have a less favorable outcome. A significant association

( p< .05) between the initial response and outcome was

reported. Patients whose initial responses were denial or

fighting spirit more frequently had a favorable outcome than

those initially showing stoic acceptance or a helpless/

hopeless response.

 Additional analysis of data from this series

 (Pettingale, Philalithis, Tee, & Greer, 1981) showed no

 evidence that biological factors biased the composition of

 the groups or accounted for the observed differences in

 outcome. And, some support was given to the notion of a

 neuroendocrine or immune pathway for the observed effect by

 additional findings from the same analysis of different

 levels of serum immunoglobulin levels among the women with

 different initial responses to the diagnosis.

 Unlike the previous studies, a prospective investiga-

tion by Rogentine et al. (1979) measured psychological

factors against the first recurrence of cancer following

curative treatment. Experimental control was enhanced by

limiting the sample to patients with a single cancer type,

cutaneous malignant melanoma, and to those in either

clinical Stage II or unfavorable prognostic subcategories of

clinical Stage I. Two consecutive groups of white patients,

67 altogether, were evaluated one week after surgery with the

Recent Life Changes Questionnaire, a symptoms check list,