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: Objectives : The internet offers new possibilities in psychosocial patient care . However , empirical data are lacking for oncological patients . A field-experimental study was conducted to obtain initial data to enable evaluation of the effectiveness of online counseling via e-mail for breast cancer patients . A secondary objective was to explore how patients reached by the service can be characterized on psychosocial status and illness . Methods : On a dedicated German- language website , 235 breast cancer patients registered for psychosocial counseling via e-mail . 133 registrants were r and omly assigned to a treatment group to receive immediate counseling or to a waiting list control group . The two-month counseling session took the form of a psychoeducation , individually tailored to each patient . Psychosocial outcome measures including psychological distress ( BSI ) and quality of life ( EORTC QLQ-C30 ) were assessed at registration and at a two-month follow-up . Descriptive data were recorded at registration . At the conclusion of the program , participants were asked to complete a patient satisfaction question naire ( ZUF-8 ) . Results : BSI responses showed that 85 % of all patients were initially diagnosable with comorbid psychopathology . Despite high severity of distress and attendant large reductions in quality of life , 72 % of all patients were not obtaining conventional assistance . Among counseling participants ( n=31 ) , no significant improvements in distress or quality of life were found in comparison to the control group ( n=34 ) , but patient satisfaction was nonetheless high . Conclusion : The study demonstrates that online counseling via e-mail reaches patients with unmet therapeutic needs , but also indicated its limitations , suggesting that the online setting may be most useful for prompting and supporting a transition to conventional counseling services The purpose s of this study were to evaluate the effects of different formats of online group support ( moderated vs peer-led ) on depressive symptoms and extent of participation in women with breast cancer . A r and omized longitudinal design was used to address the study aims . The setting was a secure password-protected Web page . Fifty women with breast cancer , at least 21 years old , who had Internet access participated . Subjects were r and omly assigned to moderated or peer-led groups , given a password , and instructed to complete the study question naires at baseline and again at 6 , 12 , and 16 weeks . The independent variables were types of  online support ( moderated or peer-led ) , and the dependent variables were depressive symptoms and extent of participation . There were no significant differences in depressive symptoms by group or by extent of group participation . Moderated groups read and posted significantly more messages than did peer-led groups . This study adds to the research base on different group formats for online support and the extent of participation and nonparticipation ( lurking ) in online groups . It provides a springboard for additional studies that include ethnic minorities , people with different types of cancer , and men OBJECTIVES Depression is known to be a major problem in cancer patients , and evidence is emerging about the importance of anxiety . Because the disorders are highly comorbid , we examined the relationship of anxiety and depression with health-related quality of life ( HRQL ) in cancer patients . METHODS Sample included 405 adult oncology patients participating in a r and omized controlled trial of telecare management for pain and depression .  This secondary cross-sectional analysis of baseline data examined independent and additive effects of anxiety and depression on HRQL , disability , and somatic symptom severity . RESULTS In 397 patients who screened positive for either pain or depression or both , 135 had comorbid anxiety and depression , 174 had depression but not anxiety , and 88 had neither . Differences existed across all nonphysical HRQL domains and were more pronounced incrementally across the three groups in the expected direction . In GLM modeling , anxiety and depression were each associated with all the domains when modeled separately ( p<0.0001 ) . When modeled together , anxiety and depression had independent and additive effects on the mental health domains of HRQL and on somatic symptom burden . In other domains ( vitality , perceived disability , overall quality of life , and general health perceptions ) , only depression had an effect . CONCLUSION Anxiety and depression have strong and independent associations