***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: OBJECTIVE A strong therapeutic alliance has been found to predict psychotherapeutic treatment success across a variety of therapeutic modalities and patient population s. However , only a few studies have examined therapeutic alliance as a predictor of psychotherapy outcome among cancer survivors , and none have examined this relation in telephone-administered cognitive-behavioral therapy ( T-CBT ) . This study evaluated the extent to which therapeutic alliance affected psychotherapy outcomes in survivors of hematopoietic stem cell transplantation ( HSCT ) , a treatment for some cancers . METHOD Forty-six patients enrolled in a r and omized clinical trial of T-CBT for posttraumatic stress disorder ( PTSD ) completed a baseline assessment ( including self-report measures of PTSD symptoms , depression , and general distress ) , 10 individual T-CBT sessions , and follow-up assessment s at 6 , 9 , and 12 months post-baseline .  Therapeutic alliance was assessed after the 3rd T-CBT session with the Working Alliance Inventory , which yields overall and subscale ( task , bond , and goal ) scores . RESULTS Analyses revealed that higher total therapeutic alliance scores prospect ively predicted decreased depressive symptomatology ; higher task scores predicted decreased overall distress , depressive symptomatology , symptoms of re-experiencing , and avoidance ; and higher bond scores predicted decreased depressive symptomatology and symptoms of re-experiencing . CONCLUSIONS These results suggest that assessment s of therapeutic alliance should be incorporated into routine clinical care , and therapeutic alliance should be specifically cultivated in interventions to maximize psychotherapeutic benefits involving vulnerable population s such as cancer survivors OBJECTIVE To examine in a sample of hematopoietic stem cell transplant patients assessed throughout protective isolation  ( i ) levels of anxiety and depression and ( ii ) pre-isolation factors ( socio-demographics , biomedical variables and personality traits ) , which might predict higher levels of anxiety and depression during isolation . METHODS The study used a longitudinal prospect i ve design . Anxiety and depression were assessed in 107 participants by the  State-Trait Anxiety Inventory and Self-rating Depression Scale  at admission and weekly at fixed time points throughout isolation . Among pre-isolation factors , patients ' psychological status was evaluated by the Cognitive Behavioral Assessment ( 2.0 ) . Predictors were explored by r and om-effects models . RESULTS One-tenth of the patients suffered from clinical ly significant anxiety and depressive symptoms at admission . Although the percentage of depressed patients increased more than twofold after 2 weeks of isolation , that of anxious patients did not significantly change over time . Female gender , higher anxiety and obsessive-compulsive symptoms , intratensive personality traits and lower performance status predicted higher depression during isolation . CONCLUSIONS Anxiety and depression represent a relevant problem for hematopoietic stem cell transplant patients during isolation . Early detection of predictors , such as anxiety levels , obsessive-compulsive symptoms and performance status , could help prevent depression via targeted psychological intervention Studies show that engaging patients in exercise and /or stress management techniques during hematopoietic cell transplantation ( HCT ) improves quality of life . The Blood and Marrow Transplant Clinical Trials Network tested the efficacy of training patients to engage in self-directed exercise and stress management during HCT . The study r and omized 711 patients at 21 centers to receive 1 of 4 training interventions before HCT : a self-directed exercise program , a self-administered stress management program , both  ,  or neither .  Participants completed self-reported assessment s at enrollment and up to 180 days after HCT . R and omization was stratified by center and transplant type . There were no differences in the primary endpoints of the Physical Component Summary and Mental Component Summary scales of the Medical Outcomes Study Short Form 36 at day + 100 among the groups , based on an intention-to-treat analysis . There also were no differences in overall survival , days of hospitalization through day + 100 post-HCT , or in other patient-reported outcomes , including treatment-related distress , sleep quality , pain , and nausea . Patients r and omized to training in stress management reported more use of those techniques , but patients r and omized to training in exercise did not report more physical activity . Although other studies have reported efficacy of more intensive interventions , brief training in an easy-to-disseminate format for either self-directed exercise or stress management was not effective in our trial OBJECTIVE Prior research supports the hypothesis that cancer survivors who help others face treatment experience a range of psychosocial and health-related