***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To evaluate prospect ively the association between parental anxiety during treatment for childhood leukemia and posttraumatic stress symptoms ( PTSS ) after treatment ends . A secondary goal is to explore concurrent variables associated with parental avoidance after treatment ends . METHODS This is a longitudinal follow-up study of 113 parents of children treated for leukemia who previously participated in a study of procedural distress during treatment .  Data included parental self-report question naires completed during treatment and after treatment . RESULTS Using hierarchical multiple regression , we found anxiety during treatment to be a significant predictor of later PTSS for mothers , but not fathers . Anxiety , self-efficacy , posttraumatic growth and length of time since treatment ended were associated with parental avoidance . CONCLUSIONS Highly anxious parents are at risk for PTSS and may benefit from approaches that decrease anxiety during treatment and afterward . Enhancing self-efficacy related to follow-up care and identifying positive aspects of the traumatic experiences are suggested as treatment approaches for families after cancer treatment Background Lumbar punctures ( LPs ) are common in children with cancer . Although pain management during the lumbar puncture has been well st and ardized , dealing with stress and anxiety is not well addressed yet . Our objective was to evaluate the potential improvement of the LP success rate using a positioning pillow , to ensure maximum lumbar flexion , and allow paravertebral muscles to relax , in children who are awake , with either conscious sedation or no sedation . Methods Children aged 2–18 years undergoing LP were r and omly assigned to a positioning pillow or no intervention . The primary outcome was the rate of success , i.e. achieving the LP ( sampling or injection ) at the first attempt , without bleeding ( RBC < 50/mm3 ) . The secondary outcomes included : the child 's pain , assessed by a self-administered visual analogical scales ( VAS ) for children over 6 years of age ; the parents ' and caregivers ' perception of the child 's pain ; the satisfaction of the children , the parents , the caregivers and the physician . The child 's cooperation and the occurrence of post-LP syndrome were also evaluated . Results 124 children ( 62 in each group ) were included . The LP pillow tended to increase the success rate of LPs ( 67 % vs. 57 % , p = 0.23 ) , and decreased the post-LP syndromes ( 15 % vs. 24 % , p = 0.17 ) but the differences were not statistically significant . In children over 6-year of age ( n = 72 ) , the rate of success was significantly higher in the pillow group ( 58.5 % vs. 41.5 % , p = 0.031 ) , with a tendency to feel less pain ( median VAS 25 vs. 15 mm , p = 0.39 ) and being more satisfied ( 84.4 % vs. 75.0 % , p = 0.34 ) . Conclusion Overall results do not demonstrate a benefit in using this pillow for lumbar punctures . This study results also suggest a benefit in the sub group of children over 6-year of age ; this result needs confirmation . Trial Registration The trial was registered with Clinical Trials.gov ( number NCT00775112 ) The purpose of this study was to assess prospect ively the behavioral effects of chemotherapy in children and adolescents with cancer . A total of 94 patients , with a range of malignancies and chemotherapy protocol s , were evaluated 1 , 4 , and 7 months after treatment initiation . Assessment s focused on behavioral distress symptoms and nausea/vomiting experienced in anticipation of chemotherapy and following its administration . Significant disturbances were described in a variety of domains , with adolescents exhibiting consistently higher levels of behavioral symptoms and nausea/vomiting than younger children . Behavioral distress tended to decrease and stabilize throughout time for children and to increase throughout time for adolescents . Age differences in behavioral distress were independent of the emetogenicity of therapy given to younger and older patients . The interaction of biologic and psychosocial factors in determining treatment-related distress is discussed , along with implication s for future predictive and intervention studies BACKGROUND The study objective was to compare a hospital-based and a home-based chemotherapy program for children with acute lymphoblastic leukemia ( ALL ) in relation to Quality of Life ( QOL ) , safety , caregiver burden , and costs . PROCEDURE A r and omized cross-over trial ( RCT ) design with repeated measures was conducted with 23 children with ALL who attended the oncology outpatient clinic of a metropolitan university affiliated tertiary level pediatric hospital and who also received home visits from a community health services care provider in central Canada . RESULTS During the home-treatment phase , children were more capable of maintaining their usual routines than when receiving hospital