***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 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 Abstract Objective : To evaluate a palliative care home support team based on an inpatient unit . Design : R and omised controlled trial with waiting list . Patients in the study group received the service immediately , those in the control group received it after one month . Main comparison point was at one month . Setting - A city of 300 000 people with a publicly funded home care service and about 200 general practitioners , most of whom provide home care . Main outcome measures : Pain and nausea levels were measured at entry to trial and at one month , as were quality of life for patients and care givers ' health . Results : Because of early deaths , problems with recruitment , and a low compliance rate for completion of question naires , the required sample size was not attained . Conclusion : In design ing evaluations of palliative care services , investigators should be prepared to deal with the following issues : attrition due to early death , opposition to r and omisation by patients and referral sources , ethical problems raised by r and omisation of dying patients , the appropriate timing of comparison points , and difficulties of collecting data from sick or exhausted patients and care givers . Investigators may choose to evaluate a service from various perspectives using different methods : controlled trials , qualitative studies , surveys , and audits . R and omised trials may prove to be impracticable for evaluation of palliative care BACKGROUND Little is known about the use of palliative care for out patients who continue to pursue treatment of their underlying disease or whether outpatient palliative medicine consultation teams improve clinical outcomes . METHODS We conducted a year-long controlled trial involving 50 intervention patients and 40 control patients in a general medicine outpatient clinic . Primary care physicians referred patients with advanced congestive heart failure , chronic obstructive pulmonary disease , or cancer who had a prognosis ranging from 1 to 5 years . In the intervention group , the primary care physicians received multiple palliative care team consultations , and patients received advance care planning , psychosocial support , and family caregiver training .  Clinical and health care utilization outcomes were assessed at 6 and 12 months . RESULTS Groups were similar at baseline . Similar numbers of patients died during the study year ( P = .63 ) . After the intervention , intervention group patients had less dyspnea ( P = .01 ) and anxiety ( P = .05 ) and improved sleep quality ( P = .05 ) and spiritual well-being ( P = .007 ) , but no change in pain ( P = .41 ) , depression ( P = .28 ) , quality of life ( P = .43 ) , or satisfaction with care ( P = .26 ) . Few patients received recommended analgesic or antidepressant medications . Intervention patients had decreased primary care ( P = .03 ) and urgent care visits ( P = .04 ) without an increase in emergency department visits , specialty clinic visits , hospitalizations , or number of days in the hospital . There were no differences in charges ( P = .80 ) . CONCLUSIONS Consultation by a palliative medicine team led to improved patient outcomes in dyspnea , anxiety , and spiritual well-being , but failed to improve pain or depression .  Palliative care for seriously ill out patients can be effective , but barriers to implementation must be explored A stratified , r and om-assignment trial of 442 cancer patients was conducted to evaluate medical , psychosocial , and financial outcomes of day hospital treatment as an alternative to inpatient care for certain cancer patients . Eligible patients required : a 4- to 8-hour  treatment plan , including chemotherapy and other long-term intravenous ( i.v . ) treatment ; a stable cardiovascular status ; mental competence ; no skilled overnight nursing ; and a helper to assist with home care . Patients were ineligible if st and ard outpatient treatment was possible . No statistically significant ( p less than 0.05 ) differences were found between the Adult Day Hospital ( ADH ) and Inpatient care in medical or psychosocial outcomes over the 60-day study period . The major difference was in medical costs -- approximately one-third lower for ADH patients ( p less than 0.001 ) than for the Inpatient group . The study demonstrates that day hospital care of medical oncology patients is clinical ly equivalent to Inpatient care , causes no negative psychosocial effects , and costs less than Inpatient care . Findings support the trend toward dehospitalization of medical treatment OBJECTIVE There is a paucity of r and omized controlled trials ( RCTs ) to evaluate models of palliative care . Although interventions vary , all have faced a variety of method ological challenges including adequate recruitment , missing data , and contamination of the control group . We describe the ENABLE II intervention , methods , and sample baseline characteristics to increase intervention and method ological transparency , and to describe our solutions to selected method ological issues . METHODS Half of the participants recruited from our rural U.S. comprehensive cancer center and affiliated clinics were r and omly assigned to a phone-based , nurse-led educational , care coordination palliative care intervention model . Intervention services were provided to half of the participants weekly for the first month and then monthly until death , including bereavement follow-up call to the caregiver . The other half of the participants were assigned to care as usual .  Symptoms , quality of life , mood , and functional status were assessed every 3 months until death . RESULTS Baseline data of 279 participants were similar to normative sample s. Solutions to method ological challenges of recruitment , missing data , and " usual care " control group contamination are described . SIGNIFICANCE OF RESULTS It is feasible to overcome many of the method ological challenges to conducting a rigorous palliative care RCT Cancer patients with advanced disease and short-survival expectancy were given hospital-based advanced home care ( AHC ) or conventional care ( CC ) , according to their preference . The two groups were compared at baseline to investigate whether there were differences between the AHC and the CC patients that may help explain their choice of care . The patients were consecutively recruited over 2(1/2 ) years .  