human
***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: 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 PURPOSE Men with prostate cancer are often advised to make changes in diet and lifestyle , although the impact of these changes has not been well documented . Therefore , we evaluated the effects of comprehensive lifestyle changes on prostate specific antigen ( PSA ) , treatment trends and serum stimulated LNCaP cell growth in men with early , biopsy proven prostate cancer after 1 year . MATERIAL S AND METHODS Patient recruitment was limited to men who had chosen not to undergo any conventional treatment , which provided an unusual opportunity to have a nonintervention r and omized control group to avoid the confounding effects of interventions such as radiation , surgery or and rogen deprivation therapy . A total of 93 volunteers with serum PSA 4 to 10 ng/ml and cancer Gleason scores less than 7 were r and omly assigned to an experimental group that was asked to make comprehensive lifestyle changes or to a usual care control group . RESULTS None of the experimental group patients but 6 control patients underwent conventional treatment due to an increase in PSA and /or progression of disease on magnetic resonance imaging . PSA decreased 4 % in the experimental group but increased 6 % in the control group ( p = 0.016 ) . The growth of LNCaP prostate cancer cells ( American Type Culture Collection , Manassas , Virginia ) was inhibited almost 8 times more by serum from the experimental than from the control group ( 70 % vs 9 % , p < 0.001 ) . Changes in serum PSA and also in LNCaP cell growth were significantly associated with the degree of change in diet and lifestyle . CONCLUSIONS Intensive lifestyle changes may affect the progression of early , low grade prostate cancer in men . Further studies and longer term followup are warranted Background Today , the 5-year relative survival rate for cancer is 65 % and there are 10.5 million survivors . The largest group of survivors are those of breast cancer . Reductions in mortality are occurring at a greater rate for women under age 50 at diagnosis than among older women . Aims Our goal was to design a socio-educational intervention for 5-year survivors aged 50 or younger at diagnosis and test the hypotheses that women in the intervention group would show greater improvement than controls with respect to ( 1 ) knowledge of breast cancer , its treatment , and long-term health concerns ; ( 2 ) lifestyle habits ( i.e. , exercise and diet ) ; and ( 3 ) communication with family and physicians . Methods Using a r and omized controlled trial with a pre-post design , 404 women who were 5 years from diagnosis and cancer-free ( response rate 54 % ) were r and omly assigned to an intervention or delayed intervention ( control ) group and were assessed at pre-test ( baseline ) and 6 months later ( 96 % retention ) . The intervention consisted of three 6-h workshops over a 3 month period . Four series of workshops were held at different geographical areas in the greater San Francisco Bay Area . The workshops included activities and information to promote physical , social , emotional , and spiritual well-being . The intervention design was based on findings from focus groups and a survey of 185 cancer-free 5-year survivors that assessed changes since the early months after diagnosis in physical , social , emotional , and spiritual concerns ( response rate 73 % ) . Results Consistent with our first hypothesis , at post-test , women in the intervention group , on average , had greater knowledge regarding breast cancer , its treatment , and their own future health than did those in the control group ( p = 0.015 ) . Hypothesis 2 was partially supported as women in the intervention group were more likely than the control group to report an increased amount of physical activity ( p = 0.036 ) , but not significant dietary changes . Social support was related to increased self report of physical activity . With the exception of the last series of workshops , the intervention group did not report improved communications with family , friends , and physicians ( hypothesis 3 ) . Conclusions A short-term intervention can affect knowledge levels and physical activity but not diet or communication in the family . Implication s for Cancer SurvivorsThe intervention was related to greater knowledge related to breast cancer , and increased report of physical activity . The program was not related to changes in reported diet or family communication Cancer-related fatigue is the most disabling symptom experienced by breast cancer patients following the cancer treatment . The positive effects of physical activity in the rehabilitation of breast cancer patients are documented in several studies . In a r and omized controlled study the effects of a structured physical training program on fatigue and health-related quality of life were evaluated . Patients and Methods : 63 breast cancer patients with cancer-related chronic fatigue were r and omized at the beginning of the inpatient rehabilitation . The control group received the st and ard complex rehabilitation program , the intervention group a structured physical training program and additional muscle strength and aerobic exercises . The effects of the treatment were evaluated by