***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: Background : Patient navigation ( PN ) is an emerging strategy to overcome barriers to cancer care . We evaluated the efficacy of PN in improving time of key events in cancer care , including positive screening tests , definitive diagnosis , initiation of therapy , and completion of initial therapy . Methods : We evaluated PN in a prospect i ve observational study of predominantly poor Hispanic women with an abnormal breast cancer screening or untreated biopsy proven breast cancer ( control = 200 , intervention = 260 ) . Controls were contemporary record-based patients with positive screening . Analyses were conducted for the entire cohort and separately by ethnic strata . We used χ2 tests to compare differences in proportions and Kaplan – Meier followed by Cox regression to compare time-to-event curves of the intervention and control groups . Results : The average days from definitive diagnosis to initiation of therapy was significantly reduced overall with PN ( PN vs. control , 57 vs. 74 days , P = 0.04 ) . This effect was more pronounced in the Hispanic strata ( 56 vs. 81 days , P = 0.02 ) . More navigated Hispanic women were diagnosed within 60 days of abnormal screening ( 62.6 % vs. 47.5 % , P < 0.01 ) and more began treatment within 60 days of diagnosis ( 80 % vs. 56.3 % , P < 0.01 ) . Navigated Hispanic and other ethnic minority women had a shorter time from positive screening test to definitive diagnosis ( 16 and 32 days , respectively ) . Conclusions : Minority women may have benefited from navigation with shorter times from definitive diagnosis to initiation of therapy . Impact : PN intervention may show promise in decreasing some delays that contribute to health disparities among minority women with breast cancer . Cancer Epidemiol Biomarkers Prev ; 21(10 ) ; 1639–44 . © 2012 AACR Abstract OBJECTIVE : Assess impact of a computer-based patient support system on quality of life in younger women with breast cancer , with particular emphasis on assisting the underserved . DESIGN : R and omized controlled trial conducted between 1995 and 1998 . SETTING : Five sites : two teaching hospitals ( Madison , Wis , and Chicago , Ill ) , two nonteaching hospitals ( Chicago , Ill ) , and a cancer re source center ( Indianapolis , Ind ) . The latter three sites treat many underserved patients . PARTICIPANTS : Newly diagnosed breast cancer patients ( N=246 ) under age 60 . INTERVENTIONS : Experimental group received Comprehensive Health Enhancement Support System ( CHESS ) , a home-based computer system providing information , decision-making , and emotional support . MEASUREMENTS AND MAIN RESULTS : Pretest and two posttest surveys ( at two- and five-month follow-up ) measured aspects of participation in care , social/information support , and quality of life . At two-month follow-up , the CHESS group was significantly more competent at seeking information , more comfortable participating in care , and had greater confidence in doctor(s ) . At five-month follow-up , the CHESS group had significantly better social support and also greater information competence . In addition , experimental assignment interacted with several indicators of medical underservice ( race , education , and lack of insurance ) , such that CHESS benefits were greater for the disadvantaged than the advantaged group . CONCLUSIONS : Computer-based patient support systems such as CHESS may benefit patients by providing information and social support , and increasing their participation in health care . These benefits may be largest for currently underserved population Background Physical activity is important following breast cancer . Trials of non-face-to-face interventions are needed to assist in reaching women living outside major metropolitan areas . Purpose This study seeks to evaluate the feasibility and effectiveness of a telephone-delivered , mixed aerobic and resistance exercise intervention for non-urban Australian women with breast cancer . Methods A r and omized controlled trial comparing an 8-month intervention delivered by exercise physiologists ( n = 73 ) to usual care  ( n = 70 ) . Results Sixty-one percent recruitment rate and 96 % retention at 12 months ; 79 % of women in the intervention group received at least 75 % of calls ; odds ( OR , 95 % CI ) of meeting intervention targets favored the intervention group for resistance training ( OR 3.2 ; 1.2 , 8.9 ) and aerobic ( OR 2.1 ; 0.8 , 5.5 ) activity . Conclusions Given the limited availability of physical activity programs for non-urban women with breast cancer , results provide strong support for feasibility and modest support for the efficacy of telephone-delivered interventions PURPOSE / OBJECTIVES To determine whether breast cancer survivors ( BCSs ) who received an uncertainty management intervention  , compared to an attention control condition  , would have