Sociodemographic and medical data , and the health-related quality of life ( HRQL ) of the two groups were compared . HRQL was assessed using a self-reporting question naire , including the European Organization for Research and Treatment of Cancer Core Quality of Life Question naire ( EORTC QLQ-C30 ) , the Impact of Event Scale ( IES ) , five questions about social support , and two items concerning general well-being . The AHC group showed significantly poorer functioning on all the EORTC QLQ-C30 scales and an overall higher symptom burden than the CC patients . Fewer of the AHC patients were receiving cancer treatment . The AHC patients had lived longer with their cancer diagnosis , had a significantly shorter survival after study enrollment , and a significantly poorer performance status . The major differences between the two groups seemed to be related to being at different stages in their disease . The results indicate that patients are reluctant to accept home care until absolutely necessary due to severity of functioning impairments and symptom burden . These findings should be taken into consideration in planning palliative care services CONTEXT There are few r and omized controlled trials on the effectiveness of palliative care interventions to improve the care of patients with advanced cancer . OBJECTIVE To determine the effect of a nursing-led intervention on quality of life , symptom intensity , mood , and re source use in patients with advanced cancer . DESIGN , SETTING , AND PARTICIPANTS R and omized controlled trial conducted from November 2003 through May 2008 of 322 patients with advanced cancer in a rural , National Cancer Institute- design ated comprehensive cancer center in New Hampshire and affiliated outreach clinics and a VA medical center in Vermont . INTERVENTIONS A multicomponent , psychoeducational intervention ( Project ENABLE [ Educate , Nurture , Advise , Before Life Ends ] ) conducted by advanced practice nurses consisting of 4 weekly educational sessions and monthly follow-up sessions until death or study completion ( n = 161 ) vs usual care ( n = 161 ) . MAIN OUTCOME MEASURES Quality of life was measured by the Functional Assessment of Chronic Illness Therapy for Palliative Care ( score range , 0 - 184 ) . Symptom intensity was measured by the Edmonton Symptom Assessment Scale ( score range , 0 - 900 ) . Mood was measured by the Center for Epidemiological Studies Depression Scale ( range , 0 - 60 ) . These measures were assessed at baseline , 1 month , and every 3 months until death or study completion . Intensity of service was measured as the number of days in the hospital and in the intensive care unit ( ICU ) and the number of emergency department visits recorded in the electronic medical record . RESULTS A total of 322 participants with cancer of the gastrointestinal tract ( 41 % ; 67 in the usual care group vs 66 in the intervention group ) , lung ( 36 % ; 58 vs 59 ) , genitourinary tract ( 12 % ; 20 vs 19 ) , and breast ( 10 % ; 16 vs 17 ) were r and omized . The estimated treatment effects ( intervention minus usual care ) for all participants were a mean ( SE ) of 4.6 ( 2 ) for quality of life ( P = .02 ) , -27.8 ( 15 ) for symptom intensity ( P = .06 ) , and -1.8 ( 0.81 ) for depressed mood ( P = .02 ) . The estimated treatment effects in participants who died during the study were a mean ( SE ) of 8.6 ( 3.6 ) for quality of life ( P = .02 ) , -24.2 ( 20.5 ) for symptom intensity ( P = .24 ) , and -2.7 ( 1.2 ) for depressed mood ( P = .03 ) . Intensity of service did not differ between the 2 groups . CONCLUSION Compared with participants receiving usual oncology care , those receiving a nurse-led , palliative care-focused intervention addressing physical , psychosocial , and care coordination provided concurrently with oncology care had higher scores for quality of life and mood , but did not have improvements in symptom intensity scores or reduced days in the hospital or ICU or emergency department visits . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00253383 A r and omised controlled trial was undertaken to assess the effectiveness of a  hospital Palliative Care Team ( PCT )  on physical symptoms and health-related quality of life ( HRQoL ) ; patient , family carer and primary care professional reported satisfaction with care ; and health service re source use . The full package of advice and support provided by a multidisciplinary specialist PCT ( ‘ full-PCT ’ ) was compared with limited telephone advice ( ‘ telephone-PCT ’ , the control group ) in the setting of a teaching hospital trust in the SW of Engl and . The trial recruited 261 out of 684 new inpatient referrals ; 175 were allocated to ‘ full-PCT ’  , 86 to  ‘ telephone-PCT ’  ( 2 : 1 r and omisation ) ; with 191 ( 73 % ) being assessed at 1 week . There were highly significant improvements in symptoms , HRQoL , mood and ‘ emotional bother ’ in ‘ full-PCT ’ at 1 week , maintained over the 4-week follow-up . A smaller effect was seen in ‘ telephone-PCT ’ ; there were no significant differences between the groups . Satisfaction with care in both groups was high and there was no significant difference between them . These data reflect a high st and ard of care of patients dying of cancer and other chronic diseases in an acute hospital environment , but do not demonstrate a difference between the two models of service delivery of specialist palliative care The aim of this prospect i ve study was to assess the quality of cancer pain control during the last week of life in two different types of units for terminal cancer patients in Finl and : on health centre wards ( N=20 ) and in a hospice ( N=30 ) .  Pain scores ( VAS ) , defined daily doses ( DDD ) , routes of administration and costs of pain medication were analysed 
    Output:
    
Outcomes were pain , symptoms , quality of life , use of hospital services , and anxiety .
Overall , the evidence demonstrated that home , hospital , and inpatient specialist palliative care significantly improved patient outcomes in the domains of pain and symptom control , anxiety , and reduced hospital admissions .
The results suggest that specialist palliative care should be part of care for cancer patients .