***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: The primary purpose of this study was to determine if a psychoeducational nursing intervention including ( a ) health education , ( b ) stress management , and ( c ) the teaching of coping skills could enhance the coping behavior and affective state of newly diagnosed Stage I/II malignant melanoma patients . The secondary purpose was to determine if this intervention could be implemented by a nurse and integrated into the overall patient care program . Sixty-one patients were r and omized to a control condition or an experimental condition that received an educational manual plus 3 h of individual nurse teaching .  Despite r and omization , experimental patients had significantly higher baseline distress . By 3 months there was a complete reversal of the baseline trend in Profile of Mood States ( POMS ) total mood disturbance ( TMD ) , suggesting that the experimental subjects were experiencing less distress over time . Between-group analysis of change scores found significant decreases in experimental subjects for POMS TMD , fatigue , and Brief Symptom Index ( BSI ) somatization . Within-group analysis found significant experimental decreases for BSI somatization , anxiety , gr and total , General Severity Index , and Positive Symptom Distress Index as well as for POMS anxiety , fatigue , confusion , vigor , and TMD . No significant changes were found for controls . Experimental patients were using significantly fewer ineffective passive resignation coping strategies than controls at 3 months OBJECTIVES We evaluated recurrence and survival for 68 patients with malignant melanoma who participated in a 6-week structured psychiatric group intervention 5 to 6 years earlier , shortly after their diagnosis and initial surgical treatment . We also explored the role of several factors as possible predictors of outcome . DESIGN This was a r and omized controlled experimental study . The Cox proportion hazards regression model was used to quantify the relationship between treatment and the outcomes adjusted by the covariates ( age , sex , Breslow depth , tumor site , baseline Profile of Mood States Total Mood Disturbance , baseline active-behavioral coping , baseline natural killer cell activity , and treatment [ ie , group intervention ] ) . The stepwise procedure was used for covariate selection . RESULTS For control patients , there was a trend for recurrence ( 13/34 ) and a statistically significant greater rate of death ( 10/34 ) than for experimental patients ( 7/34 and 3/34 , respectively ) . We found that being male and having a greater Breslow depth predicted greater recurrence and poorer survival . Analysis of multiple covariates found that only Breslow depth and treatment ( ie , group intervention ) were significant . Adjusting for Breslow depth , treatment effect remained significant . Finally , baseline affective distress and baseline coping were significant psychobehavioral predictors for recurrence and survival . Surprisingly , higher levels of baseline distress as well as baseline coping and enhancement of active-behavioral coping over time were predictive of lower rates of recurrence and death . CONCLUSION Psychiatric interventions that enhance effective coping and reduce affective distress appear to have beneficial effects on survival but are not proposed as an alternative or independent treatment for cancer or any other illness or disease . However , the exact nature of this relationship warrants further investigation Using a r and omized design , the effects of an information programme for melanoma patients were studied . The programme consisted of a group meeting and a brochure . The present study reports on the six-month follow-up of the effects of the programme . A total of 128 patients participated in the programme , 55 before and 73 after the first medical control visit . Question naires regarding knowledge about melanoma , psychological and psychosomatic variables were completed at the first medical control visit and six months later by mail . A question naire concerning patients attitudes to the programme was included after six months . Knowledge about melanoma increased and a majority of patients were satisfied with the information brochure , the group meeting and the group leader , but 40 % considered that too few participants attended in their group meeting . No effects on psychological or psychosomatic variables were found . Men and women participated to the same extent Purpose To investigate psychological reactions and quality of life among patients with posterior uveal melanoma . Methods Consecutive patients with uveal malignant melanoma ( 99/106 ) , referred to st Erik 's Eye Hospital 1995–1996 , treated with rutheniuim plaque radiotherapy ( n = 50 ) or enucleation ( n = 49 ) , were included in this non-r and omised prospect i ve comparative study . Question naires were completed before treatment ( Hospital Anxiety and Depression Scale , HAD scale ) and 2 and 12 months after diagnosis including the HAD scale , the Impact of Event Scale and the EORTC QLQ-C30 . A disease-specific question naire was included 12 months after diagnosis . Between-group differences were analysed by chi-square , Student 's t-test and ANOVA . Results A majority of the patients reported reduced ‘ Quality of Life ’ ( 72–85 % ) , ‘ Emotional functioning ’ ( 60–74 % ) and ‘ Cognitive functioning ’ ( 51–61 % ) . ‘ Fatigue ’ was the most frequently reported symptom ( 61–72 % ) followed by ‘ Insomnia ’ ( 43–58 % ) . Anxiety and depressive symptoms were relatively frequent up to 1 year after treatment , but the levels of anxiety decreased during the first year after treatment . Disease and treatment-related problems were reported in both treatment groups 1 year after diagnosis . Enucleated patients had more problems with appearance and judging distances , whereas those treated with radiotherapy reported vision impairment to a higher extent . Conclusion Enucleated patients reported high levels of emotional distress , problems with appearance and judging distances during the first year after treatment . Patients treated with radiotherapy reported similar levels of quality of life and emotional problems , but more problems with