with mental health domains and somatic symptom burden in cancer patients . However , depression has a more pervasive association with multiple other domains of HRQL . Paying attention to both anxiety and depression may be particularly important when addressing mental health needs and somatic symptom distress PURPOSE Early breast cancer survivors ( BCSs ) report high unmet care needs , and easily accessible care is not routinely available for this growing population . The Breast Cancer E-Health ( BREATH ) trial is a Web-based self-management intervention to support the psychological adjustment of women after primary treatment , by reducing distress and improving empowerment . PATIENTS AND METHODS This multicenter , r and omized , controlled , parallel-group trial evaluated whether care as usual ( CAU ) plus BREATH is superior to CAU alone . BREATH is delivered in sixteen fully automated weekly modules covering early survivorship issues . Two to 4 months post-treatment , BCSs were r and omly assigned to receive CAU + BREATH ( n = 70 ) or CAU alone ( n = 80 ) using a stratified block design ( ratio 1:1 ) . Primary outcomes were distress ( Symptom Checklist-90 ) and empowerment ( Cancer Empowerment Question naire ) , assessed before r and om assignment ( baseline , T0 ) and after 4 ( T1 ) , 6 ( T2 ) , and 10 months ( T3 ) of follow-up . Statistical ( analysis of covariance ) and clinical effects ( reliable change index ) were tested in an intention-to-treat analysis ( T0 to T1 ) . Follow-up effects ( T0 to T3 ) were assessed in assessment completers . RESULTS CAU + BREATH participants reported significantly less distress than CAU-alone participants ( -7.79 ; 95 % CI , -14.31 to -1.27 ; P = .02 ) with a small-to-medium effect size ( d = 0.33 ) , but empowerment was not affected ( -1.71 ; 95 % CI , 5.20 to -1.79 ; P = .34 ) . More CAU + BREATH participants ( 39 of 70 [ 56 % ] ; 95 % CI , 44.1 to 66.8 ) than CAU-alone participants ( 32 of 80 [ 40 % ] ; 95 % CI , 30.0 to 51.0 ) showed clinical ly significant improvement ( P = .03 ) . This clinical effect was most prominent in low-distress BCSs . Secondary outcomes confirmed primary outcomes . There were no between-group differences in primary outcomes during follow-up . CONCLUSION Access to BREATH reduced distress among BCSs , but this effect was not sustained during follow-up Abstract Depressive symptoms are common in glioma patients , and can negatively affect health-related quality of life ( HRQOL ) . We performed a nation-wide r and omized controlled trial to evaluate the effects of an online guided self-help intervention for depressive symptoms in adult glioma patients . Glioma patients with depressive symptoms were r and omized to a 5-week online course based on problem-solving therapy , or a waiting list control group . After having received the intervention , the glioma patient groups combined were compared with patients with cancer outside the central nervous system ( non-CNS cancer controls ) , who also received the intervention . Sample size calculations yielded 63 participants to be recruited per arm . The primary outcome [ depressive symptoms ( CES-D ) ] and secondary outcomes [ fatigue ( Checklist Individual Strength ( CIS ) ) and HRQOL ( Short Form-36 ) ] , were assessed online at baseline , post-intervention , and 3 and 12 months follow-up . In total , 89 glioma patients ( intervention N = 45 ; waiting list N = 44 ) and 26 non-CNS cancer controls were included , of whom 35 and 54 % completed the intervention , respectively . Recruitment could not be extended beyond 3.5 years due to funding . On depression , no statistically significant differences between the groups were found . Fatigue decreased post-treatment in the glioma intervention group compared with the waiting list group ( p = 0.054 , d = 0.306 ) . At 12 months , the physical component summary ( HRQOL ) remained stable in glioma patients , while scores improved in non-CNS cancer controls ( p = 0.035 , d = 0.883 ) . In this underpowered study , no evidence for the effectiveness of online guided self-help for depression or HRQOL in glioma patients was found , but it may improve fatigue . Trial registration Netherl and s Trial Register NTR3223 Background Approximately one third of all patients who have been successfully treated for cancer suffer from chronic cancer-related fatigue ( CCRF ) . Effective and easily accessible interventions are needed for these patients . Objective The current paper reports on the results of a 3-armed r and omized controlled trial investigating the clinical effectiveness of two different guided Web-based interventions for reducing CCRF compared to an active control