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Nancy W. Fawzy

Bio: Nancy W. Fawzy is an academic researcher from St. John's University. The author has contributed to research in topics: Psychosocial & Psychological intervention. The author has an hindex of 13, co-authored 17 publications receiving 3333 citations. Previous affiliations of Nancy W. Fawzy include University of California, Los Angeles.

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TL;DR: Psychiatric interventions that enhance effective coping and reduce affective distress appear to have beneficial effects on survival but are not proposed as an alternative or independent treatment for cancer or any other illness or disease.
Abstract: Objectives: We evaluated recurrence and survival for 68 patients with malignant melanoma who participated in a 6-week structured psychiatric group intervention 5 to 6 years earlier, shortly after their diagnosis and initial surgical treatment. We also explored the role of several factors as possible predictors of outcome. Design: This was a randomized controlled experimental study. The Cox proportion hazards regression model was used to quantify the relationship between treatment and the outcomes adjusted by the covariates (age, sex, Breslow depth, tumor site, baseline Profile of Mood States Total Mood Disturbance, baseline active-behavioral coping, baseline natural killer cell activity, and treatment [ie, group intervention]). The stepwise procedure was used for covariate selection. Results: For control patients, there was a trend for recurrence (13/34) and a statistically significant greater rate of death (10/34) than for experimental patients (7/34 and 3/34, respectively). We found that being male and having a greater Breslow depth predicted greater recurrence and poorer survival. Analysis of multiple covariates found that only Breslow depth and treatment (ie, group intervention) were significant. Adjusting for Breslow depth, treatment effect remained significant. Finally, baseline affective distress and baseline coping were significant psychobehavioral predictors for recurrence and survival. Surprisingly, higher levels of baseline distress as well as baseline coping and enhancement of active-behavioral coping over time were predictive of lower rates of recurrence and death. Conclusion: Psychiatric interventions that enhance effective coping and reduce affective distress appear to have beneficial effects on survival but are not proposed as an alternative or independent treatment for cancer or any other illness or disease. However, the exact nature of this relationship warrants further investigation.

1,026 citations

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TL;DR: It is indicated that a short-term psychiatric group intervention for patients with malignant melanoma effectively reduces psychological distress and enhances longer-term effective coping.
Abstract: • We evaluated the immediate and long-term effects on psychological distress and coping methods of a 6-week, structured, psychiatric group intervention for postsurgical patients with malignant melanoma. The intervention consisted of health education, enhancement of problem-solving skills, stress management (eg, relaxation techniques), and psychological support. In spite of good prognosis, most patients had high levels of psychological distress at baseline, comparable with other patients with cancer. However, at the end of brief psychiatric intervention, the experimental subjects (n = 38), while not without some distress, exhibited higher vigor and greater use of active-behavioral coping than the controls (n = 28). At 6 months' follow-up, the group differences were even more pronounced. The intervention-group patients then showed significantly lower depression, fatigue, confusion, and total mood disturbance as well as higher vigor. They were also using significantly more active-behavioral and active-cognitive coping than the controls. These results indicate that a short-term psychiatric group intervention for patients with malignant melanoma effectively reduces psychological distress and enhances longer-term effective coping.

631 citations

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TL;DR: This comprehensive review of the intervention literature reveals the availability of a wide range of options for patients with cancer and their potential psychological and physical health benefits.
Abstract: T need for a large variety of psychosocial interventions is enhanced as increasing numbers of patients with cancer have longer survival. This article reviews the four interventions used most commonly: (1) education, (2) behavioral training, (3) individual psychotherapy, and (4) group interventions. It examines the outcomes of each type of intervention. This comprehensive review of the intervention literature reveals the availability of a wide range of options for patients with cancer and their potential psychological and physical health benefits.

566 citations

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TL;DR: The results indicate that a short-term psychiatric group intervention in patients with malignant melanoma with a good prognosis was associated with longer-term changes in affective state, coping, and the NK lymphoid cell system.
Abstract: • We evaluated the immediate and long-term effects on immune function measures of a 6-week structured psychiatric group intervention for patients with malignant melanoma. Along with a reduction in levels of psychological distress and greater use of active coping methods, the following immune changes were seen at the 6-month assessment point in the interventiongroup patients (n 35) compared with controls (n = 26): significant increases in the percent of large granular lymphocytes (defined as CD57 with Leu-7) and natural killer (NK) cells (defined as CD16 with Leu-11 and CD56 with NKH1) along with indications of increase in NK cytotoxic activity; and a small decrease in the percent of CD4 (helper/inducer) T cells. At the 6-week follow-up point, the majority of these changes were not yet observable. The results indicate that a short-term psychiatric group intervention in patients with malignant melanoma with a good prognosis was associated with longer-term changes in affective state, coping, and the NK lymphoid cell system. Affective rather than coping measures showed some significant correlations with immune cell changes.

