***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 
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    Input: Background Breast cancer among women is a relatively common with a more favorable expected survival rates than other forms of cancers . This study aim ed to determine the improved quality of life for post-mastectomy women through peer education . Methods Using pre and post test follow up and control design approach , 99 women with stage I and II of breast cancer diagnosis were followed one year after modified radical mastectomy .  To measure the quality of life an instrument design ed by the European organization for research and treatment of cancer , known as the Quality of Life Question ( QLQ-30 ) and it 's breast cancer supplementary measure ( QLQ-BR23 ) at three points in time ( before , immediately and two months after intervention ) for both groups were used . The participant selection was a convenient sampling method and women were r and omly assigned into two experimental and control groups . The experimental group was r and omly assigned to five groups and peer educators conducted weekly educational programs for one month . Tabulated data were analyzed using chi square , t test , and repeated measurement multivariate to compare the quality of life differences over time . Results For the experimental group , the results showed statistically significant improvement in all performance aspects of life quality and symptom reduction ( P < 0.001 ) , while the control group had no significant differences in all aspects of life quality . Conclusion The findings of this study suggest that peer led education is a useful intervention for post-mastectomy women to improves their quality of life OBJECTIVE The aim is to evaluate the effectiveness of a manualized 12-week supportive-expressive group therapy program among primary breast cancer patients treated in community setting s , to determine whether highly distressed patients were most likely to benefit and whether therapist 's training or experience was related to outcome . METHOD Three hundred and fifty-three women within one year of diagnosis with primary breast cancer were r and omly assigned to receive supportive-expressive group therapy or to an education control condition . Participants were recruited from two academic centers and nine oncology practice s , which were members of NCI 's Community Clinical Oncology Program ( CCOP ) and were followed over 2 years . RESULTS A 2x2x19 analysis of variance was conducted with main effects of treatment condition , cohort , and baseline distress and their interactions . There was no main effect for treatment condition after removing one subject with an extreme score .  Highly distressed women did not derive a greater benefit from treatment . Therapist training and psychotherapy experience were not associated with a treatment effect . CONCLUSIONS This study provides no evidence of reduction in distress as the result of a brief supportive-expressive intervention for women with primary breast cancer . Future studies might productively focus on women with higher initial levels of distress PURPOSE Evidence suggests that the re-entry phase ( ie , early period after medical treatment completion ) presents distinct challenges for cancer patients . To facilitate the transition to recovery , we conducted the Moving Beyond Cancer ( MBC ) trial , a multisite , r and omized , controlled trial of psychoeducational interventions for breast cancer patients . METHODS Breast cancer patients were registered within 6 weeks after surgery . After medical treatment , they completed baseline measures and were r and omly assigned to st and ard National Cancer Institute print material ( CTL ) ; st and ard print material and peer-modeling videotape ( VID ) ; or st and ard print material , videotape , two sessions with a trained cancer educator , and informational workbook ( EDU ) . Two primary end points were examined : energy/fatigue and cancer-specific distress . Secondary end points were depressive symptoms and post-traumatic growth . Perceived preparedness for re-entry was analyzed as a moderator of effects . RESULTS Of 558 women r and omly assigned to treatment , 418 completed the 6-month assessment and 399 completed the 12-month assessment . In analyses controlling for study site and baseline depressive symptoms , VID produced significant improvement in energy/fatigue at 6 months relative to CTL , particularly among women who felt less prepared for re-entry at baseline . No significant main effect of the interventions emerged on cancer-specific distress , but EDU prompted greater reduction in this outcome relative to CTL at 6 months for patients who felt more prepared for re-entry . Between-group differences in the primary outcomes were not significant at 12 months , and no significant effects emerged on the secondary end points . CONCLUSION A peer-modeling videotape can accelerate the recovery of energy during the re-entry phase in women treated for breast cancer , particularly among those who feel less prepared for re-entry OBJECTIVES Considerable morbidity persists among survivors of breast cancer ( BC ) including high levels of psychological stress , anxiety , depression , fear of recurrence , and physical symptoms including pain , fatigue , and sleep disturbances , and impaired quality of life . Effective interventions are needed during this difficult transitional period . METHODS We conducted a r and omized controlled trial of 84 female BC survivors ( Stages 0-III ) recruited from the H. Lee Moffitt Cancer and Research Institute . All subjects were within 18 months of treatment completion with surgery and adjuvant radiation and /or chemotherapy .  