question naires at the start of rehabilitation ( t1 ) , end of rehabilitation ( t2 ) , and 3 months after t2 ( t3 ) . Isometric muscle strength and aerobic capacity were evaluated at t1 and t2 . Results : There was an improvement of muscle strength at the end of rehabilitation for both groups . The increase from t1 to t2 was significantly higher for the training group . The scores for global quality of life , physical well-being , and functionality increased from t1 to t2 , but further improvement in the follow-up ( t3 ) was only observed in the training group . The cancer-related fatigue was significantly reduced in the training group from t1 to t3 , however , not in the control group . Conclusions : Structured physical training programs initiated during inpatient rehabilitation and continuously practice d in the time thereafter can improve symptoms of chronic fatigue and quality of life in breast cancer patients OBJECTIVE This study examined change in self-efficacy as a mediator of the effects of a mailed print intervention on the dietary and exercise practice s of newly diagnosed breast and prostate cancer survivors . METHOD A total of 543 breast and prostate cancer patients were recruited from 39 states and two provinces within North America . Participants were r and omly assigned to receive a 10-month program of tailored mailed print material s that aim ed to increase fruit and vegetable consumption , reduce fat intake , and /or increase exercise or a 10-month program of publically available material s on diet and exercise . Telephone surveys conducted at baseline and 1 year assessed dietary practice s , physical activity , and self-efficacy for engaging in these health behaviors . RESULTS Results indicated that changes in self-efficacy for fat restriction and eating more fruits and vegetables were significant mediators of the intervention 's effects on dietary outcomes at 1-year follow-up . The intervention did not significantly affect self-efficacy for exercise ; however , a significant , positive relationship was found between self-efficacy for exercise and exercise duration at follow-up . CONCLUSIONS Findings are largely consistent with Social Cognitive Theory and support the use of strategies to increase self-efficacy in health promotion interventions for cancer survivors OBJECTIVES We evaluated recurrence and survival for 68 patients with malignant melanoma who participated in a 6-week structured psychiatric group intervention 5 to 6 years earlier , shortly after their diagnosis and initial surgical treatment . We also explored the role of several factors as possible predictors of outcome . DESIGN This was a r and omized controlled experimental study . The Cox proportion hazards regression model was used to quantify the relationship between treatment and the outcomes adjusted by the covariates ( age , sex , Breslow depth , tumor site , baseline Profile of Mood States Total Mood Disturbance , baseline active-behavioral coping , baseline natural killer cell activity , and treatment [ ie , group intervention ] ) . The stepwise procedure was used for covariate selection . RESULTS For control patients , there was a trend for recurrence ( 13/34 ) and a statistically significant greater rate of death ( 10/34 ) than for experimental patients ( 7/34 and 3/34 , respectively ) . We found that being male and having a greater Breslow depth predicted greater recurrence and poorer survival . Analysis of multiple covariates found that only Breslow depth and treatment ( ie , group intervention ) were significant . Adjusting for Breslow depth , treatment effect remained significant . Finally , baseline affective distress and baseline coping were significant psychobehavioral predictors for recurrence and survival . Surprisingly , higher levels of baseline distress as well as baseline coping and enhancement of active-behavioral coping over time were predictive of lower rates of recurrence and death . CONCLUSION Psychiatric interventions that enhance effective coping and reduce affective distress appear to have beneficial effects on survival but are not proposed as an alternative or independent treatment for cancer or any other illness or disease . However , the exact nature of this relationship warrants further investigation PURPOSE Interventions to increase physical activity among breast cancer survivors are needed to improve health and quality of life and possibly to reduce the risk of disease recurrence and early mortality . Therefore , we report the feasibility and preliminary outcomes of a pilot r and omized trial design ed to increase physical activity in sedentary breast cancer survivors receiving hormone therapy . METHODS Forty-one sedentary women on estrogen receptor modulators or aromatase inhibitors for stage I , II , or IIIA breast cancer were r and omly assigned to receive a 12-wk multidisciplinary physical activity behavior change intervention or usual care . RESULTS Recruitment was 34 % , intervention adherence was 99 % , and complete follow-up data were obtained on 93 % . Most participants ( 93 % ) were white with mean age of 53 + /- 9 yr . Differences favoring the intervention group were noted for accelerometer physical activity counts ( mean difference = 72,103 ; 95 % confidence interval ( CI ) = 25,383 - 119,000 ; effect size ( d ) = 1.02 ; P = 