***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 Treatment recommendations for the same condition from different guideline bodies often disagree , even when the same r and omized controlled trial ( RCT ) evidence is cited . Guideline appraisal tools focus on methodology and quality of reporting , but not on the nature of the supporting evidence . This study was done to evaluate the quality of the evidence ( based on consideration of its internal validity , clinical relevance , and applicability ) underlying therapy recommendations in evidence -based clinical practice guidelines . Methods and Findings A cross-sectional analysis of  cardiovascular risk management recommendations  was performed for three different conditions ( diabetes mellitus , dyslipidemia , and hypertension ) from three pan-national guideline panels ( from the United States , Canada , and Europe ) . Of the 338 treatment recommendations in these nine guidelines , 231 ( 68 % ) cited RCT evidence but only 105 ( 45 % ) of these RCT -based recommendations were based on high- quality evidence . RCT -based evidence was down grade d most often because of reservations about the applicability of the RCT to the population s specified in the guideline recommendation ( 64/126 cases , 51 % ) or because the RCT reported surrogate outcomes ( 59/126 cases , 47 % ) . Conclusions The results of internally valid RCTs may not be applicable to the population s , interventions , or outcomes specified in a guideline recommendation and therefore should not always be assumed to provide high- quality evidence for therapy recommendations Little has been done to study the effectiveness of antidepressants in controlling anxiety/depression in a population of cancer patients . A double‐blind placebo‐controlled study was therefore design ed to assess the effectiveness of 20 mg fluoxetine . Of 115 cancer patients who fulfilled entry criteria for levels of distress , 45 patients were r and omized to a  fluoxetine treatment group ( FA ) and 46 patients to a placebo group ( PA ) after a 1‐week placebo period design ed to exclude placebo responders . The Montgomery and Asberg Depression Scale ( MADRS ) , the Hamilton Anxiety Scale ( HAS ) , the Hospital Anxiety and Depression Scale ( HADS ) , the Revised Symptom Checklist ( SCL90‐R ) and the Spitzer Quality of Life Index ( SQOLI ) were used to assess the efficacy of fluoxetine . The response rate , defined by a HADS score lower than 8 after 5 weeks of treatment , was not significantly higher in the FA group ( 11 % ) compared to the PA group ( 7 % ) . Compared to the PA group , patients in the FA group showed a significantly greater decrease in SCL90‐R mean total score after 5 weeks , but not a greater decrease in HADS mean score . No difference between the two groups was found in observer‐reported assessment s ( MADRS , HAS and SQOLI ) . Significantly more drop‐outs were observed in the FA group ( n=15 ) than in the PA group ( n=7 ) , although the frequencies of side‐effects were not significantly different PURPOSE Although psychosocial intervention can reduce psychosocial distress following breast cancer , many women who are experiencing problems are not identified and offered additional help . This trial assessed effects on quality of life of psychologic distress screening among newly diagnosed , nonmetastatic breast cancer patients . PATIENTS AND METHODS From 1990 to 1992 , all eligible patients in one regional breast cancer center were identified and offered study participation . Women in both control and experimental groups received brief psychosocial intervention from a social worker at initial treatment . The experimental group also had monthly telephone screening of distress levels using a brief , vali date d instrument , with additional psychosocial intervention offered only to those with high distress at screening . RESULTS Among 282 eligible patients , 89 % were r and omized and completed the study . Participants ' psychologic distress levels decreased over the study period ( P = .0001 ) . However , no between-group differences were observed . Mean distress scores among control and experimental women at 0- , 3- , and 12-month interviews were 20.7 and 20.4 , 15.5 and 15.0 , and 14.6 and 13.5 , respectively . No between-group differences were observed with respect to physical health , functional status , social and leisure activities , return to work , or marital satisfaction . CONCLUSION Our results indicate that , among patients who receive a minimal psychosocial intervention as part of their initial cancer care , a distress screening program does not improve quality of life .  