less uncertainty , better uncertainty management , fewer breast cancer-specific concerns , and more positive psychological outcomes . DESIGN A 2 × 2 r and omized block , repeated- measures design , with data collected at baseline and two other points postintervention , as well as a few days before or after either a mammogram or oncologist visit . SETTING Rural and urban clinical and community setting s. SAMPLE 313 female BCSs aged 50 or younger ; 117 African Americans and 196 Caucasians . METHODS Participants were blocked on ethnicity and r and omly assigned to intervention or control . The intervention , consisting of a scripted CD and a guide booklet , was supplemented by four scripted , 20-minute weekly training calls conducted by nurse interventionists . The control group received the four scripted , 20-minute weekly training calls . MAIN RESEARCH VARIABLES Uncertainty in illness , uncertainty management , breast cancer-specific concerns , and positive psychological outcomes . FINDINGS BCSs who received the intervention reported reductions in uncertainty and significant improvements in behavioral and cognitive coping strategies to manage uncertainty , self-efficacy , and sexual dysfunction . CONCLUSIONS The intervention was effective as delivered in managing uncertainties related to being a younger BCS . IMPLICATION S FOR NURSING The intervention can realistically be applied in practice because of its efficient and cost-effective nature requiring minimal direct caregiver involvement . The intervention allows survivors who are having a particular survival issue at any given point in time to access information , re sources , and management strategies . KNOWLEDGE TRANSLATION Material s tested in CD and guide booklet format could be translated into online format for survivors to access as issues arise during increasingly lengthy survivorship periods . Material s could be downloaded to a variety of electronic devices , fitting with the information needs and management styles of younger BCSs OBJECTIVE Obesity is a risk factor for breast cancer recurrence . Rural women have higher obesity rates compared with urban women and are in need of distance-based interventions that promote long-term weight loss . METHODS In this two-phase trial , rural breast cancer survivors who lost > 5 % of their starting weight during a 6-month lifestyle intervention ( delivered through weekly group conference calls ) were r and omized to one of two 12-month interventions for weight loss maintenance : continued biweekly phone-based group counseling or mailed newsletters . The primary outcome was weight regain from 6 to 18 months . Secondary outcomes included dichotomous measures of weight change and costs . RESULTS Mean weight loss at 6 months was 14.0 ± 5.1 % . Participants in the group phone condition regained less weight ( 3.3 ± 4.8 kg ) compared with participants in the newsletter condition ( 4.9 ± 4.8 kg ; P = 0.03 ) . At 18 months , 75.3 % of participants in the group phone condition remained ≥5 % below baseline weight compared with 57.8 % in the newsletter condition ( P = 0.02 ) . Incremental cost-effectiveness ratios were $ 882 to keep one more person ≥5 % below baseline weight . CONCLUSIONS A lifestyle intervention incorporating group phone-based support improved the magnitude of weight loss maintained and increased the proportion of survivors who maintained clinical ly significant reductions CONTEXT Significant barriers exist in the delivery of state-of-the-art cancer care to rural population s. Rural providers ' knowledge and practice s , their rural health care delivery systems , and linkages to cancer specialists are not optimal ; therefore , rural cancer patient outcomes are less than achievable . PURPOSE To test the effects of a strategy targeting rural providers and their practice environment on patient travel for care , satisfaction , economic barriers , and health-related quality of life . METHODS A group-r and omized trial was conducted with 18 rural communities in the north- central United States . Twelve of these communities were included and defined as the unit of analysis for the patient outcomes portion of the study . The intervention targeted rural providers and their practice environment . The subjects were patients with breast , colorectal , lung , and prostate cancers from the rural communities . The main outcomes were patients ' travel to obtain health care , satisfaction with care , perceptions of economic barriers to care , and health-related quality of life . In total , 881 patients were included . RESULTS Group r and omization was balanced . Travel for health care was significantly reduced in the community group exposed to the intervention during months 13 to 24 following cancer diagnosis . The mean miles traveled per patient were 1,326 ( SE = 306 ) for the experimental group and 2,186 ( SE = 347 ) for the control group ( P = 0.03 ) . No significant