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: Background Despite the fact that the fear of cancer recurrence is to varying degrees almost universal in cancer survivors , there is a lack of vali date d multidimensional instruments to evaluate this issue specifically . Purpose The goal of this study was to develop and empirically vali date a multidimensional self-report scale for assessing the fear of cancer recurrence , the  Fear of Cancer Recurrence Inventory ( FCRI ) . Methods A provincial medical data bank was used to r and omly select a pool of 1,704 French-Canadian patients who had been treated for breast , prostate , lung , and colorectal cancer within the past 10 years . Of these , 300 patients were asked to complete the FCRI on two occasions . Results The factorial analysis conducted on the final 42-item scale revealed a seven-component solution ( 64 % of the variance ) including the following factors : triggers , severity , psychological distress , coping strategies , functioning impairments , insight , and reassurance . The results also supported the internal consistency ( α = 0.95 ) and the temporal stability ( r = 0.89 ) of the FCRI , as well as its construct validity with other self-report scales assessing fear of cancer recurrence ( r = 0.68 to 0.77 ) or related constructs such as psychological distress ( r = 0.43 to 0.77 ) and quality of life ( r = −0.20 to −0.36 ) . Conclusions This study suggests that the French-Canadian version of the FCRI is a reliable and valid instrument for evaluating the multidimensional aspects of the fear of cancer recurrence OBJECTIVES Considerable morbidity persists among survivors of breast cancer ( BC ) including high levels of psychological stress , anxiety , depression , fear of recurrence , and physical symptoms including pain , fatigue , and sleep disturbances , and impaired quality of life . Effective interventions are needed during this difficult transitional period . METHODS We conducted a r and omized controlled trial of 84 female BC survivors ( Stages 0-III ) recruited from the H. Lee Moffitt Cancer and Research Institute . All subjects were within 18 months of treatment completion with surgery and adjuvant radiation and /or chemotherapy .  Subjects were r and omly assigned to a 6-week Mindfulness-Based Stress Reduction ( MBSR ) program design ed to self-regulate arousal to stressful circumstances or symptoms ( n=41 ) or to usual care ( n=43 ) . Outcome measures compared at 6 weeks by r and om assignment included vali date d measures of psychological status ( depression , anxiety , perceived stress , fear of recurrence , optimism , social support ) and psychological and physical subscales of quality of life ( SF-36 ) . RESULTS Compared with usual care , subjects assigned to MBSR(BC ) had significantly lower ( two-sided p<0.05 ) adjusted mean levels of depression ( 6.3 vs 9.6 ) , anxiety ( 28.3 vs 33.0 ) , and fear of recurrence ( 9.3 vs 11.6 ) at 6 weeks , along with higher energy ( 53.5 vs 49.2 ) , physical functioning ( 50.1 vs 47.0 ) , and physical role functioning ( 49.1 vs 42.8 ) . In stratified analyses , subjects more compliant with MBSR tended to experience greater improvements in measures of energy and physical functioning . CONCLUSIONS Among BC survivors within 18 months of treatment completion , a 6-week MBSR(BC ) program result ed in significant improvements in psychological status and quality of life compared with usual care AIMS To evaluate the generic and condition-specific health-related quality of life ( HRQL ) of long-term survivors of extremity melanoma treated with isolated limb perfusion ( ILP ) .  METHODS Between 1978 and 2001 , 292 patients with melanoma of the limbs underwent ILP in our institution . Of these patients , 59 were alive and disease-free for at least six months prior to study entry . Fifty-one of these 59 patients completed a mailed question naire assessing generic HRQL ( SF-36 ) , condition-specific HRQL ( limb function , cosmetic results , fear of recurrence ) , and problems regarding work and insurance .  