Minimal psychosocial intervention at initial treatment may be effective in reducing distress , thus making it difficult to obtain additional benefit from a screening program Background Depression is common among older cancer patients , but little is known about the optimal approach to caring for this population . This analysis evaluates the effectiveness of the Improving Mood-Promoting Access to Collaborative Treatment ( IMPACT ) program , a stepped care management program for depression in primary care patients who had an ICD-9 cancer diagnosis . Methods Two hundred fifteen cancer patients were identified from the 1,801 participants in the parent study . Subjects were 60 years or older with major depression ( 18 % ) , dysthymic disorder ( 33 % ) , or both ( 49 % ) , recruited from 18 primary care clinics belonging to 8 health-care organizations in 5 states . Patients were r and omly assigned to the IMPACT intervention ( n = 112 ) or usual care ( n = 103 ) . Intervention patients had access for up to 12 months to a depression care manager who was supervised by a psychiatrist and a primary care provider and who offered education , care management , support of antidepressant management , and brief , structured psychosocial interventions including behavioral activation and problem-solving treatment . Results At 6 and 12 months , 55 % and 39 % of intervention patients had a 50 % or greater reduction in depressive symptoms ( SCL-20 ) from baseline compared to 34 % and 20 % of usual care participants ( P = 0.003 and P = 0.029 ) . Intervention patients also experienced greater remission rates ( P = 0.031 ) , more depression-free days ( P < 0.001 ) , less functional impairment ( P = 0.011 ) , and greater quality of life ( P = 0.039 ) at 12 months than usual care participants . Conclusions The IMPACT collaborative care program appears to be feasible and effective for depression among older cancer patients in diverse primary care setting BACKGROUND Cognitive behaviour therapy ( CBT ) has been shown to reduce psychological morbidity in people with cancer , but no r and omized controlled trial ( RCT ) exists in palliative care . We aim ed to determine whether home care nurses could be taught to deliver basic cognitive behavioural techniques and so reduce symptoms of anxiety and depression . METHOD Clinical nurse specialists ( CNSs ) at St Christopher 's Hospice were r and omly allocated to receive training in CBT or continue their usual practice . At the end of the trial , nurses were rated on the Cognitive Therapy First Aid Rating Scale ( CTFARS ) for CBT competence . Home care patients who scored as possible cases on the Hospital Anxiety and Depression Scale ( HADS ) entered the trial . Participants received home care nursing visits . Assessment s were carried out at baseline , 6 , 10 and 16 weeks . RESULTS Eight nurses received CBT training and seven continued practice as usual . The mean CTFARS scores were 35.9 for the CBT nurses and 19.0 for the controls ( p=0.02 ) . A total of 328 patients ( 54 % ) were possible cases and 80 entered the trial ; most of those excluded were too ill to participate . There was an interaction between group and time : individuals receiving CBT had lower anxiety scores over time [ coefficient -0.20 , 95 % confidence interval ( CI ) -0.35 to -0.05 , p=0.01 ] . No effect of the training was found for depression . CONCLUSIONS It is possible to conduct a r and omized trial of psychological interventions in palliative care but there is considerable attrition from physical morbidity and mortality . Nurses can learn to integrate basic CBT methods into their clinical practice . This training may be associated with better outcomes for symptoms of anxiety PURPOSE Although patient-reported cancer symptoms and quality -of-life issues ( SQLIs ) have been promoted as essential to a comprehensive assessment , efficient and efficacious methods have not been widely tested in clinical setting s. The purpose of this trial was to determine the effect of the Electronic Self-Report Assessment -Cancer ( ESRA-C ) on the likelihood of SQLIs discussed between clinicians and patients with cancer in ambulatory clinic visits . Secondary objectives included comparison of visit duration between groups and usefulness of the ESRA-C as reported by clinicians . PATIENTS AND METHODS This r and omized controlled trial was conducted in 660 patients with various cancer diagnoses and stages at two institutions of a comprehensive cancer center .  