condition . Methods Severely fatigued cancer survivors were recruited via online and offline channels , and self-registered on an open-access website . After eligibility checks , 167 participants were r and omized via an embedded automated r and omization function into : ( 1 ) physiotherapist-guided Ambulant Activity Feedback ( AAF ) therapy encompassing the use of an accelerometer ( n=62 ) ; ( 2 ) psychologist-guided Web-based mindfulness-based cognitive therapy ( eMBCT ; n=55 ) ; or ( 3 ) an unguided active control condition receiving psycho-educational emails ( n=50 ) . All interventions lasted nine weeks . Fatigue severity was self-assessed using the Checklist Individual Strength - Fatigue Severity subscale ( primary outcome ) six times from baseline ( T0b ) to six months ( T2 ) . Mental health was self-assessed three times using the Hospital Anxiety and Depression Scale and Positive and Negative Affect Schedule ( secondary outcome ) . Treatment dropout was investigated . Results Multiple group latent growth curve analysis , corrected for individual time between assessment s , showed that fatigue severity decreased significantly more in the AAF and eMBCT groups compared to the psycho-educational group . The analyses were checked by a research er who was blind to allocation . Clinical ly relevant changes in fatigue severity were observed in 66 % ( 41/62 ) of patients in AAF , 49 % ( 27/55 ) of patients in eMBCT , and 12 % ( 6/50 ) of patients in psycho-education . Dropout was 18 % ( 11/62 ) in AAF , mainly due to technical problems and poor usability of the accelerometer , and 38 % ( 21/55 ) in eMBCT , mainly due to the perceived high intensity of the program . Conclusions Both the AAF and eMBCT interventions are effective for managing fatigue severity compared to receiving psycho-educational emails . Trial Registration Trialregister.nl NTR3483 ; http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=3483 ( Archived by WebCite at http://www.webcitation.org/6NWZqon3o Purpose The web-based computer-tailored Kanker Nazorg Wijzer ( Cancer Aftercare Guide ) supports cancer survivors with psychosocial issues during cancer recovery . The current study investigates whether the 6-month effects in increasing emotional and social functioning and reducing depression and fatigue hold at 12 months from baseline . Moreover , it explores whether patient characteristics moderate the 6- and 12-month intervention effectiveness . Methods Cancer survivors from 21 Dutch hospitals ( November 2013–June 2014 ) were r and omized to an intervention ( n = 231 ) or a wait-list control group ( n = 231 ) . Intervention effects on emotional and social functioning ( EORTC QLQ-C30 ) , depression ( HADS ) , and fatigue ( CIS ) were evaluated through multilevel linear regression analyses . Results At 12 months from baseline , the intervention group no longer differed from the control group in emotional and social functioning , depression , and fatigue . Moderator analyses indicated that , at 6 months , the intervention was effective in improving social functioning for men ( d = 0.34 ) , reducing fatigue for participants ≤56 years ( d = 0.44 ) , and reducing depression for participants who received chemotherapy ( d = 0.36 ) . At 12 months , participants with a medium educational level reported higher social functioning ( d = 0.19 ) , while participants with a low educational level reported lower social functioning ( d = 0.22 ) than participants with a similar educational level in the control group . Conclusions The intervention gave cancer patients a head start to psychological recovery after the end of cancer treatment . The control group caught up in the long run . Implication s for cancer survivorsThe Cancer Aftercare Guide expedited recovery after cancer treatment . Being a low intensity , easy accessible , and relatively low cost intervention , it could serve as a relevant step in recovery and stepped care PURPOSE This study aim ed to determine the effect of individualized patient education along with emotional support on the quality of life ( QoL ) of breast cancer patients undergoing chemotherapy . It also aim ed to determine the intervention 's feasibility in the Pakistani context . METHODS A quasi-experimental design , with pre- and post-test , in two groups , via time block , was used . The study was conducted at a public hospital in Karachi with a sample of 50 patients ; 25 patients each in the intervention and control group . The intervention was delivered over a period of six weeks . It comprised verbal and written patient education , availability of a nurse during patients ' chemotherapy administration and over the telephone 
