***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: PURPOSE To examine the effect of weekly completion of a patient-held  quality -of-life ( QOL ) diary in routine oncology practice for palliative care patients . PATIENTS AND METHODS In a pragmatic r and omized controlled trial , 115 patients with inoperable lung cancer were r and omly assigned to receive either st and ard care or a structured QOL diary ( European Organisation for Research and Treatment of Cancer Quality of Life Question naire C30 and the related lung cancer module LC13 ) that they completed at home each week for 16 weeks . Patients were encouraged to share the QOL information with health professionals involved in their care . Changes in QOL over time ( measured by the Functional Assessment of Cancer Therapy-Lung question naire and the Palliative Care Quality of Life Index ) , discussion of patient problems , and satisfaction with communication and general care were assessed at baseline and at 2 and 4 months after baseline . RESULTS Analysis of QOL indicated a small but consistent difference between patients in the diary group and the st and ard care group . The diary group had a poorer QOL in many domains . Two different QOL summary scores ( total and overall QOL ) indicated a statistically significant between-group difference . No effects were found in relation to satisfaction with care , communication , or the discussion of patient problems . CONCLUSION The regular completion of a QOL question naire without appropriate feedback to health care professionals and without the provision of appropriate support may have a negative impact on inoperable lung cancer patients . Further research should focus on identifying features such as feedback loops that are required for the successful and meaningful use of QOL question naires in routine patient care Sc and J Prim Health Care 2003;21:00 - 00 . ISSN 0281 - 3432 Objective r - r To investigate general practitioner ( GP ) assessment of a structured oncology information pack sent to GPs when newly referred patients had visited a department of oncology for the first time , and to compare their assessment of this material with their assessment of traditional information provided by the department . Design r - r R and omised , unblinded clinical trial . Setting r - r Patients and GPs in the catchment area of a regional oncology department . Subjects / patients r - r 248 cancer patients and their 199 GPs . Main outcome measures r - r GP assessment of the quality of the information material received for each patient . Results r - r 88.3 % of the 248 question naires were returned . The structured information pack improved GP knowledge of oncology ; GPs found themselves better equipped to support and counsel patients during the course of their illness , and practitioner satisfaction with the department rose . Conclusion r - r Intervention , though reasonably simple , inexpensive and not particularly time-consuming , improved cooperation between the specialist department and the GP . While this is a small step in the right direction , the need remains for new initiatives and further studies into how to improve cooperation and communication between the primary and secondary healthcare sectors OBJECTIVES --To measure effects on terminally ill cancer patients and their families of coordinating the services available within the NHS and from local authorities and the voluntary sector . DESIGN --R and omised controlled trial . SETTING --Inner London health district . PATIENTS --Cancer patients were routinely notified from 1987 to 1990 . 554 patients expected to survive less than one year entered the trial and were r and omly allocated to a coordination or a control group . INTERVENTION -- All patients received routinely available services . Coordination group patients received the assistance of two nurse coordinators , whose role was to ensure that patients received appropriate and well coordinated services , tailored to their individual needs and circumstances . MAIN OUTCOME MEASURES -- Patients and carers were interviewed at home on entry to the trial and at intervals until death . Interviews after bereavement were also conducted . Outcome measures included the presence and severity of physical symptoms , psychiatric morbidity , use of and satisfaction with services , and carers ' problems . Results from the baseline interview , the interview closest to death , and the interview after bereavement were analysed . RESULTS --Few differences between groups were significant . Coordination group patients were less likely to suffer from vomiting , were more likely to report effective treatment for it , and less likely to be concerned about having an itchy skin . Their carers were more likely to report that in the last week of life the patient had had a cough and had had effective treatment for constipation , and they were less likely to rate the patient 's difficulty swallowing as severe or to report effective treatment for anxiety . Coordination group patients were more likely to have seen a chiropodist and their carers were more likely to contact a specialist nurse in a night time emergency . These carers were less likely to feel angry about the death of the patient . CONCLUSIONS --This coordinating service made little difference