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Discussant David Spiegel, MD

JAMA. 1999;282:371-378.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

INTRODUCTION

DR PARKER: Mrs K is a 43-year-old woman with metastatic breast cancer. Formerly an elementary school teacher, she now stays home with her husband and 5-year-old son. She has private insurance and has experienced no restrictions in her complex care.

Her mother died of breast cancer at age 58 years. Therefore, Mrs K started breast self-examinations at age 20 years and mammograms every 6 months at age 25 years. Due to the birth of her child and breast-feeding, she had an interval of 2 years without a mammogram. During that period in 1995, she detected a breast lump, which was malignant. She underwent a modified radical mastectomy followed by cyclophosphamide, methotrexate, and fluorouracil chemotherapy for 6 months. At the time of surgery, lymph nodes were negative.

In 1996, she felt a lump in her abdomen. A computed tomography scan revealed both lung and liver metastases. She . . . [Full Text of this Article]

MRS K: HER UNDERSTANDING AND PERCEPTIONS

DR B: HER UNDERSTANDING AND PERCEPTIONS

AT THE CROSSROADS: QUESTIONS FOR DR SPIEGEL

Using the Medical History

Positive Aspects of a Positive Attitude

Psychotherapeutic Intervention

Social Support

Complimenting Complementary Treatments

QUESTIONS AND DISCUSSION

Author Affiliation: Dr Spiegel is Professor and Associate Chair, Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, Calif.

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