human
***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 A cohort of 63 patients participating in a prospect ively r and omized trial evaluating two different radiotherapy regimens and adjuvant tamoxifen in the conservative management of early breast cancer were monitored by a series of psychological measures . The aim was to determine whether there was any difference between the radiotherapy schedules in terms of their impact on the patient 's quality of life and whether measures of coping style and trait anxiety could be used to predict the subjective response to treatment . Overall , radiotherapy had little effect on quality of life and the differences between the two regimens were minor with significantly more of those women on the longer treatment schedule experiencing a transient weight change , disruption of private life and loss of positivity compared with those on the shorter schedule . In anticipating psychological adjustment to treatment , coping style proved unhelpful but trait anxiety was found to be a robust indicator of response , suggesting that it may be possible to determine in advance those patients who are likely to exhibit  psychological distress during radiotherapy Quality of life ( QOL ) assessment s of women entering a UK r and omised trial of adjuvant radiotherapy ( START ) were investigated to estimate the independent effects on QOL of age , time since surgery , type of breast surgery , chemotherapy and endocrine therapy .  QOL was evaluated using the EORTC general cancer QOL scale ( EORTC QLQ-C30 ) , breast cancer module ( BR23 ) , the Body Image Scale ( BIS ) and the Hospital Anxiety and Depression Scale ( HADS ) . Independent effects of age and clinical factors were tested using multiple regression analysis . A total of 2208 ( mean age 56.9 years , range 26 - 87 ) consented to the QOL study prior to radiotherapy ; 17.1 % had undergone mastectomy ( Mx ) and the remainder had undergone a wide local excision ( WLE ) . 33.3 % had received adjuvant chemotherapy ( CT ) and 56.7 % were taking endocrine therapy ( ET ) . Age had significant effects on QOL with older and younger subgroups predicting poorer QOL for different domains . CT affected most QOL domains and result ed in worse body image , sexual functioning , breast and arm symptoms ( < 0.001 ) . Mx was associated with greater body image concerns ( p<0.001 ) , and WLE with more arm symptoms ( p=0.01 ) . There were no effects of  ET  on QOL .  Women < 50 years ( proxy pre-menopausal ) had worse QOL in respect of anxiety , body image and breast symptoms but age and clinical factors had no effect on depression . Overall , QOL and mental health were favourable for most women about to start RT , but younger age and receiving CT were significant risk factors for poorer QOL , and so patients in these subgroups warrant further monitoring . Surgery had a limited impact and ET had no effect on QOL Late effects of adjuvant treatment on perceived health and quality of life were assessed through a question naire mailed to 448 premenopausal and postmenopausal breast cancer patients , free from recurrence 2 - 10 years after primary therapy . The patients had been r and omised to postoperative radiotherapy or adjuvant chemotherapy as adjuncts to primary surgery . The differences between the two treatments were generally small . However , the radiotherapy patients had significantly greater problems with decreased stamina , symptoms related to the operation scar and anxiety . The chemotherapy patients had significantly more problems with smell aversion . Activity level inside and outside the home , anxiousness and depressive symptoms were similar in both groups . The chemotherapy patients scored their overall quality of life higher than the radiotherapy patients In a r and omized patient series of 184 women suffering from primary operable breast carcinoma , psychosocial adjustment to breast-conserving therapy ( BCT ) vs mastectomy ( M )  was analysed retrospectively , including : ( i ) a comparison of intergroup characteristics ; ( ii ) patient experience of the quality of professional pre-operative information ; and ( iii ) the extent to which influence on choice of treatment was required . Using LASA ( Linear Analogue Self- Assessment Scale ) , STAI ( State-Trait Anxiety Inventory ) , and a  semi-structured interview  , no psychosocial benefits were found in BCT compared with M. Mean observation time was 31 months ( range : 15 - 65 ) . Body image was less impaired in BCT than in M. Both groups scored highly on professional information , but reported reduced ability to take in such information in the peri-operative period . Both groups tended to depend on the surgeon when choosing between surgical options . Irrespective of primary therapy , women must still confront the fact that they have had cancer , a life-threatening disease which may recur . A need for further research into peri-operative information procedures was demonstrated , and some suggestions were derived concerning the surgeon 's role in deciding on surgical options The purpose of this study was to identify how mood disturbance and social support were related to the symptoms experienced by Korean women with breast cancer . A