benefits as a result of peer helping . This study investigates an expressive helping ( EH ) intervention design ed to harness those benefits by targeting survivorship problems among cancer survivors treated with hematopoietic stem cell transplant . EH includes two components : ( a ) emotionally expressive writing ( EW ; writing one 's deepest thoughts and feelings about the transplant experience in a series of brief , structured writing sessions ) followed by ( b ) peer helping ( PH ; helping other people prepare for transplant by sharing one 's own transplant experiences along with advice and encouragement through a written narrative ) . METHOD EH was compared with neutral writing ( NW ) , EW ( without PH ) , and PH ( without EW ) in a 4-arm r and omized controlled trial in which survivors completed baseline measures , 4 structured writing exercises ( with instructions depending on r and omization ) , and postintervention measures including vali date d measures of general psychological distress , physical symptoms , and health-related quality of life ( HRQOL ) . RESULTS Among survivors with moderate-severe survivorship problems , EH reduced distress ( compared with NW and PH ; ps < .05 ) and improved physical symptoms ( compared with NW , PH , and EW ; ps < .002 ) and HRQOL ( compared with NW ; p = .02 ) . CONCLUSIONS Peer helping through writing benefits transplant survivors with moderate-severe survivorship problems , but only if they have first completed expressive writing BACKGROUND This study aims to examine the effectiveness of a self-management multimodal comprehensive coping strategy program ( CCSP ) on quality of life ( QOL ) among breast cancer patients 1 year after treatment . METHODS Patients ( n = 110 ) with stage II , III , or IV breast cancer scheduled to receive high dose chemotherapy and autologous hematopoietic stem cell transplantation were r and omized to either CCSP treatment or control group . The CCSP intervention was taught 2 week before hospital admission with reinforcement at specified times during treatment and 3 months after discharge . The CCSP components included educational information , cognitive restructuring , coping skills enhancement , and relaxation with guided imagery . Instruments administered at baseline included the following : Quality of Life Index-Cancer Version ( QOLI-CV ) , State-Trait Anxiety Inventory , Beck Depression Inventory , and Coping Strategies Question naire . At 1-year follow-up , patients ( n = 73 ) completed and returned the follow-up QOLI-CV . RESULTS Patients were mainly ≥ 40 years of age , married , Caucasian , and diagnosed with advanced breast cancer . A model measuring effectiveness of CCSP on QOL ( total and subscale ) at 1-year follow-up showed that the CCSP group ( n = 38 ) had significant improvement in overall QOL ( p < 0.01 ) , health and functioning ( p < 0.05 ) , and socioeconomic ( p < 0.05 ) and psychological/spiritual well-being ( p < 0.01 ) compared with the control group ( n = 35 ) . The CCSP patients frequently used the CCSP to manage psychological ( 51 % ) and sleep problems ( 60 % ) . CONCLUSIONS The CCSP  improved QOL for patients at 1-year follow-up . Patients overwhelmingly reported that CCSP was beneficial . The CCSP as an effective coping intervention has potential as a self-management program for breast cancer survivors Summary : In this 3-year prospect i ve inpatient study , 220 patients received stem-cell transplantation ( SCT ) for hematologic cancer at a single institution . The objective of the study is to provide data on patient-rated emotional ( depression and anxiety ) and physical ( overall physical status , energy level , and systemic symptomatology ) functioning during hospitalization for SCT and to compare whether these differ between autologous and allogeneic SCT .  Patients were assessed at hospital admission ( T1 ) , day of SCT ( T2 ) , and 7 days ( T3 ) and 14 days ( T4 ) after SCT  , yielding a total of 852 evaluations . For the overall sample , anxiety was highest at T1 and decreased afterwards ; a marked worsening in physical health status variables corresponded with a sharp increase in depression from T1 to T3 , and was followed by an improvement in physical health and a reduction of depression . Compared to allogeneic SCT , a better physical outcome for autologous SCT was demonstrated by the significant group effect for systemic symptomatology and by the significant group × time interaction for overall physical status and energy level ; there were no significant differences in depression or anxiety between SCT groups . These findings have implication s for treatment decision making , coping with the transplantation process , and improving prevention and treatment strategies Background Psychological distress ( i.e. depression and anxiety ) is a strong predictor of functional status and other aspects of quality of life in autologous stem cell transplantation following high-dose chemotherapy . Treatment of psychological distress is hypothesized to result in improvement of functional status and other aspects of quality of life . The aim is to evaluate the outcome of stepped care for psychological distress on functional status and other aspects of quality of life in patients with hematological malignancy treated with autologous stem cell transplantation . Methods / Design The study is design ed as a r and omized clinical trial with 2 treatment arms : a stepped care intervention program versus care as usual .  