chemotherapy ( Wilcoxon statistic = 80 , P = 0.023 ) , but they appeared to experience greater emotional distress ( Wilcoxon sign rank statistic S = 66 , P = 0.043 ) according to parental report . Treatment location had no effect on caregiver burden and adverse effects . No significant differences between groups existed with respect to societal costs of care . As the child 's age increased , QOL improved relative to younger children ( t(20 ) = -2.37 , P = 0.02 ) , the time burden related to child care tasks was reduced ( t(21 ) = -3.56 , P = 0.002 ) , caregiver effort/difficulty in physical and behavioral support decreased ( t(21 ) = -2.09 , P = 0.049 ) and the odds of experiencing one or more adverse events decreased ( OR = 0.79 , CI = ( 0.63 - 1.00 ) , chi(1 ) ( 2 ) = 4.01 , P = 0.045 ) . CONCLUSIONS With few differences noted between groups , these results indicate preliminary support for administrating some or all of a child 's chemotherapy at home . Home chemotherapy was associated with specific improvements and decrements in parent reported QOL . No effects were seen on burden of care , adverse events , or cost . Overall , young age adversely affected QOL , burden of care , and adverse events . These data provide important information to families and caregivers as they consider home or hospital-based therapy in childhood ALL A mixed methods research design was used to investigate the effects of a music therapy CD ( MTCD ) creation intervention on pediatric oncology patients ' distress and coping during their first radiation therapy treatment .  The music therapy method involved children creating a music CD using interactive computer-based music software , which was " remixed " by the music therapist- research er to extend the musical material . Eleven pediatric radiation therapy out patients aged 6 to 13 years were r and omly assigned to either an experimental group , in which they could create a music CD prior to their initial treatment to listen to during radiation therapy , or to a st and ard care group . Quantitative and qualitative analyses generated multiple perceptions from the pediatric patients , parents , radiation therapy staff , and music therapist- research er . Ratings of distress during initial radiation therapy treatment were low for all children . The comparison between the two groups found that 67 % of the children in the st and ard care group used social withdrawal as a coping strategy , compared to 0 % of the children in the music therapy group ; this trend approached significance ( p = 0.076 ) . MTCD creation was a fun , engaging , and developmentally appropriate intervention for pediatric patients , which offered a positive experience and aided their use of effective coping strategies to meet the dem and s of their initial radiation therapy treatment R and omized 64 children ages 5 to 13 years with newly diagnosed cancer to either a Social Skills Training experimental treatment group or a School Reintegration st and ard treatment group . Children who received explicit training in social skills reported higher perceived classmate and teacher social support at the 9-month follow-up in comparison to pretreatment levels , while parents reported a decrease in internalizing and externalizing behavior problems and an increase in school competence . Method ological improvements for Phase III clinical trials are addressed OBJECTIVE To report acceptability , feasibility , and outcome data from a r and omized clinical trial ( RCT ) of a brief intervention for caregivers of children newly diagnosed with cancer . METHOD Eighty-one families were r and omly assigned following collection of baseline data to Intervention or Treatment as Usual ( TAU ) . Recruitment and retention rates and progression through the protocol were tracked . Measures of state anxiety and posttraumatic stress symptoms served as outcomes . RESULTS Difficulties enrolling participants included a high percentage of newly diagnosed families failing to meet inclusion criteria ( 40 % ) and an unexpectedly low participation rate ( 23 % ) . However , movement through the protocol was generally completed in a timely manner and those completing the intervention provided positive feedback . Outcome data showed no significant differences between the arms of the RCT . CONCLUSIONS There are many challenges inherent in conducting a RCT shortly after cancer diagnosis . Consideration of alternative research design s and optimal timing for interventions are essential next steps ABSTRACT Venepuncture for blood sampling can be a distressing experience for a considerable number of children . A prospect i ve controlled trial was conducted to compare the efficacy of a local anaesthetic ( EMLA ) with a combination of EMLA with self‐hypnosis in the relief of venepuncture‐induced pain and anxiety in 45 paediatric cancer out patients ( age 6–16 years ) . A secondary aim of the trial was to test whether the intervention will have a beneficial effect on  