cross-sectional , correlational design was used for the study . A convenience sample of 134 Korean women receiving chemotherapy for breast cancer was recruited . The participants completed question naires on symptom experience  using the Symptom Experience Scale , mood disturbance using the Linear Analogue Self- Assessment Scale  , and social support using the Social Support Scale . Mood disturbance and social support had a significant interaction effect on symptom experience . A higher level of mood disturbance led to a higher level of symptoms when the level of social support was average or low , which implies that clinical interventions for attenuating the impact of mood disturbance on symptom experience might be effective only for women perceiving average or low levels of social support In a prospect i ve interview study , design ed to compare the psycho-social outcome after a  breast-conserving vs. a mastectomy operation  , we analysed possible predictors of the psycho-social adjustment . 99 women with breast cancer histopathological TNM stages I and II were consecutively admitted to the study .  Half-structured interviews , based on the Social Adjustment Scale and a scale by P. Maguire , were performed 4 and 13 months after the operation . Living together with the spouse seems to protect women from developing psycho-social problems postoperatively . Women who were gainfully employed or who were given radiotherapy had a higher risk of poor adjustment after 4 months . At 13 months , the scorings indicate that radiotherapy has a reassuring effect . Type of surgery was controlled for in the analysis and showed that , of the risk factors studied , the most consistent trend for an overall better outcome was in the breast-conserved group except for sexual disturbances OBJECTIVES --To assess outside a clinical trial the psychological outcome of different treatment policies in women with early breast cancer who underwent either mastectomy or breast conservation surgery depending on the surgeon 's opinion or the patient 's choice . To determine whether the extent of psychiatric morbidity reported in women who underwent breast conservation surgery  was associated with their participation in a r and omised clinical trial . DESIGN -- Prospect i ve , multicentre study capitalising on individual and motivational differences among patients and the different management policies among surgeons for treating patients with early breast cancer . SETTING --12 District general hospitals , three London teaching hospitals , and four private hospitals . PATIENTS --269 Women under 75 with a probable diagnosis of stage I or II breast cancer who were referred to 22 different surgeons . INTERVENTIONS --Surgery and radiotherapy or adjuvant chemotherapy , or both , depending on the individual surgeon 's stated preferences for managing early breast cancer . MAIN OUTCOME MEASURES --Anxiety and depression as assessed by st and ard methods two weeks , three months , and 12 months after surgery . RESULTS --Of the 269 women , 31 were treated by surgeons who favoured mastectomy , 120 by surgeons who favoured breast conservation , and 118 by surgeons who offered a choice of treatment . Sixty two of the women treated by surgeons who offered a choice were eligible to choose their surgery , and 43 of these chose  breast conserving surgery . The incidences of anxiety , depression , and sexual dysfunction were high in all treatment groups . There were no significant differences in the incidences of anxiety and depression between women who underwent mastectomy and those who underwent lumpectomy . A significant effect of surgeon type on the incidence of depression was observed , with patients treated by surgeons who offered a choice showing less depression than those treated by other surgeons ( p = 0.06 ) . There was no significant difference in psychiatric morbidity between women treated by surgeons who offered a choice who were eligible to choose their treatment and those in the same group who were not able to choose . Most of the women ( 159/244 ) gave fear of cancer as their primary fear rather than fear of losing a breast . The overall incidences of psychiatric morbidity in women who underwent mastectomy and those who underwent lumpectomy were similar to those found in the Cancer Research Campaign breast conservation study . At 12 months 28 % of women who underwent mastectomy in the present study were anxious compared with 26 % in the earlier study , and 27 % of women in the present study who underwent lumpectomy were anxious compared with 31 % in the earlier study . In both the present and earlier study 21 % of women who underwent mastectomy were depressed , and 19 % of women who underwent lumpectomy in the present study were depressed compared with 27 % in the earlier study . ) CONCLUSIONS --There is still no evidence that women with early breast cancer who undergo breast conservation surgery have less psychiatric morbidity after treatment than those who undergo mastectomy . Women who surrender autonomy for decision making by agreeing to participate in r and omised clinical trials do not experience any different psychological , sexual , or social problems from those women who are treated for breast cancer outside a clinical trial Psychological morbidity was compared in 52 patients treated by mastectomy and 67 patients treated by lumpectomy for early breast cancer . An informal counselling service was provided for all patients . Morbidity was measured at 6 , 9 and 12 months after surgery with two self‐rating scales : the general health question naire and the Leeds depression and anxiety scales . There was a significant excess of severe depression in the mastectomy group . In contrast to the findings of previous research , this result suggests that breast conservation reduces psychological morbidity This study evaluated the possible value of psychological variables in predicting clinical and pathological response to primary chemotherapy .  