504 citations

Journal ArticleDOI
TL;DR: The findings suggest that the survival benefit of the intervention has weakened since the 5- to 6-year follow-up; however, it has not entirely disappeared and remains predictive of survival when statistically controlling for the effects of other known prognostic indicators.
Abstract: Background The influence of psychiatric intervention on cancer outcome remains a topic of considerable debate. We previously reported the survival benefits for 68 patients with malignant melanoma 5 to 6 years following their participation in a structured psychiatric group intervention. In this article, we report the effects of the intervention on disease outcome in these same patients at the 10-year follow-up. Methods In this univariate analysis, the survival and recurrence distributions for the intervention and control groups were estimated using the Kaplan-Meier method, and were tested for equality by the log-rank test. The multivariate analysis used the Cox proportional hazards regression model with the following prognostic factors: age, sex, Breslow depth, tumor site, and treatment status (ie, intervention group vs control group). Results When analyzed as single covariates, differences between the intervention and control groups were not significant for outcome at the 10-year follow-up. However, being male and having a greater Breslow depth were predictive of poorer outcome. Analysis of multiple covariates also revealed that sex and Breslow depth were significant for recurrence and survival. In addition, participation in the intervention was significant for survival. After adjusting for sex and Breslow depth, participation in the intervention remained significant for survival. Conclusions These findings suggest that the survival benefit of the intervention has weakened since the 5- to 6-year follow-up; however, it has not entirely disappeared. At the 10-year follow-up, participation in the intervention remained predictive of survival when statistically controlling for the effects of other known prognostic indicators. Despite the potential health benefits, we do not propose that psychiatric intervention be used in lieu of standard medical care, but as one of its integral components.

172 citations


Cited by
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Journal ArticleDOI
TL;DR: The emerging field of emotion regulation studies how individuals influence which emotions they have, when they have them, and how they experience and express them as mentioned in this paper, and characterizes emotion in terms of response tendencies.
Abstract: The emerging field of emotion regulation studies how individuals influence which emotions they have, when they have them, and how they experience and express them. This review takes an evolutionary perspective and characterizes emotion in terms of response tendencies. Emotion regulation is denned and distinguished from coping, mood regulation, defense, and affect regulation. In the increasingly specialized discipline of psychology, the field of emotion regulation cuts across traditional boundaries and provides common ground. According to a process model of emotion regulation, emotion may be regulated at five points in the emotion generative process: (a) selection of the situation, (b) modification of the situation, (c) deployment of attention, (d) change of cognitions, and (e) modulation of responses. The field of emotion regulation promises new insights into age-old questions about how people manage their emotions.

6,835 citations

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TL;DR: The long-term effect of the physiologic response to stress is reviewed, which I refer to as allostatic load, which is the ability to achieve stability through change.
Abstract: Over 60 years ago, Selye1 recognized the paradox that the physiologic systems activated by stress can not only protect and restore but also damage the body. What links these seemingly contradictory roles? How does stress influence the pathogenesis of disease, and what accounts for the variation in vulnerability to stress-related diseases among people with similar life experiences? How can stress-induced damage be quantified? These and many other questions still challenge investigators. This article reviews the long-term effect of the physiologic response to stress, which I refer to as allostatic load.2 Allostasis — the ability to achieve stability through change3 — . . .

5,932 citations

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TL;DR: The author argues that all 3 variables that assess different aspects of social relationships are associated with health outcomes, that these variables each influence health through different mechanisms, and that associations between these variables and health are not spurious findings attributable to the authors' personalities.
Abstract: The author discusses 3 variables that assess different aspects of social relationships—social support, social integration, and negative interaction. The author argues that all 3 are associated with health outcomes, that these variables each influence health through different mechanisms, and that associations between these variables and health are not spurious findings attributable to our personalities. This argument suggests a broader view of how to intervene in social networks to improve health. This includes facilitating both social integration and social support by creating and nurturing both close (strong) and peripheral (weak) ties within natural social networks and reducing opportunities for negative social interaction. Finally, the author emphasizes the necessity to understand more about who benefits most and least from socialconnectedness interventions.

3,981 citations

Journal ArticleDOI
TL;DR: Reappraisal decreased disgust experience, whereas suppression increased sympathetic activation, suggesting that these 2 emotion regulatory processes may have different adaptive consequences.
Abstract: Using a process model of emotion, a distinction between antecedent-focused and response-focused emotion regulation is proposed. To test this distinction, 120 participants were shown a disgusting film while their experiential, behavioral, and physiological responses were recorded. Participants were told to either (a) think about the film in such a way that they would feel nothing (reappraisal, a form of antecedent-focused emotion regulation), (b) behave in such a way that someone watching them would not know they were feeling anything (suppression, a form of response-focused emotion regulation), or (c) watch the film (a control condition). Compared with the control condition, both reappraisal and suppression were effective in reducing emotion-expressive behavior. However, reappraisal decreased disgust experience, whereas suppression increased sympathetic activation. These results suggest that these 2 emotion regulatory processes may have different adaptive consequences.

3,778 citations

Journal ArticleDOI
TL;DR: The Multidimensional Fatigue Inventory was tested for its psychometric properties in cancer patients receiving radiotherapy, patients with the chronic fatigue syndrome, psychology students, medical students, army recruits and junior physicians, and support the validity of the MFI.

2,892 citations