0.004 ) , aerobic fitness ( mean difference = 2.9 ; 95 % CI = -0.1 to 5.8 ; d = 0.64 ; P = 0.058 ) , back/leg muscle strength ( mean difference = 12.3 ; 95 % CI = 0.4 - 15.9 ; d = 0.81 ; P = 0.017 ) , waist-to-hip ratio ( mean difference = -0.05 ; 95 % CI = -0.01 to -0.08 ; d = -0.77 ; P = 0.018 ) , and social well-being ( mean difference = 2.0 ; 95 % CI = 0.3 - 3.8 ; d = 0.76 ; P = 0.03 ) . However , the intervention group also reported a greater increase in joint stiffness ( mean difference = 1.1 ; 95 % CI = 0.1 - 2.2 ; d = 0.70 ; P = 0.04 ) . CONCLUSIONS A behavior change intervention for breast cancer survivors based on the social cognitive theory is feasible and results in potentially meaningful improvements in physical activity and selected health outcomes . Confirmation in a larger study is warranted This longitudinal study examined the long-term impact of a diagnosis of cancer on physical and psychological functioning , by comparing 8-year cancer survivors ( n = 206 ) to a r and omly selected sample of similar-aged references without cancer ( n = 120 ) in the Netherl and s. Comparisons were made at three fixed points in time : 3 months ( T1 ) , 15 months ( T2 ) , and 8 years ( T3 ) after diagnosis . The results showed that , at 8 years after diagnosis , cancer survivors and references do not differ significantly in the level of depressive symptoms , anxiety , life satisfaction , self-esteem , social support , and marital satisfaction . However , survivors reported more physical symptoms , and those with a recurrence of cancer also reported more limitations in household and social activities . Most improvements in functioning were found in the year following diagnosis . Intriguingly , we found no evidence that cancer survivors experienced more positive changes in the self , relationships , or life in general than references , even though many cancer survivors attributed these changes to the cancer experience . In the discussion , we address the role of finding positive meaning in the process of adjustment to cancer PURPOSE Cancer survivors are at increased risk for cardiovascular disease , diabetes , osteoporosis , and second primary tumors . Healthful lifestyle practice s may improve the health and well-being of survivors . The FRESH START trial tested the efficacy of sequentially tailored versus st and ardized mailed material s on improving cancer survivors ' diet and exercise behaviors . METHODS Five hundred forty-three individuals with newly diagnosed locoregional breast or prostate cancer were recruited from 39 states and two provinces within North America . Participants were r and omly assigned either 
    Output:
    
agent
***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: 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 PURPOSE Men with prostate cancer are often advised to make changes in diet and lifestyle , although the impact of these changes has not been well documented . Therefore , we evaluated the effects of comprehensive lifestyle changes on prostate specific antigen ( PSA ) , treatment trends and serum stimulated LNCaP cell growth in men with early , biopsy proven prostate cancer after 1 year . MATERIAL S AND METHODS Patient recruitment was limited to men who had chosen not to undergo any conventional treatment , which provided an unusual opportunity to have a nonintervention r and omized control group to avoid the confounding effects of interventions such as radiation , surgery or and rogen deprivation therapy . A total of 93 volunteers with serum PSA 4 to 10 ng/ml and cancer Gleason scores less than 7 were r and omly assigned to an experimental group that was asked to make comprehensive lifestyle changes or to a usual care control group . RESULTS None of the experimental group patients but 6 control patients underwent conventional treatment due to an increase in PSA and /or progression of disease on magnetic resonance imaging . PSA decreased 4 % in the experimental group but increased 6 % in the control group ( p = 0.016 ) . The growth of LNCaP prostate cancer cells ( American Type Culture Collection , Manassas , Virginia ) was inhibited almost 8 times more by serum from the experimental than from the control group ( 70 % vs 9 % , p < 0.001 ) . Changes in serum PSA and also in LNCaP cell growth were significantly associated with the degree of change in diet and lifestyle . CONCLUSIONS Intensive lifestyle changes may affect the progression of early , low grade prostate cancer in men . Further studies and longer term followup are warranted Background Today , the 5-year relative survival rate for cancer is 65 % and there are 10.5 million survivors . The largest group of survivors are those of breast cancer . Reductions in mortality are occurring at a greater rate for women under age 50 at diagnosis than among older women . Aims Our goal was to design a socio-educational intervention for 5-year survivors aged 50 or younger at diagnosis and test the hypotheses that women in the intervention group would show greater improvement than controls with respect to ( 1 ) knowledge of breast cancer , its treatment , and long-term health concerns ; ( 2 ) lifestyle habits ( i.e. , exercise and diet ) ; and ( 3 ) communication with family and physicians . Methods Using a r and omized controlled trial with a pre-post design , 404 women