visual impairment . These differences in impact on disease-related functioning should be taken into account when treatment options are discussed Background Patient-orientated endpoints have attracted little attention in patients with malignant choroidal melanoma . This study was conducted to explore the long-term effects of malignant choroidal melanoma and radiotherapy on QOL by means of a differentiated and modular QOL approach , including global QOL , social support , and mental health , in comparison with sociodemographically matched healthy controls . Methods A r and om sample of 100 out patients treated by radiotherapy  were asked by mail to take part in a psychodiagnostic study [ instruments : Short-Form 36 Health-Survey ( SF-36 ) , Symptom Checklist-90-Revised , German Social Support Question naire ] . The same instruments were applied to a healthy control group , which was matched to patients with regard to age , gender , and vocational situation . Results 93 patients ( average age 61.2 years ) responded at an average of 5.5 years ( ±3.7 ) after diagnosis . Visual acuity in the affected eye decreased considerably from diagnosis ( 0.49±0.30 ) to participation in the study ( 0.09±0.21 ) . Compared with healthy controls , patients reported on average statistically significantly lower global QOL ( SF-36 ) , whereas social support and mental distress did not differ . Frequencies of clinical ly relevant mental distress were significantly higher in patients than in controls ( 35.5 % vs. 16.1 % ) . Mental distress was associated with poorer visual acuity , but not with the extent of loss of visual acuity or number of follow-up treatments . Conclusion Patients with choroidal melanoma suffer from low long-term global QOL , and every third patient suffers from relevant mental distress . Regular screening for mental distress should be implemented along with psychological counseling . Additional follow-up treatment does not seem to induce mental distress We evaluated the immediate and long-term effects on immune function measures of a 6-week structure psychiatric group intervention for patients with malignant melanoma . Along with a reduction in levels of psychological distress and greater use of active coping methods , the following immune changes were seen at the 6-month assessment point in the  intervention-group patients ( n = 35 ) compared with  controls ( n = 26 ) : significant increases in the percent of large granular lymphocytes ( defined as CD57 with Leu-7 ) and natural killer ( NK ) cells ( defined as CD16 with Leu-11 and CD56 with NKH1 ) along with indications of increase in NK cytotoxic activity ; and a small decrease in the percent of CD4 ( helper/inducer ) T cells . At the 6-week follow-up point , the majority of these changes were not yet observable . The results indicate that a short-term psychiatric group intervention in patients with malignant melanoma with a good prognosis was associated with longer-term changes in affective state , coping , and the NK lymphoid cell system . Affective rather than coping measures showed some significant correlations with immune cell changes PURPOSE In 1993 , a r and omized intervention study among patients with malignant melanoma showed a significant decrease in psychological distress and increased coping capacity 6 months after the intervention and enhanced survival 6 years later . We applied a similar intervention with a few modifications in a r and omized controlled trial among Danish patients with malignant melanoma and evaluated results on immediate and long-term effects on psychological distress and coping capacity . PATIENTS AND METHODS A total of 262 patients with primary cutaneous malignant melanoma were r and omly assigned to the control or intervention group . Patients in the intervention group were offered six weekly sessions of 2 hours of psychoeducation , consisting of health education , enhancement of problem-solving skills , stress management , and psychological support . The participants were assessed at baseline before r and om assignment and 6 and 12 months after surgery . The analyses of the main effects of the intervention were based on analyses of covariance . RESULTS The patients in the intervention group showed significantly less fatigue , greater vigor , and lower total mood disturbance compared with the controls , and they used significantly more active-behavioral and active-cognitive coping than the patients in the control group . The improvements were only significant at first follow-up . CONCLUSION The findings of this study support the results of an earlier intervention study among patients with malignant melanoma and indicate that a psychoeducational group intervention for such patients can decrease psychological distress and enhance effective coping . However , this effect is short term and the clinical relevance is not obvious The psychological and medical problems encountered by cancer patients are numerous and unique . The diagnosis of cancer frequently produces psychological distress . A review of the literature and the authors ' clinical and research experience suggest that cancer patients may benefit from a variety of psychological intervention programs . A structured , psychiatric intervention consisting of health education , stress management/behavioral training , coping ( including problem-solving techniques ) , and psychosocial group support offers the greatest potential benefit for patients newly diagnosed or in the early stages of their treatment . Early-stage interventions that encourage active behavioral coping and active cognitive coping rather than avoidance or passive acceptance of the illness can be helpful psychologically . These active behavioral and cognitive coping behaviors , which can be learned , can attenuate the psychological distress caused by stressful illness , decrease the amount of psychosocial adjustment to the illness needed , improve overall quality of life , and may also be associated with longer survical times 
    Output:
    
A number of empirically demonstrated risk factors for distress were identified , including female sex , younger age , lower education , visibility of affected body site , lack of social support , and negative appraisal of melanoma .