GROWING AMOUNT OF LITERAture suggests that addressing patients' psychological needs produces both psychological and physical health benefits. [1][2][3] Expressive writing is one such technique that has been used successfully in several controlled studies. [4][5][6] A brief written emotional expression exercise developed by Pennebaker and Beall 7 has been tested in studies of health benefits in healthy persons. It calls for participating subjects to write an essay, typically during a 3-day period, expressing their thoughts and feelings about a traumatic experience. Differences have been found between control subjects (who write about innocuous topics) and experimental subjects in frequency of subsequent health center visits, subjective well-being, and immune function. 8-10 A recent metaanalysis of this written emotional expression exercise concluded that the procedure reliably improved health outcomes. 11 Prior studies have not addressed the clinical relevance of these findings, in part because their samples were physically healthy people. It is not clear that the effects extend to individuals with medical conditions. Prior studies were Author Affiliations are listed at the end of this article.

The balance between production and activation of MMPs and their inhibition by TIMPs is a crucial aspect of cancer invasion and metastasis. On the basis of the concept that MMPs synthesized in tissues seep into the bloodstream, we have examined MMP levels in the plasma of patients with cancer. In colorectal, breast, prostate, and bladder cancer, most patients with aggressive disease have increased plasma levels of gelatinase B. In patients with advanced colorectal cancer, high levels of either gelatinase B or TIMP complex were associated with shortened survival. We propose that these assays may be clinically useful in characterizing metastatic potential in selected kinds of cancer. In rheumatoid arthritis and systemic lupus erythematosus (SLE), serum and plasma levels of stromelysin-1 were approximately 3-5-fold increased. Fluctuating serum stromelysin-1 levels in SLE did not correspond with change in disease activity. In SLE, stromelysin-1 may be a component of the chronic tissue repair process rather than being responsible for inciting tissue damage. On the basis of these observations, we conclude that measurement of plasma/serum MMP and TIMP levels may provide important data for selecting and following patients considered for treatment with drugs that interfere with MMP activity.

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