Patients are r and omized immediately pre transplant .  Stepped care and care as usual are initiated after a 6 weeks buffer period . Outcome is evaluated at 13 , 30 , and 42 weeks post transplant . In the experimental group , the first step includes an Internet-based self-help program . If psychological distress persists after the self-help intervention , the second step of the program is executed , i.e. a diagnostic evaluation and a st and ardized interview , yielding a problem analysis . Based on this information , a contract is made with the patient and treatment is provided consisting of individual face-to-face counseling , medication , or referral to other services . Care as usual comprises an interview with the patient , on ad hoc basis ; emotional support and advice , on ad hoc basis ; if urgent problems emerge , the patient is referred to other services . Primary outcome variables are psychological distress and functional status . Data are analyzed according to the intention to treat-principle . Discussion This study has several innovative characteristics . First , the outcome of the intervention for psychological distress in patients with hematological malignancy treated with autologous stem cell transplantation is evaluated in a r and omized controlled study . Second , the impact of the intervention on functional status is evaluated : it is hypothesized that reduction of psychological distress results in improved functional status . Furthermore , the intervention concerns an Internet-based treatment in the first step . Finally , the intervention is characterized by an emphasis on self-management , efficiency , and a multi-disciplinary approach with nurses taking up a central role . Trial Registration Recent research has shown that cancer patients undergoing bone marrow transplantation ( BMT )  experience moderate to severe mouth pain due to treatment-related mucositis in spite of morphine therapy . Treatment-related emotional distress in  BMT patients is also described widely . This study examined several biomedical , psychological and social variables as possible predictors for the intensity of treatment-related mouth pain and anxious mood in 63 cancer patients undergoing BMT or stem cell transplantation ( SCT )  within a prospect i ve longitudinal design . Biomedical predictors included biomedical risk , mucositis , the mode of transplantation , total body irradiation , age and gender . Psychological predictors were depression ( BDI ) ,  BMT-related distress , chronic stress and re sources in everyday life ( KISS ) , pain-related coping behaviour ( KPI-17 ) and social support ( ISSS ) . Among the social variables we evaluated education , being married and the living situation . Criteria variables were the intensity of mouth pain and anxious mood which were assessed daily by numeric self-rating scales for 24 days after transplantation . Results of stepwise multiple regressions indicated that psychological and social variables were important predictors of mouth pain , besides biomedical variables . Whereas the biomedical variables revealed the most predictive power during the second week after BMT , psychological predictors were more important during the early and late phases of the treatment . Daily anxious mood was best predicted by psychological and social variables . Among the biomedical variables mucositis was most strongly related to mouth pain besides mode of transplantation , risk , TBI and age . Among the psychological variables BMT-related distress was the most important predictor , with re sources in private life or at work and pain-related coping modes as further significant predictors . These results imply that relevant predictors should be assessed as high risk factors for an increased vulnerability for treatment-related side-effects before treatment starts indicating an additional offer of psychological treatment in high risk patients .Bone Marrow Transplantation ( 2002 ) 29 , 341–351 . PURPOSE To determine the prevalence of psychiatric disorders during hospitalization for hematopoietic stem-cell transplantation ( SCT ) and to estimate their impact on hospital length of stay ( LOS ) . PATIENTS AND METHODS In a prospect i ve inpatient study conducted from July 1994 to August 1997 , 220 patients aged 16 to 65 years received SCT 
    Output:
    
Interventions tended to show better efficacy when incorporating a major psychological component involving cognitive behavioural or emotional processing methods with substantial interventionist input .
However , this was also associated with method ological limitations and threats to internal validity such as poor confounder and common factors control .