    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: Objectives : The internet offers new possibilities in psychosocial patient care . However , empirical data are lacking for oncological patients . A field-experimental study was conducted to obtain initial data to enable evaluation of the effectiveness of online counseling via e-mail for breast cancer patients . A secondary objective was to explore how patients reached by the service can be characterized on psychosocial status and illness . Methods : On a dedicated German- language website , 235 breast cancer patients registered for psychosocial counseling via e-mail . 133 registrants were r and omly assigned to a treatment group to receive immediate counseling or to a waiting list control group . The two-month counseling session took the form of a psychoeducation , individually tailored to each patient . Psychosocial outcome measures including psychological distress ( BSI ) and quality of life ( EORTC QLQ-C30 ) were assessed at registration and at a two-month follow-up . Descriptive data were recorded at registration . At the conclusion of the program , participants were asked to complete a patient satisfaction question naire ( ZUF-8 ) . Results : BSI responses showed that 85 % of all patients were initially diagnosable with comorbid psychopathology . Despite high severity of distress and attendant large reductions in quality of life , 72 % of all patients were not obtaining conventional assistance . Among counseling participants ( n=31 ) , no significant improvements in distress or quality of life were found in comparison to the control group ( n=34 ) , but patient satisfaction was nonetheless high . Conclusion : The study demonstrates that online counseling via e-mail reaches patients with unmet therapeutic needs , but also indicated its limitations , suggesting that the online setting may be most useful for prompting and supporting a transition to conventional counseling services The purpose s of this study were to evaluate the effects of different formats of online group support ( moderated vs peer-led ) on depressive symptoms and extent of participation in women with breast cancer . A r and omized longitudinal design was used to address the study aims . The setting was a secure password-protected Web page . Fifty women with breast cancer , at least 21 years old , who had Internet access participated . Subjects were r and omly assigned to moderated or peer-led groups , given a password , and instructed to complete the study question naires at baseline and again at 6 , 12 , and 16 weeks . The independent variables were types of  online support ( moderated or peer-led ) , and the dependent variables were depressive symptoms and extent of participation . There were no significant differences in depressive symptoms by group or by extent of group participation . Moderated groups read and posted significantly more messages than did peer-led groups . This study adds to the research base on different group formats for online support and the extent of participation and nonparticipation ( lurking ) in online groups . It provides a springboard for additional studies that include ethnic minorities , people with different types of cancer , and men OBJECTIVES Depression is known to be a major problem in cancer patients , and evidence is emerging about the importance of anxiety . Because the disorders are highly comorbid , we examined the relationship of anxiety and depression with health-related quality of life ( HRQL ) in cancer patients . METHODS Sample included 405 adult oncology patients participating in a r and omized controlled trial of telecare management for pain and depression .  This secondary cross-sectional analysis of baseline data examined independent and additive effects of anxiety and depression on HRQL , disability , and somatic symptom severity . RESULTS In 397 patients who screened positive for either pain or depression or both , 135 had comorbid anxiety and depression , 174 had depression but not anxiety , and 88 had neither . Differences existed across all nonphysical HRQL domains and were more pronounced incrementally across the three groups in the expected direction . In GLM modeling , anxiety and depression were each associated with all the domains when modeled separately ( p<0.0001 ) . When modeled together , anxiety and depression had independent and additive effects on the mental health domains of HRQL and on somatic symptom burden . In other domains ( vitality , perceived disability , overall quality of life , and general health perceptions ) , only depression had an effect . CONCLUSION Anxiety and depression have strong and independent associations