The purpose of the study was to examine the effect of different stressors on various domains of quality of life (QOL) in cancer patients. The study focused on testing a model describing interrelations between two kinds of stress antecedents, two mediating variables--perceived stress and self-efficacy--and QOL. The participants were 60 cancer patients of both genders and various diagnoses. They were administered questionnaires of background information, QOL, perceived stress and general self-efficacy. Two stress indices were defined empirically: health stress (based on advanced disease stage, long disease duration, and undergoing treatment) and social stress (based on unemployment, recent immigration, and older age). Confirmatory factor analysis enabled defining five factors of QOL. Hierarchical regression analyses showed that the index of social stress was related to more QOL scales than the index of health stress and very few interactions with the mediating variables. Structural equation modeling provided a more comprehensive and accurate view. It showed that the index of health stress affected QOL mainly through perceived stress, and that self-efficacy affected QOL by reducing perceived stress and increasing QOL. The major conclusions are that QOL is affected negatively by both health stresses and social stresses, but the former are mediated primarily by the experience of perceived stress.

evaporated in vacuo. The residue was purified by radial chromatography, eluting with 10% MeOH/CH2Cl2 to yield 46 mg (44%) of product: [a]p -125°(c 0.2, CHC13) (lit. -128).23Reduction of Egenine and Corytensine. To a solution of the phthalide isoquinoline hemiacetal in ethanol was added 1 molar equiv of NaBH4. The reaction mixture was stirred overnight at room temperature. After removal of the solvent in vacuo, saturated ammonium chloride was added, and the mixture was extracted with three portions of CH2C12. The combined organic phases were dried over MgS04 and evaporated in vacuo. The residue was purified by radial chromatography, eluting with 10% MeOH/CH2Cl2. Bicucullinediol (17e) was obtained in 73% yield (8 mg) from 11 mg of 2: [o]D +16.3°( c, 0.4, CHC13) (lit. -17°for the [S-(R*,S*)] isomer).18Adlumidinediol (17t) was obtained in 74% yield (14 mg) from 19 mg of 4: [a]D +25°(c 0.3, CHC13) (lit. -24°for the [S-(R*fl*)] isomer).18Acknowledgment. This work was generously supported by the National Institutes of Health: grant GM-37985 supported this work and grants RR-03351 and RR-04680 funded NMR and MS facilities, respectively. K.S.R. also thanks the University of Miami for a Maytag Fellowship.Supplementary Material Available: NMR spectra for compounds 2, 4-6, and 12-16 (18 pages). Ordering information is given on any current masthead page.

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