96 women with newly diagnosed large , or locally advanced , breast cancer ( T2 > 4 cm , T3 , T4 , N2 and M0 ) participated in a prospect i ve , r and omised trial to evaluate the effects of relaxation training with guided imagery and L-arginine on response to primary chemotherapy . Before the first of six cycles of primary chemotherapy , women were assessed using the Hospital Anxiety and Depression Scale ( HADS ) and the Eysenck Personality Question naire ( EPQ ) . The primary outcomes were clinical response ( evaluated using st and ard International Union Against Cancer ( UICC ) criteria ) and pathological response ( grade d by means of a previously published 5-point scale ) following primary chemotherapy . Stepwise linear regressions were used to estimate the predictive value of age , menopausal status , clinical nodal status , tumour size at diagnosis , oestrogen receptor status , dietary supplementation ( L-arginine versus placebo ) , personality ( EPQ-L scores ) , mood ( HADS scores ) and a psychological intervention . HADS depression score was a significant independent predictor of pathological response to chemotherapy .  HADS anxiety score was a significant independent predictor of clinical response . Because the original tumour size before chemotherapy ( also a significant predictor of clinical and pathological responses ) was taken into account in the analyses , the results can not be explained in terms of psychobiological factors related to tumour size . This study supports the importance of psychological factors as independent predictors of response to primary chemotherapy in patients with breast cancer . If they can be replicated , these findings have major implication s for the management of women with breast cancer . Psychological factors need to be assessed and evaluated in future trials of chem 
    Output:
    
agent
***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 A cohort of 63 patients participating in a prospect ively r and omized trial evaluating two different radiotherapy regimens and adjuvant tamoxifen in the conservative management of early breast cancer were monitored by a series of psychological measures . The aim was to determine whether there was any difference between the radiotherapy schedules in terms of their impact on the patient 's quality of life and whether measures of coping style and trait anxiety could be used to predict the subjective response to treatment . Overall , radiotherapy had little effect on quality of life and the differences between the two regimens were minor with significantly more of those women on the longer treatment schedule experiencing a transient weight change , disruption of private life and loss of positivity compared with those on the shorter schedule . In anticipating psychological adjustment to treatment , coping style proved unhelpful but trait anxiety was found to be a robust indicator of response , suggesting that it may be possible to determine in advance those patients who are likely to exhibit  psychological distress during radiotherapy Quality of life ( QOL ) assessment s of women entering a UK r and omised trial of adjuvant radiotherapy ( START ) were investigated to estimate the independent effects on QOL of age , time since surgery , type of breast surgery , chemotherapy and endocrine therapy .  QOL was evaluated using the EORTC general cancer QOL scale ( EORTC QLQ-C30 ) , breast cancer module ( BR23 ) , the Body Image Scale ( BIS ) and the Hospital Anxiety and Depression Scale ( HADS ) . Independent effects of age and clinical factors were tested using multiple regression analysis . A total of 2208 ( mean age 56.9 years , range 26 - 87 ) consented to the QOL study prior to radiotherapy ; 17.1 % had undergone mastectomy ( Mx ) and the remainder had undergone a wide local excision ( WLE ) . 33.3 % had received adjuvant chemotherapy ( CT ) and 56.7 % were taking endocrine therapy ( ET ) . Age had significant effects on QOL with older and younger subgroups predicting poorer QOL for different domains . CT affected most QOL domains and result ed in worse body image , sexual functioning , breast and arm symptoms ( < 0.001 ) . Mx was associated with greater body image concerns ( p<0.001 ) , and WLE with more arm symptoms ( p=0.01 ) . There were no effects of  ET  on QOL .  