with mental health domains and somatic symptom burden in cancer patients . However , depression has a more pervasive association with multiple other domains of HRQL . Paying attention to both anxiety and depression may be particularly important when addressing mental health needs and somatic symptom distress PURPOSE Early breast cancer survivors ( BCSs ) report high unmet care needs , and easily accessible care is not routinely available for this growing population . The Breast Cancer E-Health ( BREATH ) trial is a Web-based self-management intervention to support the psychological adjustment of women after primary treatment , by reducing distress and improving empowerment . PATIENTS AND METHODS This multicenter , r and omized , controlled , parallel-group trial evaluated whether care as usual ( CAU ) plus BREATH is superior to CAU alone . BREATH is delivered in sixteen fully automated weekly modules covering early survivorship issues . Two to 4 months post-treatment , BCSs were r and omly assigned to receive CAU + BREATH ( n = 70 ) or CAU alone ( n = 80 ) using a stratified block design ( ratio 1:1 ) . Primary outcomes were distress ( Symptom Checklist-90 ) and empowerment ( Cancer Empowerment Question naire ) , assessed before r and om assignment ( baseline , T0 ) and after 4 ( T1 ) , 6 ( T2 ) , and 10 months ( T3 ) of follow-up . Statistical ( analysis of covariance ) and clinical effects ( reliable change index ) were tested in an intention-to-treat analysis ( T0 to T1 ) . Follow-up effects ( T0 to T3 ) were assessed in assessment completers . RESULTS CAU + BREATH participants reported significantly less distress than CAU-alone participants ( -7.79 ; 95 % CI , -14.31 to -1.27 ; P = .02 ) with a small-to-medium effect size ( d = 0.33 ) , but empowerment was not affected ( -1.71 ; 95 % CI , 5.20 to -1.79 ; P = .34 ) . More CAU + BREATH participants ( 39 of 70 [ 56 % ] ; 95 % CI , 44.1 to 66.8 ) than CAU-alone participants ( 32 of 80 [ 40 % ] ; 95 % CI , 30.0 to 51.0 ) showed clinical ly significant improvement ( P = .03 ) . This clinical effect was most prominent in low-distress BCSs . Secondary outcomes confirmed primary outcomes . There were no between-group differences in primary outcomes during follow-up . CONCLUSION Access to BREATH reduced distress among BCSs , but this effect was not sustained during follow-up Abstract Depressive symptoms are common in glioma patients , and can negatively affect health-related quality of life ( HRQOL ) . We performed a nation-wide r and omized controlled trial to evaluate the effects of an online guided self-help intervention for depressive symptoms in adult glioma patients . Glioma patients with depressive symptoms were r and omized to a 5-week online course based on problem-solving therapy , or a waiting list control group . After having received the intervention , the glioma patient groups combined were compared with patients with cancer outside the central nervous system ( non-CNS cancer controls ) , who also received the intervention . Sample size calculations yielded 63 participants to be recruited per arm . The primary outcome [ depressive symptoms ( CES-D ) ] and secondary outcomes [ fatigue ( Checklist Individual Strength ( CIS ) ) and HRQOL ( Short Form-36 ) ] , were assessed online at baseline , post-intervention , and 3 and 12 months follow-up . In total , 89 glioma patients ( intervention N = 45 ; waiting list N = 44 ) and 26 non-CNS cancer controls were included , of whom 35 and 54 % completed the intervention , respectively . Recruitment could not be extended beyond 3.5 years due to funding . On depression , no statistically significant differences between the groups were found . Fatigue decreased post-treatment in the glioma intervention group compared with the waiting list group ( p = 0.054 , d = 0.306 ) . At 12 months , the physical component summary ( HRQOL ) remained stable in glioma patients , while scores improved in non-CNS cancer controls ( p = 0.035 , d = 0.883 ) . In this underpowered study , no evidence for the effectiveness of online guided self-help for depression or HRQOL in glioma patients was found , but it may improve fatigue . Trial registration Netherl and s Trial Register NTR3223 Background Approximately one third of all patients who have been successfully treated for cancer suffer from chronic cancer-related fatigue ( CCRF ) . Effective and easily accessible interventions are needed for these patients . Objective The current paper reports on the results of a 3-armed r and omized controlled trial investigating the clinical effectiveness of two different guided Web-based interventions for reducing CCRF compared to an active control condition . Methods Severely fatigued cancer survivors were recruited via online and offline channels , and self-registered on an open-access website . After eligibility checks , 167 participants were r and omized via an embedded automated r and omization function into : ( 1 ) physiotherapist-guided Ambulant Activity Feedback ( AAF ) therapy encompassing the use of an accelerometer ( n=62 ) ; ( 2 ) psychologist-guided Web-based mindfulness-based cognitive therapy ( eMBCT ; n=55 ) ; or ( 3 ) an unguided active control condition receiving psycho-educational emails ( n=50 ) . All interventions lasted nine weeks . Fatigue severity was self-assessed using the Checklist Individual Strength - Fatigue Severity subscale ( primary outcome ) six times from baseline ( T0b ) to six months ( T2 ) . Mental health was self-assessed three times using the Hospital Anxiety and Depression Scale and Positive and Negative Affect Schedule ( secondary outcome ) . Treatment dropout was investigated . Results Multiple group latent growth curve analysis , corrected for individual time between assessment s , showed that fatigue severity decreased significantly more in the AAF and eMBCT groups compared to the psycho-educational group . The analyses were checked by a research er who was blind to allocation . Clinical ly relevant changes in fatigue severity were observed in 66 % ( 41/62 ) of patients in AAF , 49 % ( 27/55 ) of patients in eMBCT , and 12 % ( 6/50 ) of patients in psycho-education . Dropout was 18 % ( 11/62 ) in AAF , mainly due to technical problems and poor usability of the accelerometer , and 38 % ( 21/55 ) in eMBCT , mainly due to the perceived high intensity of the program . Conclusions Both the AAF and eMBCT interventions are effective for managing fatigue severity compared to receiving psycho-educational emails . Trial Registration Trialregister.nl NTR3483 ; http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=3483 ( Archived by WebCite at http://www.webcitation.org/6NWZqon3o Purpose The web-based computer-tailored Kanker Nazorg Wijzer ( Cancer Aftercare Guide ) supports cancer survivors with psychosocial issues during cancer recovery . The current study investigates whether the 6-month effects in increasing emotional and social functioning and reducing depression and fatigue hold at 12 months from baseline . Moreover , it explores whether patient characteristics moderate the 6- and 12-month intervention effectiveness . Methods Cancer survivors from 21 Dutch hospitals ( November 2013–June 2014 ) were r and omized to an intervention ( n = 231 ) or a wait-list control group ( n = 231 ) . Intervention effects on emotional and social functioning ( EORTC QLQ-C30 ) , depression ( HADS ) , and fatigue ( CIS ) were evaluated through multilevel linear regression analyses . Results At 12 months from baseline , the intervention group no longer differed from the control group in emotional and social functioning , depression , and fatigue . Moderator analyses indicated that , at 6 months , the intervention was effective in improving social functioning for men ( d = 0.34 ) , reducing fatigue for participants ≤56 years ( d = 0.44 ) , and reducing depression for participants who received chemotherapy ( d = 0.36 ) . At 12 months , participants with a medium educational level reported higher social functioning ( d = 0.19 ) , while participants with a low educational level reported lower social functioning ( d = 0.22 ) than participants with a similar educational level in the control group . Conclusions The intervention gave cancer patients a head start to psychological recovery after the end of cancer treatment . The control group caught up in the long run . Implication s for cancer survivorsThe Cancer Aftercare Guide expedited recovery after cancer treatment . Being a low intensity , easy accessible , and relatively low cost intervention , it could serve as a relevant step in recovery and stepped care PURPOSE This study aim ed to determine the effect of individualized patient education along with emotional support on the quality of life ( QoL ) of breast cancer patients undergoing chemotherapy . It also aim ed to determine the intervention 's feasibility in the Pakistani context . METHODS A quasi-experimental design , with pre- and post-test , in two groups , via time block , was used . The study was conducted at a public hospital in Karachi with a sample of 50 patients ; 25 patients each in the intervention and control group . The intervention was delivered over a period of six weeks . It comprised verbal and written patient education , availability of a nurse during patients ' chemotherapy administration and over the telephone 
    Output:
    