***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: In a r and omized controlled design , this study tested the efficacy of a theoretically based uncertainty management intervention delivered to older long-term breast cancer survivors . The sample included 509 recurrence-free women ( 360 Caucasian , 149 African-American women ) with a mean age of 64 years ( S.D.=8.9 years ) who were 5 - 9 years post-treated for breast cancer . Women were r and omly assigned to either the intervention or usual care control condition . The intervention was delivered during four weekly telephone sessions , in which study nurses guided cancer survivors in the use of audiotaped cognitive-behavioral strategies to manage uncertainty about recurrence , and a self-help manual design ed to help women underst and and manage long-term treatment side effects and other symptoms . Treatment outcome data on uncertainty management were gathered at pre-intervention and 10-months afterward . Repeated measures MANOVA evaluating treatment group , ethnic group , and treatment by ethnic interaction effects indicated that training in uncertainty management result ed in improvements in cognitive reframing , cancer knowledge , patient-health care provider communication , and a variety of coping skills . Results are discussed in terms of the importance of theory-based interventions for cancer survivors that target triggers of uncertainty about recurrence and in terms of ethnic differences in response to the intervention This longitudinal study evaluated the effect a prostate cancer-specific online support group had for self-assessed quality of life .  Participants ( N = 40 ) were r and omly assigned to an online support group or the control group . Data consisted of four previously vali date d quality -of-life measurements . Analysis determined that over time , quality of life improved for those in the online group and decreased for those in the control group , but returned to baseline at eight weeks . Providing support using online methods is effective ; the length of time this intervention should be provided to patients will require further research 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 Cancer survivors have experienced high stress which impairs psychological functioning and decreases quality of life ( QOL ) . This study aims to assess the mediating effect of self-efficacy on mood disturbance and QOL , and determine the effectiveness of a 12 week rehabilitation programme to improve self-efficacy as well as improve mood disturbance and QOL in Chinese cancer survivors . A total of 47 cancer patients were r and omly assigned into the experimental ( n = 24 ) and control ( n = 23 ) groups . The participants in the experimental group received cancer-related education , progressive muscle relaxation and emotional support . Self-reported question naires , including General Self-efficacy Scale ( GSES ) , Profile of Mood States Scale-Short Form ( POMS-SF ) and European Organization for Research and Treatment of Cancer Quality of Life Question naire Core 30 ( EORTC QLQ-C30 ) were collected in pre- and post-intervention . Findings from this study indicated that self-efficacy was a complete mediator between mood disturbance and QOL , and the 12 week rehabilitation programme had a positive effect on self-efficacy , mood disturbance and QOL for Chinese cancer survivors Purpose : Cancer diagnosis and treatment imparts chronic stressors affecting quality of life ( QOL ) and basic physiology . However , the capacity to increase survival by improving QOL is controversial . Patients with cervical cancer , in particular , have severely compromised QOL , providing a population well-suited for the evaluation of novel psychosocial interventions and the exploration of mechanisms by which modulation of the psychoneuroimmune axis might result in improved clinical outcomes . Experimental Design : A r and omized clinical trial was conducted in cervical cancer survivors that were enrolled at ≥13 and < 22 months after diagnosis ( n = 50 ) , comparing a unique psychosocial telephone counseling ( PTC ) intervention to usual care . QOL and biological specimens ( saliva and blood ) were collected at baseline and 4 months post-enrollment . Results : The PTC intervention yielded significantly improved QOL ( P = 0.011 ) . Changes in QOL were significantly associated with a shift of immune system T helper type 1 and 2 ( Th1/Th2 ) bias , as measured by IFN-γ/interleukin-5 ELISpot T lymphocyte precursor frequency ; improved QOL being associated with increased Th1 bias ( P = 0.012 ) . Serum interleukin-10 and the neuroendocrine variables of cortisol and dehydroepi and rosterone revealed trends supporting this shift in immunologic stance and suggested a PTC-mediated decrease of the subject 's chronic stress response . Conclusions : This study documents the utility of a unique PTC intervention and an association between changes in QOL and adaptive immunity ( T helper class ) . These data support the integration of the chronic stress response into biobehavioral models of cancer survivorship and suggests a novel mechanistic hypotheses by which interventions leading to enhanced QOL could result in improved clinical outcome including survival UNLABELLED This r and omized controlled trial assessed the effect of a SMART ( Stress Management and Resiliency Training ) program among 25 women diagnosed with breast cancer .  Resilience , perceived stress , anxiety , and quality of life improved at 12 weeks in the active but not the control arm . A brief training in the SMART program can enhance resilience and quality of life and decrease stress and anxiety . INTRODUCTION Patients with breast cancer experience stress and anxiety related to their diagnosis , with result ing lower quality of life . The purpose of this study was to assess the effect of a SMART ( Stress Management and Resiliency Training ) program for increasing resiliency and for decreasing stress and anxiety among mentors who themselves were previously diagnosed with breast cancer . MATERIAL S AND METHODS The program consisted of two 90-minute group training sessions , a brief individual session , and 3 follow-up telephone calls . Twenty-four mentors at Mayo Clinic in Rochester , Minnesota , were r and omized in a single-blind , wait-list controlled clinical trial to either the SMART intervention or a control group for 12 weeks . Primary outcome measures assessed at baseline and at week 12 included the Connor Davidson Resilience Scale , Perceived Stress Scale , Smith Anxiety Scale , and Linear Analog Self