Women < 50 years ( proxy pre-menopausal ) had worse QOL in respect of anxiety , body image and breast symptoms but age and clinical factors had no effect on depression . Overall , QOL and mental health were favourable for most women about to start RT , but younger age and receiving CT were significant risk factors for poorer QOL , and so patients in these subgroups warrant further monitoring . Surgery had a limited impact and ET had no effect on QOL Late effects of adjuvant treatment on perceived health and quality of life were assessed through a question naire mailed to 448 premenopausal and postmenopausal breast cancer patients , free from recurrence 2 - 10 years after primary therapy . The patients had been r and omised to postoperative radiotherapy or adjuvant chemotherapy as adjuncts to primary surgery . The differences between the two treatments were generally small . However , the radiotherapy patients had significantly greater problems with decreased stamina , symptoms related to the operation scar and anxiety . The chemotherapy patients had significantly more problems with smell aversion . Activity level inside and outside the home , anxiousness and depressive symptoms were similar in both groups . The chemotherapy patients scored their overall quality of life higher than the radiotherapy patients In a r and omized patient series of 184 women suffering from primary operable breast carcinoma , psychosocial adjustment to breast-conserving therapy ( BCT ) vs mastectomy ( M )  was analysed retrospectively , including : ( i ) a comparison of intergroup characteristics ; ( ii ) patient experience of the quality of professional pre-operative information ; and ( iii ) the extent to which influence on choice of treatment was required . Using LASA ( Linear Analogue Self- Assessment Scale ) , STAI ( State-Trait Anxiety Inventory ) , and a  semi-structured interview  , no psychosocial benefits were found in BCT compared with M. Mean observation time was 31 months ( range : 15 - 65 ) . Body image was less impaired in BCT than in M. Both groups scored highly on professional information , but reported reduced ability to take in such information in the peri-operative period . Both groups tended to depend on the surgeon when choosing between surgical options . Irrespective of primary therapy , women must still confront the fact that they have had cancer , a life-threatening disease which may recur . A need for further research into peri-operative information procedures was demonstrated , and some suggestions were derived concerning the surgeon 's role in deciding on surgical options The purpose of this study was to identify how mood disturbance and social support were related to the symptoms experienced by Korean women with breast cancer . A cross-sectional , correlational design was used for the study . A convenience sample of 134 Korean women receiving chemotherapy for breast cancer was recruited . The participants completed question naires on symptom experience  using the Symptom Experience Scale , mood disturbance using the Linear Analogue Self- Assessment Scale  , and social support using the Social Support Scale . Mood disturbance and social support had a significant interaction effect on symptom experience . A higher level of mood disturbance led to a higher level of symptoms when the level of social support was average or low , which implies that clinical interventions for attenuating the impact of mood disturbance on symptom experience might be effective only for women perceiving average or low levels of social support In a prospect i ve interview study , design ed to compare the psycho-social outcome after a  breast-conserving vs. a mastectomy operation  , we analysed possible predictors of the psycho-social adjustment . 99 women with breast cancer histopathological TNM stages I and II were consecutively admitted to the study .  Half-structured interviews , based on the Social Adjustment Scale and a scale by P. Maguire , were performed 4 and 13 months after the operation . Living together with the spouse seems to protect women from developing psycho-social problems postoperatively . Women who were gainfully employed or who were given radiotherapy had a higher risk of poor adjustment after 4 months . At 13 months , the scorings indicate that radiotherapy has a reassuring effect . Type of surgery was controlled for in the analysis and showed that , of the risk factors studied , the most consistent trend for an overall better outcome was in the breast-conserved group except for sexual disturbances OBJECTIVES --To assess outside a clinical trial the psychological outcome of different treatment policies in women with early breast cancer who underwent either mastectomy or breast conservation surgery depending on the surgeon 's opinion or the patient 's choice . To determine whether the extent of psychiatric morbidity reported in women who underwent breast conservation surgery  was associated with their participation in a r and omised clinical trial . DESIGN -- Prospect i ve , multicentre study capitalising on individual and motivational differences among patients and the different management policies among surgeons for treating patients with early breast cancer . SETTING --12 District general hospitals , three London teaching hospitals , and four private hospitals . PATIENTS --269 Women under 75 with a probable