIONS While depression is significantly more common in women with ovarian cancer than in the general population , it is caregivers of such patients who report much higher levels of both sub clinical and clinical depression and anxiety 
    Output:
    
Conclusions Our findings suggest that the prevalence of depression and anxiety in women with ovarian cancer , across the treatment spectrum , is significantly greater than in the healthy female population .