Assessment Scale . RESULTS Twenty patients completed the study . A statistically significant improvement in resilience , perceived stress , anxiety , and overall quality of life at 12 weeks , compared with baseline was observed in the study arm . No significant difference in any of these measures was noted in the control group . CONCLUSION This study demonstrates that a brief , predominantly group-based resilience training intervention is feasible in patients with previous breast cancer ; also , it may be efficacious BACKGROUND The aim of this study was to evaluate the short-term effectiveness of the web-based computer-tailored intervention Kanker Nazorg Wijzer ( Cancer Aftercare Guide ) . The intervention aims to support cancer survivors with managing psychosocial and lifestyle-related issues . In this study , the impact on quality of life , anxiety , depression , and fatigue were evaluated . METHODS Cancer survivors were recruited through 21 Dutch hospitals ( November 2013-June 2014 ) . Outcome measures included quality of life ( European Organization for Research and Treatment of Cancer Quality of Life Question naire-C30 ) , anxiety and depression ( Hospital Anxiety and Depression Scale ) , and fatigue ( Checklist Individual Strength ) . In a r and omized controlled trial with an intervention group ( n = 231 ) and a waiting list control group ( n = 231 ) , the short-term effectiveness was evaluated through multilevel linear regression analyses , controlling for selective dropout , baseline differences , and several demographic and disease-related characteristics . RESULTS In total , 188 participants of the intervention group and 221 of the control group completed the 6-month measurement ( dropout = 11.5 % ) . The intervention was effective in reducing depression ( B = -0.63 , p = 0.007 , f2 = 0.019 , d = 0.21 ) and fatigue ( B = -4.36 , p = 0.020 , f2 = 0.013 , d = 0.21 ) . In addition , effects were found for emotional ( B = 3.47 , p = 0.022 , f2 = 0.013 , d = 0.15 ) and social functioning ( B = 3.95 , p = 0.011 , f2 = 0.017 , d = 0.15 ) , although this evidence was less strong . There were indications that the effects of fatigue and social functioning were influenced by module use . CONCLUSIONS While effect sizes were small , they can be considered as clinical ly relevant . With the Cancer Aftercare Guide being an effective , low-intensive , and easy accessible intervention , it could serve as a first step in stepped care for needs assessment and initial support for psychosocial problems that are present after cancer treatment . Copyright © 2016 John Wiley & Sons , To investigate the mechanism(s ) of action of mindfulness based stress reduction ( MBSR(BC ) ) including reductions in fear of recurrence and other potential mediators . Eighty-two post-treatment breast cancer survivors ( stages 0–III ) were r and omly assigned to a 6-week MBSR(BC ) program ( n = 40 ) or to usual care group ( UC ) ( n = 42 ) . Psychological and physical variables were assessed as potential mediators at baseline and at 6 weeks . MBSR(BC ) compared to UC experienced favorable changes for five potential mediators : ( 1 ) change in fear of recurrence problems mediated the effect of MBSR(BC ) on 6-week change in perceived stress ( z = 2.12 , p = 0.03 ) and state anxiety ( z = 2.03 , p = 0.04 ) ; and ( 2 ) change in physical functioning mediated the effect of MBSR(BC ) on 6-week change in perceived stress ( z = 2.27 , p = 0.02 ) and trait anxiety ( z = 1.98 , p = 0.05 ) . MBSR(BC )  reduces fear of recurrence and improves physical functioning which reduces perceived stress and anxiety . Findings support the beneficial effects of MBSR(BC ) and provide insight into the possible cognitive mechanism of action BACKGROUND To determine whether the Health Partner Program is effective in training long-term cancer survivors to be health coaches . MATERIAL S AND METHODS We r and omly assigned cancer survivors who were selected through a rigorous screening process to either the Health Partner Program or the waiting-list control group .  The program consisted of 8 weeks of training in health management , leadership , and coaching . At baseline , 8 , and 16 weeks , we measured primary outcomes using the Seven Habit Profile ( SHP ) , the Korean Leadership Coaching Competency Inventory ( KCCI ) , Ed Diner 's Satisfaction with Life Scale ( SWLS ) , and the Posttraumatic Growth inventory ( PTGI ) and secondary outcomes using the Hospital Anxiety and Depression Scale ( HADS ) , the Impact of Event Scale-Revised ( IES-R ) , and the Medical Outcomes Study ( MOS ) short form 36-item question naire ( SF- 36 ) . RESULTS We recruited 70 subjects and r and omly assigned 34 to the intervention group . The Sharpen the Saw habit of the SHP increased significantly more in intervention group than in the control group ( p = 0.049 ) , as did most PTGI factors . The intervention group also showed a significantly greater enhancement of vitality ( p = 0.015 ) and mental health ( p = 0.049 ) SF-36 scores but no improvement in KCCI , SWLS , HADS , or IES-R scores . The intervention group also showed a greater clinical ly meaningful improvement in the " Think Win-Win " of SHP ( p = 0.043 ) and in the personal strength score ( p = 0.025 ) and total score ( p = 0.015 ) of the PTGI . CONCLUSIONS Long-term cancer survivors can benefit from the Health Partner Program to become health coaches OBJECTIVE The outcomes of a 10-week cognitive-behavioral stress management ( CBSM ) group intervention were evaluated in prostate cancer survivors . A model was tested in which CBSM-related improvements in emotional well-being were attained through changes in men 's perceptions of their condition , as conceptualized by information processing explanations of self-regulation theory . The model also tested whether life stress and treatment-related side effects moderated intervention effects . METHODS Men treated for localized prostate cancer ( n = 257 ) within the past 18 months were r and omized to CBSM or a half-day psy 
    Output:
    
Subgroup analysis showed that counseling was the most effective intervention for quality of life , and behavioral therapy was an effective intervention for all positive and negative outcomes .
Publication bias was not detected except for psychological distress .
CONCLUSION Psychoeducational intervention appears to be effective in improving quality of life and coping and self-efficacy , and it is effective in reducing psychological symptoms in cancer survivors .
Behavioral therapy , especially , is commonly effective in improving psychosocial outcomes .