diagnosis of stage I or II breast cancer who were referred to 22 different surgeons . INTERVENTIONS --Surgery and radiotherapy or adjuvant chemotherapy , or both , depending on the individual surgeon 's stated preferences for managing early breast cancer . MAIN OUTCOME MEASURES --Anxiety and depression as assessed by st and ard methods two weeks , three months , and 12 months after surgery . RESULTS --Of the 269 women , 31 were treated by surgeons who favoured mastectomy , 120 by surgeons who favoured breast conservation , and 118 by surgeons who offered a choice of treatment . Sixty two of the women treated by surgeons who offered a choice were eligible to choose their surgery , and 43 of these chose  breast conserving surgery . The incidences of anxiety , depression , and sexual dysfunction were high in all treatment groups . There were no significant differences in the incidences of anxiety and depression between women who underwent mastectomy and those who underwent lumpectomy . A significant effect of surgeon type on the incidence of depression was observed , with patients treated by surgeons who offered a choice showing less depression than those treated by other surgeons ( p = 0.06 ) . There was no significant difference in psychiatric morbidity between women treated by surgeons who offered a choice who were eligible to choose their treatment and those in the same group who were not able to choose . Most of the women ( 159/244 ) gave fear of cancer as their primary fear rather than fear of losing a breast . The overall incidences of psychiatric morbidity in women who underwent mastectomy and those who underwent lumpectomy were similar to those found in the Cancer Research Campaign breast conservation study . At 12 months 28 % of women who underwent mastectomy in the present study were anxious compared with 26 % in the earlier study , and 27 % of women in the present study who underwent lumpectomy were anxious compared with 31 % in the earlier study . In both the present and earlier study 21 % of women who underwent mastectomy were depressed , and 19 % of women who underwent lumpectomy in the present study were depressed compared with 27 % in the earlier study . ) CONCLUSIONS --There is still no evidence that women with early breast cancer who undergo breast conservation surgery have less psychiatric morbidity after treatment than those who undergo mastectomy . Women who surrender autonomy for decision making by agreeing to participate in r and omised clinical trials do not experience any different psychological , sexual , or social problems from those women who are treated for breast cancer outside a clinical trial Psychological morbidity was compared in 52 patients treated by mastectomy and 67 patients treated by lumpectomy for early breast cancer . An informal counselling service was provided for all patients . Morbidity was measured at 6 , 9 and 12 months after surgery with two self‐rating scales : the general health question naire and the Leeds depression and anxiety scales . There was a significant excess of severe depression in the mastectomy group . In contrast to the findings of previous research , this result suggests that breast conservation reduces psychological morbidity This study evaluated the possible value of psychological variables in predicting clinical and pathological response to primary chemotherapy .  96 women with newly diagnosed large , or locally advanced , breast cancer ( T2 > 4 cm , T3 , T4 , N2 and M0 ) participated in a prospect i ve , r and omised trial to evaluate the effects of relaxation training with guided imagery and L-arginine on response to primary chemotherapy . Before the first of six cycles of primary chemotherapy , women were assessed using the Hospital Anxiety and Depression Scale ( HADS ) and the Eysenck Personality Question naire ( EPQ ) . The primary outcomes were clinical response ( evaluated using st and ard International Union Against Cancer ( UICC ) criteria ) and pathological response ( grade d by means of a previously published 5-point scale ) following primary chemotherapy . Stepwise linear regressions were used to estimate the predictive value of age , menopausal status , clinical nodal status , tumour size at diagnosis , oestrogen receptor status , dietary supplementation ( L-arginine versus placebo ) , personality ( EPQ-L scores ) , mood ( HADS scores ) and a psychological intervention . HADS depression score was a significant independent predictor of pathological response to chemotherapy .  HADS anxiety score was a significant independent predictor of clinical response . Because the original tumour size before chemotherapy ( also a significant predictor of clinical and pathological responses ) was taken into account in the analyses , the results can not be explained in terms of psychobiological factors related to tumour size . This study supports the importance of psychological factors as independent predictors of response to primary chemotherapy in patients with breast cancer . If they can be replicated , these findings have major implication s for the management of women with breast cancer . Psychological factors need to be assessed and evaluated in future trials of chem 
    Output:
    