Subjects were r and omly assigned to a 6-week Mindfulness-Based Stress Reduction ( MBSR ) program design ed to self-regulate arousal to stressful circumstances or symptoms ( n=41 ) or to usual care ( n=43 ) . Outcome measures compared at 6 weeks by r and om assignment included vali date d measures of psychological status ( depression , anxiety , perceived stress , fear of recurrence , optimism , social support ) and psychological and physical subscales of quality of life ( SF-36 ) . RESULTS Compared with usual care , subjects assigned to MBSR(BC ) had significantly lower ( two-sided p<0.05 ) adjusted mean levels of depression ( 6.3 vs 9.6 ) , anxiety ( 28.3 vs 33.0 ) , and fear of recurrence ( 9.3 vs 11.6 ) at 6 weeks , along with higher energy ( 53.5 vs 49.2 ) , physical functioning ( 50.1 vs 47.0 ) , and physical role functioning ( 49.1 vs 42.8 ) . In stratified analyses , subjects more compliant with MBSR tended to experience greater improvements in measures of energy and physical functioning . CONCLUSIONS Among BC survivors within 18 months of treatment completion , a 6-week MBSR(BC ) program result ed in significant improvements in psychological status and quality of life compared with usual care PURPOSE / OBJECTIVES To find the most effective methods of providing social support for women diagnosed with breast cancer by testing the effectiveness of a telephone social support and education intervention to promote emotional and interpersonal adaptation to breast cancer . DESIGN Multisite , two-group experimental study with repeated measures . SETTING Arkansas and New Jersey . SAMPLE The Arkansas sample consisted of 106 women who entered the study two to four weeks postsurgery for nonmetastatic breast cancer and were r and omly assigned to an experimental or control group . The comparison group consisted of 91 women from New Jersey who had participated in a previously completed study that used the same interventions and found that telephone support result ed in more positive , statistically significant adaptation to the disease . METHODS The experimental group received 13 months of telephone social support and education . Both groups received educational material s via a mailed re source kit . The Profile of Mood States ; Visual Analogue Scale-Worry ; Relationship Change Scale ; University of California , Los Angeles , Loneliness Scale-Version 3 ; and the modified Symptom Distress Scale provided data regarding the variables of interest . Data analysis included descriptive statistics , t tests , and multivariate analysis of variance with repeated measures . MAIN RESEARCH VARIABLES Mood , worry , relationships with significant others , loneliness , and symptoms . FINDINGS Data analysis showed no significant differences between groups , and both improved on some of the outcomes . Significant time-by-location interaction effects were found when comparing the Arkansas and New Jersey sample s , thereby supporting the need to consider regional differences when developing interventions . CONCLUSIONS The mailed educational re source kit alone appeared to be as effective as the telephone social support provided by oncology nurses in conjunction with the mailed re source kit . IMPLICATION S FOR NURSING Mailed educational re source kits may be the most efficient and cost-effective way to provide educational support to newly diagnosed patients with breast cancer , but their effect may differ according to region Abstract Background : This study aims to evaluate the effects of Group Cognitive Behavioral Therapy ( GCBT ) in treating major depression in Chinese women with breast cancer . Methods : Sixty-two breast cancer patients diagnosed with major depression were r and omly assigned to GCBT group ( N = 31 ) or a waiting list control group provided with an educational booklet ( N = 31 ) . The primary outcome measure was the 17-Item Hamilton Depression Rating Scale ( 17-HAMD ) . The second outcome measures were Self-Rating Anxiety Scale , Functional Assessment of Cancer Therapy – Breast and Self-Esteem Scale ( SES ) . Assessment s were carried out at completion of the study and six-month afterwards . Results : Patients in the GCBT group had a significant reduction in the 17-HAMD mean score by 9 points ( p < 0.001 ) , more than any reduction among patients in the control group from baseline to the end of therapy and a significant 7 points ( p < 0.001 ) more reduction