***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 To evaluate the efficacy of an interactive self-help workbook in reducing distress , and improving quality of life ( QOL ) and coping for women recently diagnosed with breast cancer . DESIGN R and omised controlled trial comparing the use of the workbook and that of an information booklet . PARTICIPANTS AND SETTING 49 women with Stage 0 to II breast cancer diagnosed in the previous month and recruited from 1 February 2007 to 1 February 2008 , in two urban Australian public hospitals . MAIN OUTCOME MEASURES The primary outcome measures were depression , anxiety , and posttraumatic stress . Secondary outcomes included QOL , body image , and the coping styles helplessness/hopelessness , cognitive avoidance and anxious preoccupation . RESULTS After controlling for baseline levels , interactions at 3-month follow-up showed that participants in the workbook group had significantly lower levels of posttraumatic stress ( F[1,89 ] = 7.01 ; P = 0.01 ) , helplessness/hopelessness ( F [ 1,89 ] = 4.75 ; P = 0.03 ) , and cognitive avoidance ( F [ 1,89 ] = 4.95 ; P = 0.03 ) than those in the control ( information booklet ) group . However , women in the workbook group had significantly poorer body image than those in the control group ( F [ 1,89 ] = 6.43 ; P = 0.01 ) . At 6 months , only the body image interaction remained significant ( F [ 1,93 ] = 7.44 ; P = 0.01 ) . CONCLUSION These results suggest that a self-help workbook can be an effective , short-term intervention for improving posttraumatic stress , cognitive avoidance , and certain depressive symptoms in women recently diagnosed with breast cancer . However , issues related to body image need to be dealt with differently . TRIAL REGISTRATION Australian New Zeal and Clinical Trials Background The p value obtained from a significance test provides no information about the magnitude or importance of the underlying phenomenon . Therefore , additional reporting of effect size is often recommended . Effect sizes are theoretically independent from sample size . Yet this may not hold true empirically : non-independence could indicate publication bias . Methods We investigate whether effect size is independent from sample size in psychological research . We r and omly sample d 1,000 psychological articles from all areas of psychological research . We extracted  p values , effect sizes , and sample sizes of all empirical papers , and calculated the correlation between effect size and sample size , and investigated the distribution of p values . Results We found a negative correlation of r = −.45 [ 95 % CI : −.53 ; −.35 ] between effect size and sample size . In addition , we found an inordinately high number of p values just passing the boundary of significance . Additional data showed that neither implicit nor explicit power analysis could account for this pattern of findings . Conclusion The negative correlation between effect size and sample s size , and the biased distribution of p values indicate pervasive publication bias in the entire field of psychology Melanoma accounts for > 79 % of skin cancer‐related deaths , although it accounts for only 4 % of skin cancer incidence . Given the potential for lethality , it is likely that patients with melanoma may experience significant emotional distress . The current study was design ed to determine the effect of a cognitive‐behavioral intervention on distress and health‐related quality of life ( HRQOL ) in patients with melanoma who had medium‐to‐high distress 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 BACKGROUND As cancer mortality rates improve in Singapore , there is an increasing need to improve the transition to posttreatment survivorship care . This study aim ed to evaluate the effectiveness of a psychoeducation group ( PEG ) intervention program compared with usual care to reduce distress for physical symptom and psychological aspects in Asian breast cancer survivors who have completed adjuvant chemotherapy . METHODS This was a r and omized , controlled trial comprising 72 Asian early stage breast cancer survivors who were r and omized into the PEG ( n = 34 ) or the control ( n = 38 ) arm . The participants in the PEG arm underwent a weekly multidisciplinary PEG program delivered in a group format over 3 weeks coupled with cultural adaptation . Both arms were assessed at baseline and 2 months after intervention using the Rotterdam Symptom Checklist , Beck Anxiety Inventory , and EORTC QLQ-C30 . A satisfaction question naire was also conducted among those survivors who have participated in the PEG program . Effective sizes were calculated using Cohen d. RESULTS The mean age ± SD of all participants was 53.0 ± 8.9 years , with the majority being Chinese ( 84.7 % ) and Malay ( 6.9 % ) , and clinical characteristics were well balanced in both arms . Compared to the control arm , the PEG arm showed a significantly greater reduction in physical symptom distress ( d = 0.76 , P = .01 ) and fatigue ( d = 0.49 , P = .04 ) . The 82.4 % of the participants in the intervention group responded to the satisfaction question naire , and the majority ( 92.9 % ) agreed that the overall duration of the PEG intervention program was appropriate . CONCLUSIONS A culturally adapted PEG program was effective in reducing physical symptom distress in Asian breast cancer survivors . ( Clinical Trials.gov : NCT02600299 ) Background Web and mobile technologies appear to hold promise for delivering evidence -informed and evidence -based intervention to cancer survivors and others living with trauma and other psychological concerns .  