parents ’ anxiety levels during their child ’s procedure . Patients were r and omized to one of three groups : local anaesthetic , local anaesthetic plus hypnosis , and local anaesthetic plus attention . Results confirmed that patients in the local anaesthetic plus hypnosis group reported less anticipatory anxiety , and less procedure‐related pain and anxiety , and were rated as demonstrating less behavioural distress during the procedure than patients in the other two groups . Parents whose children were r and omized to the local anaesthetic plus hypnosis condition experienced less anxiety during their child ’s procedure than parents whose children had been r and omized to the other two conditions . The therapeutic benefit of the brief hypnotic intervention was maintained in the follow‐up . The present findings are particularly important in that this study was a r and omized , controlled trial conducted in a naturalistic medical setting . In this context , convergence of subjective and objective outcomes was reached with large effect sizes that were consistently supportive of the beneficial effects of self‐hypnosis , an intervention that can be easily taught to children , is noninvasive and poses minimal risk to young patients and their parents Background Most studies on health-related quality of life ( HRQOL ) in children with cancer focussed on survivors . Only few studies have evaluated patients during ongoing oncological treatment . The aim of this study was a prospect i ve assessment of HRQOL in children during the first year after diagnosis of cancer and an examination of demographic , medical , and parental predictors of HRQOL . Methods Fifty-two patients ( mean age : 10.9 years ) were assessed 6 weeks and 1 year after diagnosis with the  TNO-AZL Question naire for Children 's Health-Related Quality of Life . Parents completed the Brief Symptom Inventory . Results Compared to a community sample , patients reported more physical complaints , reduced motor functioning and autonomy , and impaired positive emotional functioning 6 weeks after diagnosis . HRQOL significantly improved over the year . However , at 1 year , patients still showed reduced motor and emotional functioning . At 6 weeks , children with leukemia were most affected . At 1 year , patients with brain tumors complained about more physical symptoms than the other groups . Intensity of treatment and presence of medical complications mainly influenced HRQOL at 6 weeks but less at 1 year . Parental psychopathology was associated with better cognitive functioning in the child . Conclusion This prospect i ve study found several domains of HRQOL to be compromised 6 weeks and 1 year after the diagnosis of cancer . Although HRQOL significantly increased over the year , there were important differences between diagnostic groups . The findings highlight the importance of repeated evaluation of HRQOL in children undergoing cancer treatment and consideration of specific differences between diagnostic groups OBJECTIVE To evaluate the efficacy of an interactive intervention in reducing distress related to radiation therapy ( RT ) among pediatric cancer participants as measured by occurrence of sedation , observed behavioral distress ( OBD ) , and heart rate ( HR ) . METHODS Seventy-nine children receiving RT simulation  were assigned r and omly to a STARBRIGHT Hospital Pals group ( i.e. , interactive intervention group ; IG ) or modified control group ( MCG ) . The interactive intervention included filmed modeling , exposure to an interactive Barney character , and passive auditory distraction . RESULTS Children in the IG experienced significantly lower HR when compared with MCG participants . No differences were found in terms of sedation or OBD . CONCLUSIONS The interactive intervention was effective at reducing RT-related distress ( as measured by HR ) and would be a useful tool in pediatric radiation oncology setting OBJECTIVES To evaluate the feasibility and efficacy of a h and held personal digital assistant (PDA)-based supplement for maternal Problem-Solving Skills Training ( PSST ) and to explore Spanish-speaking mothers ' experiences with it . METHODS Mothers ( n = 197 ) of children with newly diagnosed cancer were r and omized to traditional PSST or PSST + PDA 8-week programs . Participants completed the Social Problem-Solving Inventory-Revised , Beck Depression Inventory-II , Profile of Mood States , and Impact of Event Scale-Revised pre- , post-treatment , and 3 months after completion of the intervention . Mothers also rated optimism , logic , and confidence in the intervention and technology . RESULTS Both groups demonstrated significant positive change over time on all psychosocial measures . No between-group differences emerged . Despite technological " glitches , " mothers expressed moderately high optimism , appreciation for logic , and confidence in both inter 
    Output:
    
Outcomes focused primarily on child distress , anxiety , and pain .