from baseline to six-month follow-up . GCBT also yielded significantly greater improvement than the control group with regard to quality of life ( QoL ; p < 0.01 ) and self-esteem ( p < 0.05 ) . No significant differences were found between groups on improving anxiety ( p > 0.05 ) . Conclusion : The results of this trial suggest that GCBT is effective for treating major depression , as well as for improving QoL and self-esteem  in breast cancer patients . Trial Registration : Chictr.org Background Among underserved , largely minority women who were breast cancer survivors , this pilot project was design ed to evaluate the quality of life outcomes of a 20 week Contemplative Self-Healing Program . Methods Women previously treated for stage I-III breast cancer were assessed before and after the 20 week program with the FACT-G , FACT-B , FACIT-Spirituality , ECOG , and the Impact of Events Scale . They participated in a 20-week intervention involving guided meditation and cognitive-affective-behavioral learning . Results With an average age of 63 , 62 % of the participants were African-American or Latino . With an average of 5.4 years since the diagnosis of breast cancer , 72 % had an ECOG performance status of 1 . 57 % were currently working . Their baseline FACT-G was 80.5 ± 15.1 , and their baseline Impact of Events Scale was 26.3 ± 18.9 . The within-patient improvement on the FACT-G was 4.6 ± 10.9 ( p = .01 ) ; in parallel the FACT-B improved by 2.8 ± 12.8 points ( p = .03 ) . The Impact of Events Scale improved by 6.6 ± 15.5 points ( p = .01 ) . There was significant within-patient improvement on both the avoidance scale ( 3.8 ± 9.2 ) and on the intrusion scale ( 2.9 ± 7.9 ) . Patients who attended more sessions and conducted more home practice had greater improvements in quality of life . Conclusion Persons receiving a 20-session contemplative self healing intervention  showed improved quality of life , with a clinical ly and statistically significant increase in the FACT-G. In addition , this population showed a significant reduction in post-traumatic stress symptoms assessed by the Impact of Events Scale . Trial registration Clinical Trials Gov NCT00278837 A prospect i ve study was conducted to measure anxiety and depression in Iranian breast cancer patients before and after diagnosis using the  Hospital Anxiety and Depression Scale ( HADS ) . The HADS was administered at two points in time : before diagnosis and 3 months after . In all , 168 breast cancer patients were interviewed . While 48 % of patients had severe symptoms of anxiety at both baseline and follow-up , more than 60 % of patients had no symptoms of depressive illness at pre- and post-diagnosis assessment s. Comparing anxiety and depression before diagnosis and after 3 months , there were no significant differences between patients ' scores on anxiety ( P = 0.42 ) and depression ( P = 0.98 ) subscales . The results showed that patients with advanced disease and a lower performance status were more anxious and experienced more depression . The study findings suggest that severe symptoms of anxiety are the most frequent symptoms in Iranian breast cancer patients . It seems that during the process of diagnosis and 3 months after psychological morbidity persists in patients who suffer from breast cancer PURPOSE Chronic insomnia is highly prevalent in cancer patients .  Cognitive-behavioral therapy ( CBT ) is considered the treatment of choice for chronic primary insomnia . However , no r and omized controlled study has been conducted on its efficacy for  insomnia secondary to cancer . Using a r and omized controlled design , this study conducted among breast cancer survivors evaluated the effect of CBT on sleep , assessed both subjectively and objective ly , and on hypnotic medication use , psychological distress , and quality of life . PATIENTS AND METHODS Fifty-seven women with insomnia caused or aggravated by breast cancer were r and omly assigned to CBT ( n = 27 ) or a waiting-list control condition ( n = 30 ) . The treatment consisted of eight weekly sessions administered in a group and combined the use of stimulus control , sleep restriction , cognitive therapy , sleep hygiene , and fatigue management . Follow-up evaluations were carried out 3 , 6 , and 12 months after the treatment . RESULTS Participants who received the insomnia treatment had significantly better subjective sleep indices ( daily sleep diary , Insomnia Severity Index ) , a lower frequency of medicated nights , lower levels of depression and anx 
    Output:
    
Clear evidence emerged for the efficacy of cognitive behavioral therapy in promoting improvements in anxiety , depression , and quality of life .
CONCLUSION This is the first meta- analysis to demonstrate the efficacy of interventions on a range of psychosocial outcomes following breast cancer surgery .
The meta- analysis highlighted that cognitive behavioral therapy was consistently the most effective psychosocial intervention promoting improvements in anxiety , depression , and quality of life .