who were 5 years from diagnosis and cancer-free ( response rate 54 % ) were r and omly assigned to an intervention or delayed intervention ( control ) group and were assessed at pre-test ( baseline ) and 6 months later ( 96 % retention ) . The intervention consisted of three 6-h workshops over a 3 month period . Four series of workshops were held at different geographical areas in the greater San Francisco Bay Area . The workshops included activities and information to promote physical , social , emotional , and spiritual well-being . The intervention design was based on findings from focus groups and a survey of 185 cancer-free 5-year survivors that assessed changes since the early months after diagnosis in physical , social , emotional , and spiritual concerns ( response rate 73 % ) . Results Consistent with our first hypothesis , at post-test , women in the intervention group , on average , had greater knowledge regarding breast cancer , its treatment , and their own future health than did those in the control group ( p = 0.015 ) . Hypothesis 2 was partially supported as women in the intervention group were more likely than the control group to report an increased amount of physical activity ( p = 0.036 ) , but not significant dietary changes . Social support was related to increased self report of physical activity . With the exception of the last series of workshops , the intervention group did not report improved communications with family , friends , and physicians ( hypothesis 3 ) . Conclusions A short-term intervention can affect knowledge levels and physical activity but not diet or communication in the family . Implication s for Cancer SurvivorsThe intervention was related to greater knowledge related to breast cancer , and increased report of physical activity . The program was not related to changes in reported diet or family communication Cancer-related fatigue is the most disabling symptom experienced by breast cancer patients following the cancer treatment . The positive effects of physical activity in the rehabilitation of breast cancer patients are documented in several studies . In a r and omized controlled study the effects of a structured physical training program on fatigue and health-related quality of life were evaluated . Patients and Methods : 63 breast cancer patients with cancer-related chronic fatigue were r and omized at the beginning of the inpatient rehabilitation . The control group received the st and ard complex rehabilitation program , the intervention group a structured physical training program and additional muscle strength and aerobic exercises . The effects of the treatment were evaluated by question naires at the start of rehabilitation ( t1 ) , end of rehabilitation ( t2 ) , and 3 months after t2 ( t3 ) . Isometric muscle strength and aerobic capacity were evaluated at t1 and t2 . Results : There was an improvement of muscle strength at the end of rehabilitation for both groups . The increase from t1 to t2 was significantly higher for the training group . The scores for global quality of life , physical well-being , and functionality increased from t1 to t2 , but further improvement in the follow-up ( t3 ) was only observed in the training group . The cancer-related fatigue was significantly reduced in the training group from t1 to t3 , however , not in the control group . Conclusions : Structured physical training programs initiated during inpatient rehabilitation and continuously practice d in the time thereafter can improve symptoms of chronic fatigue and quality of life in breast cancer patients OBJECTIVE This study examined change in self-efficacy as a mediator of the effects of a mailed print intervention on the dietary and exercise practice s of newly diagnosed breast and prostate cancer survivors . METHOD A total of 543 breast and prostate cancer patients were recruited from 39 states and two provinces within North America . Participants were r and omly assigned to receive a 10-month program of tailored mailed print material s that aim ed to increase fruit and vegetable consumption , reduce fat intake , and /or increase exercise or a 10-month program of publically available material s on diet and exercise . Telephone surveys conducted at baseline and 1 year assessed dietary practice s , physical activity , and self-efficacy for engaging in these health behaviors . RESULTS Results indicated that changes in self-efficacy for fat restriction and eating more fruits and vegetables were significant mediators of the intervention 's effects on dietary outcomes at 1-year follow-up . The intervention did not significantly affect self-efficacy for exercise ; however , a significant , positive relationship was found between self-efficacy for exercise and exercise duration at follow-up . CONCLUSIONS Findings are largely consistent with Social Cognitive Theory and support the use of strategies to increase self-efficacy in health promotion interventions for cancer survivors OBJECTIVES We evaluated recurrence and survival for 68 patients with malignant melanoma who participated in a 6-week structured psychiatric group intervention 5 to 6 years earlier , shortly after their diagnosis and initial surgical treatment . We also explored the role of several factors as possible predictors of outcome . DESIGN This was a r and omized