differences in satisfaction with care , economic barriers to care , or health-related quality of life were found . CONCLUSIONS The intervention significantly reduced  cancer patient travel for health care , which suggests that access to care improved in the experimental group . The results of this study do not allow conclusion that there was no effect on other patient outcomes . The results supported the study 's conceptual framework and many of its hypotheses PURPOSE The purpose of this article is to report the main learning outcomes of the Lake Superior Rural Cancer Care Project . DESCRIPTION OF STUDY The authors design ed and tested a multimodal intervention directed at rural providers and their healthcare systems in a large rural area in the north central United States . An experimental design was used to r and omize rural providers at the group level . The intervention consisted of providing increased education for rural providers with a number of approaches , including the use of clinical opinion leaders . The main outcome of the intervention was knowledge scoring on discipline-specific cancer management tests . RESULTS Knowledge scores for providers in the experimental group significantly increased from pretest to post-test : 66 to 79 for physicians ( and physician assistants ) ( P=.02 ) ; 58 to 71 for nurses ( P=.01 ) ; and 54 to 64 for pharmacists ( P=.01 ) . At post-test , participating providers in the experimental group performed significantly better on the knowledge tests ( P < .01 ) than those in the control groups . CLINICAL IMPLICATION S This study may be the first to test educational interventions to improve rural providers '  knowledge about cancer practice using an experimental design . The intervention may possibly change provider practice behaviors and , thus , patient outcomes , data that will be reported in a future issue . Finally , this educational intervention may prove useful for providers in other rural areas Background : The efficacy of a group-based psychosocial intervention with ethnic minority health population s may depend on consideration for cultural factors that can interact with group processes . Purpose : The current study explored the efficacy of a 10-week group-based cognitive-behavioral stress management ( CBSM ) intervention that was linguistically and culturally adapted for use with Hispanic monolingual men recently treated for localized prostate carcinoma ( PC ) . Methods : 71 Hispanic monolingual Spanish speakers were r and omly assigned to a 10-week CBSM intervention or a half-day stress management seminar ( control condition ) . Hierarchical regression was used to predict post-intervention QoL. Results : After controlling for relevant covariates , assignment to the CBSM condition significantly predicted greater physical well-being , emotional well-being , sexual functioning , and total well-being after the 10-week intervention period . Conclusions : Results suggest that participation in a culturally and linguistically adapted CBSM group intervention improved QoL in Hispanic monolingual men treated for localized PC In a pilot study , 55 low-income Latina patients with breast or cervical cancer and comorbid depression were r and omly assigned to receive collaborative care as part of the Multifaceted Oncology Depression Program or usual care . Relative to patients in the usual care condition , patients receiving collaborative care were more likely to show > or=50 % improvement in depressive symptoms as measured by the Personal Health Question naire ( OR=4.51 , 95 % CI=1.07 - 18.93 ) . Patients in the collaborative care program were also more likely to show improvement in emotional well-being ( increase of 2.15 ) as measured by the Functional Assessment of Cancer Therapy Scale than were those receiving usual care ( decrease of 0.50 ) ( group difference=2.65 , 95 % CI : 0.18 - 5.12 ) . Despite health system , provider , and patient barriers to care , these initial results suggest that patients in public sector oncology clinics can benefit from onsite depression treatment Purpose The purpose of this study was to examine the effects of a r and omized controlled trial ( RCT ) of treatment summaries and survivorship care plans coupled with a nurse counseling session , primarily on physician implementation of and secondarily on patient adherence to recommended survivorship care , among a low-income population of breast cancer survivors ( survivors ) . Methods We recruited 212 low-income , predominantly Latina ( 72.6 % ) survivors with stage 0 to III breast cancer , with an average age of 53 years , from two Los Angeles County public hospitals into an RCT of a survivorship care nurse counseling session coupled with the provision of individualized treatment summaries and 
    Output:
    
The impact of interventions design ed to improve cancer treatment and follow-up care in socially disadvantages groups is multifactorial .