Patient-reported SQLIs  were automatically displayed on a graphical summary and provided to the clinical team before an on-treatment visit ( n = 327 ) ; in the control group , no summary was provided ( n = 333 ) . SQLIs were scored for level of severity or distress . One on-treatment clinic visit was audio recorded for each participant and then scored for discussion of each SQLI . We hypothesized that problematic SQLIs would be discussed more often when the intervention was delivered to the clinicians . RESULTS The likelihood of SQLIs being discussed differed by r and omized group and depended on whether an SQLI was first reported as problematic ( P = .032 ) . Clinic visits were similar with regard to duration between groups , and clinicians reported the summary as useful . CONCLUSION The ESRA-C is the first electronic self-report application to increase discussion of SQLIs in a US r and omized clinical trial BACKGROUND Major depressive disorder severely impairs the quality of life of patients with medical disorders such as cancer , but evidence to guide its management is scarce . We aim ed to assess the efficacy and cost of a nurse-delivered complex intervention that was design ed to treat major depressive disorder in patients who have cancer . METHODS We did a r and omised trial in a regional cancer centre in Scotl and , UK . 200 out patients who had cancer with a prognosis of greater than 6 months and major depressive disorder ( identified by screening ) were eligible and agreed to take part . Their mean age was 56.6 ( SD 11.9 ) years , and 141 ( 71 % ) were women . We r and omly assigned 99 of these participants to usual care , and 101 to usual care plus the intervention , with minimisation for sex , age , diagnosis , and extent of disease . The intervention was delivered by a cancer nurse at the centre over an average of seven sessions . The primary outcome was the difference in mean score on the self-reported Symptom Checklist-20 depression scale ( range 0 to 4 ) at 3 months after r and omisation . Analysis was by intention to treat . This trial is registered as IS RCT N84767225 . FINDINGS Primary outcome data were missing for four patients . For 196 patients for whom we had data at 3 months , the adjusted difference in mean Symptom Checklist-20 depression score , between those who received the intervention and those who did not , was 0.34 ( 95 % CI 0.13 - 0.55 ) . This treatment effect was sustained at 6 and 12 months . The intervention also improved anxiety and fatigue but not pain or physical functioning . It cost an additional pound sterling 5278 ( US$ 10 556 ) per quality -adjusted life-year gained . INTERPRETATION The intervention-Depression Care for People with Cancer-offers a model for the management of major depressive disorder in patients with cancer and other medical disorders who are attending specialist medical services that is feasible , acceptable , and potentially cost effective The potential benefits of health-related quality of life ( HRQL ) assessment in oncology clinical practice include better detection of problems , enhanced disease and treatment monitoring and improved care . However , few empirical studies have investigated the effects of incorporating such assessment s into routine clinical care . Recent r and omized studies have reported improved detection of and communication about patients ' concerns , but few have found effects on patient HRQL or satisfaction . This study examined whether offering interpretive assistance of HRQL results would improve these patient outcomes . Two hundred and thirteen participants with metastatic breast , lung or colorectal cancer were r and omly assigned to one of three conditions : usual care ; HRQL assessment or HRQL assessment followed by a structured interview and discussion . Interviews about patients ' assessment responses were conducted by a research nurse , who then presented HRQL information to the treating nurse . HRQL and treatment satisfaction outcomes were assessed at 3 and 6 months . No significant differences were found between study conditions in HRQL or satisfaction . Results suggest that routine HRQL assessment , even with description of results , is insufficient to improve patient HRQL and satisfaction . It is suggested that positive effects may require supplementing assessment results with specific suggestions for clinical management changes Depression is a major complication of cancer . The efficacy and safety of mianserin were evaluated in a r and omized placebo‐controlled trial of 73 depressed women with cancer . According to RDC diagnosis , all patients showed situational major depression . Both groups were well matched for cancer localization , clinical stages , Karnofsky scores , duration of depression , baseline values on the Hamilton Depression Rating Scale ( HDRS ) , Zung Self‐Rating Depression Scale ( ZSRDS ) , and Clinical Global Impression of Illness Severity ( CGI‐S ) , and for type of depression , whether dominantly depressive or depressive‐anxious . Between days 7–21 , there were significantly fewer dropouts with mianserin ( 7 ) than with placebo ( 15 ) . When compared with place 
    Output:
    
Pharmacological , psychotherapy and collaborative care interventions generally reduced distress with small to moderate effects .
CONCLUSION Treatment studies reported modest improvement in distress symptoms , but only a single eligible study was found on the effects of screening cancer patients for distress , and distress did not improve in screened patients versus those receiving usual care .