controlled experimental study . The Cox proportion hazards regression model was used to quantify the relationship between treatment and the outcomes adjusted by the covariates ( age , sex , Breslow depth , tumor site , baseline Profile of Mood States Total Mood Disturbance , baseline active-behavioral coping , baseline natural killer cell activity , and treatment [ ie , group intervention ] ) . The stepwise procedure was used for covariate selection . RESULTS For control patients , there was a trend for recurrence ( 13/34 ) and a statistically significant greater rate of death ( 10/34 ) than for experimental patients ( 7/34 and 3/34 , respectively ) . We found that being male and having a greater Breslow depth predicted greater recurrence and poorer survival . Analysis of multiple covariates found that only Breslow depth and treatment ( ie , group intervention ) were significant . Adjusting for Breslow depth , treatment effect remained significant . Finally , baseline affective distress and baseline coping were significant psychobehavioral predictors for recurrence and survival . Surprisingly , higher levels of baseline distress as well as baseline coping and enhancement of active-behavioral coping over time were predictive of lower rates of recurrence and death . CONCLUSION Psychiatric interventions that enhance effective coping and reduce affective distress appear to have beneficial effects on survival but are not proposed as an alternative or independent treatment for cancer or any other illness or disease . However , the exact nature of this relationship warrants further investigation PURPOSE Interventions to increase physical activity among breast cancer survivors are needed to improve health and quality of life and possibly to reduce the risk of disease recurrence and early mortality . Therefore , we report the feasibility and preliminary outcomes of a pilot r and omized trial design ed to increase physical activity in sedentary breast cancer survivors receiving hormone therapy . METHODS Forty-one sedentary women on estrogen receptor modulators or aromatase inhibitors for stage I , II , or IIIA breast cancer were r and omly assigned to receive a 12-wk multidisciplinary physical activity behavior change intervention or usual care . RESULTS Recruitment was 34 % , intervention adherence was 99 % , and complete follow-up data were obtained on 93 % . Most participants ( 93 % ) were white with mean age of 53 + /- 9 yr . Differences favoring the intervention group were noted for accelerometer physical activity counts ( mean difference = 72,103 ; 95 % confidence interval ( CI ) = 25,383 - 119,000 ; effect size ( d ) = 1.02 ; P = 0.004 ) , aerobic fitness ( mean difference = 2.9 ; 95 % CI = -0.1 to 5.8 ; d = 0.64 ; P = 0.058 ) , back/leg muscle strength ( mean difference = 12.3 ; 95 % CI = 0.4 - 15.9 ; d = 0.81 ; P = 0.017 ) , waist-to-hip ratio ( mean difference = -0.05 ; 95 % CI = -0.01 to -0.08 ; d = -0.77 ; P = 0.018 ) , and social well-being ( mean difference = 2.0 ; 95 % CI = 0.3 - 3.8 ; d = 0.76 ; P = 0.03 ) . However , the intervention group also reported a greater increase in joint stiffness ( mean difference = 1.1 ; 95 % CI = 0.1 - 2.2 ; d = 0.70 ; P = 0.04 ) . CONCLUSIONS A behavior change intervention for breast cancer survivors based on the social cognitive theory is feasible and results in potentially meaningful improvements in physical activity and selected health outcomes . Confirmation in a larger study is warranted This longitudinal study examined the long-term impact of a diagnosis of cancer on physical and psychological functioning , by comparing 8-year cancer survivors ( n = 206 ) to a r and omly selected sample of similar-aged references without cancer ( n = 120 ) in the Netherl and s. Comparisons were made at three fixed points in time : 3 months ( T1 ) , 15 months ( T2 ) , and 8 years ( T3 ) after diagnosis . The results showed that , at 8 years after diagnosis , cancer survivors and references do not differ significantly in the level of depressive symptoms , anxiety , life satisfaction , self-esteem , social support , and marital satisfaction . However , survivors reported more physical symptoms , and those with a recurrence of cancer also reported more limitations in household and social activities . Most improvements in functioning were found in the year following diagnosis . Intriguingly , we found no evidence that cancer survivors experienced more positive changes in the self , relationships , or life in general than references , even though many cancer survivors attributed these changes to the cancer experience . In the discussion , we address the role of finding positive meaning in the process of adjustment to cancer PURPOSE Cancer survivors are at increased risk for cardiovascular disease , diabetes , osteoporosis , and second primary tumors . Healthful lifestyle practice s may improve the health and well-being of survivors . The FRESH START trial tested the efficacy of sequentially tailored versus st and ardized mailed material s on improving cancer survivors ' diet and exercise behaviors . METHODS Five hundred forty-three individuals with newly diagnosed locoregional breast or prostate cancer were recruited from 39 states and two provinces within North America . Participants were r and omly assigned either 
    Output:
    