to patient or family outcomes , perhaps because the service did not have a budget with which it could obtain services or because the professional skills of the nurse-coordinators may have conflicted with the requirements of the coordinating role Objective : To assess the effectiveness of nurse led follow up in the management of patients with lung cancer . Design : R and omised controlled trial . Setting : Specialist cancer hospital and three cancer units in southeastern Engl and Participants : 203 patients with lung cancer who had completed their initial treatment and were expected to survive for at least 3 months . Intervention : Nurse led follow up of out patients compared with conventional medical follow up . Outcome measures : Quality of life , patients ' satisfaction , general practitioners ' satisfaction , survival , symptom-free survival , progression-free survival , use of re sources , and comparison of costs . Results : Patient acceptability of nurse led follow up was high : 75 % ( 203/271 ) of eligible patients consented to participate . Patients who received the intervention had less severe dyspnoea at 3 months ( P=0.03 ) and had better scores for emotional functioning ( P=0.03 ) and less peripheral neuropathy ( P=0.05 ) at 12 months . Intervention group patients scored significantly better in most satisfaction subscales at 3 , 6 , and 12 months ( P<0.01 for all subscales at 3 months ) . No significant differences in general practitioners ' overall satisfaction were seen between the two groups . No differences were seen in survival or rates of objective progression , although nurses recorded progression of symptoms sooner than doctors ( P=0.01 ) . Intervention patients were more likely to die at home rather than in a hospital or hospice ( P=0.04 ) , attended fewer consultations with a hospital doctor during the first 3 months ( P=0.004 ) , had fewer radiographs during the first 6 months ( P=0.04 ) , and had more radiotherapy within the first 3 months ( P=0.01 ) . No other differences were seen between the two groups in terms of the use of re sources . Conclusion : Nurse led follow up was acceptable to lung cancer patients and general practitioners and led to positive outcomes This study reports results from a r and omised controlled trial of nurse-led care and was design ed to determine whether nurse-led follow up improved patients morbidity and satisfaction with care in men treated with radical radiotherapy for prostate and bladder cancer . The aim was to compare outcomes in terms of toxicity , symptoms experienced , quality of life , satisfaction with care and health care costs , between those receiving nurse-led care and a group receiving st and ard care .  The study population was of men prescribed radical radiotherapy ( greater than 60 Gy ) .  Participants completed self- assessment question naires for symptoms and quality of life within the first week of radiotherapy treatment , at week 3 , 6 and 12 weeks from start of radiotherapy .  Satisfaction with clinical care was also assessed at 12 weeks post-treatment . Observer-rated RTOG toxicity scores were recorded pre-treatment , weeks 1 , 3 , 6 and 12 weeks from start of radiotherapy . The results presented in this paper are on 115 of 132 ( 87 % ) of eligible men who agreed to enter the r and omised trial . 6 men ( 4 % ) refused and 11 ( 8 % ) were missed for inclusion in the study . Data were analysed as a comparison at cross-sectional time points and as a general linear model using multiple regression . There was no significant difference in maximum symptom scores over the time of the trial between nurse-led follow-up care and conventional medical care . Differences were seen in scores in the initial self assessment of symptoms ( week 1 ) that may have been as a result of early nursing intervention . Those men who had received nurse-led care were significantly more satisfied ( P < 0.002 ) at 12 weeks and valued the continuity of the service provided . There were also significant ( P < 0.001 ) cost benefits , with a 31 % reduction in costs with nurse-led , compared to medically led care . Evidence from this study suggests that a specialist nurse is able to provide safe follow up for men undergoing radiotherapy . The intervention focused on coping with symptoms , and provided continuity of care and telephone support . Further work is required to improve the management of patients during and after radiotherapy . © 2001 Cancer Research Campaign Objective : To determine the effect of a shared care programme on the attitudes of newly referred cancer patients towards the healthcare system and their health related quality of life and performance status , and to assess patients ’ reports on contacts with their general practitioner ( GP ) . Setting : Department of Oncology at Aarhus University Hospital and general practice s. Design : R and omised controlled trial in which patients completed question naires at three time points . The shared care programme included transfer of knowledge from the oncologist to the GP , improved communication between the parties , and active patient involvement . Participants : 248 consecutive cancer patients recently referred to the department . Main outcome measures : Patients ’ attitudes towards the healthcare services , their