Health-space.net was developed as a comprehensive online social networking and coping skills training program for cancer survivors living with distress . Purpose The purpose of this study was to evaluate the effects of a 12-week social networking intervention on distress , depression , anxiety , vigor , and fatigue in cancer survivors reporting high levels of cancer-related distress . Methods We recruited 347 participants from a local cancer registry and internet , and all were r and omized to either a 12-week waiting list control group or to immediate access to the intervention . Intervention participants received secure access to the study website , which provided extensive social networking capabilities and coping skills training exercises facilitated by a professional facilitator . Results Across time , the prevalence of clinical ly significant depression symptoms declined from 67 to 34 % in both conditions . The health-space.net intervention had greater declines in fatigue than the waitlist control group , but the intervention did not improve outcomes for depression , trauma-related anxiety symptoms , or overall mood disturbance . For those with more severe levels of anxiety at baseline , greater engagement with the intervention was associated with higher levels of symptom reduction over time . Conclusions The intervention result ed in small but significant effects on fatigue but not other primary or secondary outcomes . Results suggest that this social networking intervention may be most effective for those who have distress that is not associated with high levels of anxiety symptoms or very poor overall psychological functioning . Trial Registration NumberThe trial was registered with the Clinical Trials.gov data base ( Clinical Trials.gov # NCT01976949 ) OBJECTIVE To compare in a multicenter r and omized controlled trial the benefits in terms of anxiety regulation of a 15-session single-component group intervention ( SGI ) based on support with those of a 15-session multiple-component structured manualized group intervention ( MGI ) combining support with cognitive-behavioral and hypnosis components . METHODS Patients with nonmetastatic breast cancer were r and omly assigned at the beginning of the survivorship period to the SGI ( n = 83 ) or MGI ( n = 87 ) .  Anxiety regulation was assessed , before and after group interventions , through an anxiety regulation task design ed to assess their ability to regulate anxiety psychologically ( anxiety levels ) and physiologically ( heart rates ) . Question naires were used to assess psychological distress , everyday anxiety regulation , and fear of recurrence . Group allocation was computer generated and concealed till baseline completion . RESULTS Compared with patients in the SGI group ( n = 77 ) , patients attending the MGI group ( n = 82 ) showed significantly reduced anxiety after a self-relaxation exercise ( P = .006 ) and after exposure to anxiety triggers ( P = .013 ) and reduced heart rates at different time points throughout the task ( P = .001 to P = .047 ) . The MGI participants also reported better everyday anxiety regulation ( P = .005 ) , greater use of fear of recurrence-related coping strategies ( P = .022 ) , and greater reduction in fear of recurrence-related psychological distress ( P = .017 ) compared with the SGI group . CONCLUSIONS This study shows that an MGI combining support with cognitive-behavioral techniques and hypnosis is more effective than an SGI based only on support in improving anxiety regulation in patients with breast cancer To compare the effectiveness of individual support , group rehabilitation and a combination of the two in improving health-related quality of life ( HRQOL ) and psychological well-being in cancer patients during 24 months after diagnosis , as compared with st and ard care ( SC ) . Furthermore , to compare the study sample and a r and om sample of the Swedish population with regard to HRQOL . A total of 481 consecutive patients , newly diagnosed with cancer , were r and omly assigned to one of the four alternatives . Data on HRQOL and psychological well-being were collected at baseline and after 3 , 6 , 12 and 24 months . The interventions did not improve HRQOL or psychological well-being , as compared with SC . At 3 months , the study sample reported an HRQOL comparable with the normal population . Many cancer patients are able to manage their cancer-related concerns with the support available from SC . However , it is reasonable to assume that the findings suffer from a lack of data from especially vulnerable patients and a possible Hawthorne effect . It can not be concluded that cancer patients have no need for additional psychosocial interventions . Future projects should include screening and target interventions for those at risk for significant and prolonged psychological distress BACKGROUND The aim of this study was to assess the efficacy of meaning-centered group psychotherapy for cancer survivors ( MCGP-CS ) to improve personal meaning , compared with supportive group psychotherapy ( SGP ) and care as usual ( CAU ) . METHOD A total of 170 cancer survivors were r and omly assigned to one of the three study arms : MCGP-CS ( n = 57 ) ; SGP ( n = 56 ) ; CAU ( n = 57 ) . The primary outcome measure was the Personal Meaning Profile ( PMP ; total score ) . Secondary outcome measures were subscales of the PMP , psychological well-being ( Scales of Psychological Well-being ; SPWB ) , post-traumatic growth ( Posttraumatic Growth Inventory ) , Mental Adjustment to Cancer ( MAC ) , optimism ( Life Orientation Test-Revised ) , hopelessness ( Beck 's Hopelessness Scale ) , psychological distress ( anxiety and depression , Hospital Anxiety and Depression Scale ; HADS ) and quality of life ( European Organization for Research and Treatment of Cancer Quality of Life Question naire ; EORTC QLQ-C30 ) . Outcome measures were assessed before r and omization , post-intervention , and after 3 and 6 months of follow-up ( FU ) . RESULTS Linear mixed model analyses ( intention-to-treat ) showed significant differences between MCGP-CS , SGP and CAU on the total PMP score , and on (sub)scales of the PMP , SPWB , MAC and HADS . Post-hoc analyses showed significantly stronger treatment effects of MCGP-CS compared with CAU on personal meaning ( d = 0.81 ) , goal -orientedness ( d = 1.07 ) , positive relations ( d = 0.59 ) , purpose in life ( d = 0.69 ) ; fighting spirit ( d = 0.61 ) ( post-intervention ) and helpless/hopeless ( d = -0.87 ) ( 3 months FU ) ; and distress ( d = -0.6 ) and depression ( d = -0.38 ) ( 6 months FU ) . Significantly stronger effects of MCGP-CS compared with SGP were found on personal growth ( d = 0.57 ) ( 3 months FU ) and environmental mastery ( d = 0.66 ) ( 6 months FU ) . CONCLUSIONS MCGP-CS is an effective intervention for cancer survivors to improve personal meaning , psychological well-being and mental adjustment to cancer in the short term , and to reduce psychological distress in the long run INTRODUCTION Gaining regular insight into the nature and severity of distress by a psychosocial nurse coupled with referral to psychosocial and /or paramed 
    Output:
    
Low psychological distress at baseline and non evidence -based interventions were the main factors identified for low effectiveness .