health related quality of life , performance status , and reports on contacts with their GPs . Results : The shared care programme had a positive effect on patient evaluation of cooperation between the primary and secondary healthcare sectors . The effect was particularly significant in men and in younger patients ( 18–49 years ) who felt they received more care from the GP and were left less in limbo . Young patients in the intervention group rated the GP ’s knowledge of disease and treatment significantly higher than young patients in the control group . The number of contacts with the GP was significantly higher in the intervention group . The EORTC quality of life question naire and performance status showed no significant differences between the two groups . Conclusions : An intersectoral shared care programme in which GPs and patients are actively involved has a positive influence on patients ’ attitudes towards the healthcare system .  Young patients and men particularly benefit from the programme Abstract Objective : To assess the medical and psychosocial effects of  early hospital discharge after surgery for breast cancer on complication rate , patient satisfaction , and psychosocial outcomes . Design : R and omised trial comparing discharge from hospital 4 days after surgery ( with drain in situ ) with discharge after drain removal ( mean 9 days in hospital ) . Psychosocial measurements performed before surgery and 1 and 4 months after . Setting : General hospital and cancer clinic in Rotterdam with a socioeconomically diverse population . Subjects : 125 women with operable breast cancer . Main outcome measures : Incidence of complications after surgery for breast cancer , patient satisfaction with treatment , and psychosocial effects of short stay or long stay in hospital . Results : Patient satisfaction with the short stay in hospital was high ; only 4 % ( 2/56 at 1 month after surgery and 2/52 at 4 months after surgery ) of patients indicated that they would have preferred a longer stay . There were no significant differences in duration of drainage from the axilla between the short stay and long stay groups ( median 8 v 9 days respectively , P=0.45 ) or the incidence of wound complications ( 10 patients v 9 patients ) . The median number of seroma aspirations per patient was higher for the long stay group ( 1 v 3.5 , P=0.04 ) . Leakage along the drain occurred more frequently in short stay patients ( 21 v 10 patients , P=0.04 ) . The two groups did not differ in scores for psychosocial problems ( uncertainty , anxiety , loneliness , disturbed sleep , loss of control , threat to self esteem ) , physical or psychological complaints , or in the coping strategies used . Before surgery , short stay patients scored higher on scales of depression ( P=0.03 ) and after surgery they were more likely to discuss their disease with their families ( at 1 month P=0.004 , at 4 months P=0.04 ) . Conclusions : Early discharge from hospital after surgery for breast cancer is safe and is well received by patients . Early discharge seems to enhance the opportunity for social support within the family . Key messages Early discharge from hospital after breast cancer surgery does not lead to an increase in the incidence of wound infection or seroma formation A short stay in hospital , with support from community nurses on the patient 's return home , is acceptable to patients Psychosocial rehabilitation is not influenced by early discharge Recovery in the family environment may facilitate discussion of the illness Patients recovering from surgery for breast cancer need not spend more than three days in hospital provided that they are in good physical condition and there is adequate nursing support available in the PURPOSE To describe a r and omized trial of a cognitive behavioral intervention on reducing symptom severity among patients diagnosed with solid tumors and undergoing a first course of chemotherapy and to determine whether the intervention had an additive or interactive effect on symptom severity in the presence of supportive care medications . PATIENTS AND METHODS Patients ( N = 237 ) were accrued from comprehensive and community cancer centers , interviewed , and r and omly assigned to either the experimental intervention ( n = 118 ) or conventional care ( n = 119 ) . A symptom severity index , based on summed severity scores across 15 symptoms , was the primary outcome . Each patient 's site of cancer , stage at diagnosis , chemotherapy protocol s , and use of supportive medications were learned from medical records . RESULTS Groups were equivalent at baseline , and attrition by characteristics by group was not different . The proportion of patients not receiving chemotherapy at 10 and 20 weeks did not differ by group . At the 10- and 20-week observations , there was a significant interaction between the experimental 
    Output:
    
Based on the median effect size estimates , no significant difference in patient health-related outcomes was found between patients assigned to interventions  and those assigned to usual care .
Results from this Cochrane review do not allow us to conclude on the effectiveness of included interventions to improve continuity of care on patient , healthcare provider or process of care outcomes .