An age- and gender-matched , normative sample of the Dutch general population was available for comparison of SF-36 scores . RESULTS Mean age of patients was 57 years , 90 % female , with a median time since ILP of 14 years ( range 3 - 25 years ) . The SF-36 scores of the patient group were equal to or better than that of the general population , significantly for bodily pain , general health perceptions , and the physical and mental health component scores . Nevertheless , the patients reported a number of specific problems : complaints of limb function were reported by 49 - 55 % , cosmetic problems by 31 - 38 % and fear of local disease recurrence and distant metastases by 77 and 63 % of the patients , respectively . Less than 10 % of patients reported problems in obtaining a mortgage or life insurance . CONCLUSIONS The HRQL of long-term survivors of melanoma treated with ILP appears comparable to , and sometimes better than that of healthy peers within the general population . Nevertheless , this survivor group reports a number of specific problems that impact on daily life . Although these findings need to be confirmed with larger , prospect i ve studies , they suggest that rehabilitation should focus on improving limb functionality , and addressing chronic fear of disease recurrence OBJECTIVE Patient Reported Outcome ( PRO ) assessment s can assist health professionals to tailor their health practice s to the individual needs of patients and improve patient care over time . The present study assessed prospect i ve predictors of unmet supportive care needs in cancer patients over a six-month period . METHODS Participants were recruited from a regional cancer treatment centre in Australia and completed the Supportive Care Needs Survey ( SCNS )  at recruitment ( n=439 ; 61.4 % response rate ) and six months follow-up ( n=396 ) . Hierarchical logistic regression was used to identify predictors of change in unmet needs across each supportive care domain . Predictor variables were socio-demographic , treatment and psychosocial factors including depression , anxiety , social support , and patient satisfaction . RESULTS Unmet needs were reported by approximately two-thirds of patients at baseline and half of patients at six months follow-up . Having unmet needs at baseline was the strongest predictor of unmet needs at six months . Longer time since diagnosis was a consistent predictor of greater unmet needs , associated with change in physical/daily living , psychological and health system and information unmet needs over time . By contrast , a complex relationship was found in that patient satisfaction , psychosocial and treatment characteristics predicted higher needs in some domains and lower needs in others . CONCLUSIONS Unmet supportive care needs persist over time and psychological needs may emerge later in the illness continuum . Interventions to meet the needs of longer term cancer survivors are needed and should closely articulate with reported supportive care needs Anxiety and fear are often associated with chronic conditions such as cancer . This paper targets the cost-effectiveness analysis of a cognitive-behavioral group therapy ( CBT ) in comparison to a client-centered , supportive-experiential group therapy ( SET ) in cancer patients with dysfunctional fear of progression . An incremental cost-effectiveness analysis was performed using data from a r and omized controlled trial among cancer patients receiving inpatient rehabilitation . The means , 95 % confidence intervals [ 95 % CI ] , incremental cost-effectiveness graphic and acceptability curve were obtained from 1,000 bootstrap replications . A total of 174 patients were included in the economic evaluation . The estimated means [ 95 % CI ] of direct costs and reduction of fear of progression were € 9,045.03 [ 6,359.07 ; 12,091.87 ] and 1.41 [ 0.93 ; 1.92 ] for patients in the SET and € 6,682.78 [ 4,998.09 ; 8,440.95 ] and 1.44 [ 1.02 ; 1.09 ] for patients in the CBT . The incremental cost-effectiveness ratio [ 95 % CI ] amounts to minus € 78,741.66 [ −154,987.20 ; 110,486.32 ] for an additional unit of effect . Given the acceptability curve , there is a 92.4 % chance that the CBT , compared with the SET , is cost-effective without the need of additional costs to payers . Our main result is the superior cost-effectiveness of the cognitive-behavioral intervention program in comparison to the non-directive encounter group for our sample of cancer patients with high levels of anxiety Recurrence risk in orofacial cancer patients is relatively high in comparison to other cancers . Little information exists on whether patients are unduly concerned over the possibility of recurrence and the association of this concern with psychological morbidity . Aim of study was to assess fear of recurrence and psychological morbidity in orofacial cancer patients . Two sample s of patients with orofacial cancer were followed prospect ively . First sample ( n = 87 ) were consecutively drawn 3 months and 7 months following initial treatment . Second sample ( n = 100 ) were cross-sectionally drawn from out-patient list and followed 2 years later . A single question item was employed to assess fear of recurrence used in previous work . Hospital Anxiety and Depression Scale was adopted as the measure of psychological morbidity . A prospect i ve survey design was employed . Over 80 % of patients expressed concern over the possibility of recurrence at 3 months post treatment . This level reduced to 72 % at 7 months ( P=0.06 ) . Approximately two-thirds of patients sample d cross-sectionally were concerned at both assessment occasions . Psychological morbidity was greatest at 3 months post treatment ( possible cases : anxiety 37 % and depression 28 % ) . Women were more likely to report anxiety ( at possible case level ) than men 3 months following treatment ( P<0.05 ) . Patients aged 65 or more years were less concerned about recurrence . This effect was significant on both occasions that sample two patients were assessed ( P's<0.002 ) . Very few patients who expressed no concern about recurrence , at 3 months , were found to report anxiety or depression sufficient to be recognized as a possible case ( 3 and 0 % respectively ) . The positive association between psychological morbidity and fears of recurrence was significant at the majority of data collection points , with the exception that depression was more independent of these concerns OBJECTIVE To examine : ( 1 ) daily religious and spiritual experiences among localized prostate cancer patients as compared to a national age and race-matched male sample ; ( 2 ) cognitive-affective and clinical predictors of prostate cancer diagnosis-related increases in religiosity and spirituality ; ( 3 ) short-term impact of daily religious and spiritual experiences on cancer recurrence worry . METHODS Analyses of data from a longitudinal question naire study among patients ( N = 254 ) diagnosed with localized prostate cancer and data from a r and om sample ( N = 238 ) of respondents to the national General Social Survey . RESULTS Compared to the national sample , prostate cancer patients reported higher levels of daily spiritual experiences . Patients with higher worry about prostate cancer and elevated levels of prostate-related symptoms around diagnosis were more likely to report a diagnosis-related increase in religiosity and spirituality . Positive benefits ( reduced recurrence worry ) of religious coping/ practice s were restricted to those patients with higher versus lower level of postdiagnosis increase in religiosity ; patients not reporting postdiagnosis increases in religion who are not engaging in religious coping/ practice adjusted equally well . Results suggest that the development of religious/spiritual interventions is premature . SIGNIFICANCE OF RESULTS This is the first prospect i ve study to report on the prevalence and influence of  daily spiritual and religious experiences  among prostate cancer patients Mastectomy and breast-conserving treatment have proven equally effective in terms of survival in early breast cancer , but studies continue to provide evidence that patients undergoing breast-conserving procedures  have a better quality of life ( QOL ) . Age is not considered to be a contraindication for breast-conserving treatment , but retrospective studies have indicated that elderly patients are less likely to be treated conservatively . In the present study , survival , QOL and treatment preference have been investigated in a multicentre , r and omised clinical trial of elderly patients with early breast cancer undergoing mastectomy or tumour excision plus tamoxifen . Eligible patients were aged 70 years or more and had histologically- or cytologically-confirmed operable breast cancer . A QOL question naire consisting of 36 items was constructed covering 9 scales assessing different QOL domains . Patients completed their assessment between 2 and 12 months after r and omisation . 136 patients ( 65 in the mastectomy arm and 71 in the local excision arm ) from six centres filled out a QOL form during the first year of follow-up . No significant difference in the duration of survival between the two treatment arms was observed when including patients included in the QOL sub- study ( P=0.33 ) . Patients undergoing tumour excision and tamoxifen did not differ from those undergoing mastectomy in terms of fatigue , emotional functioning , fear of recurrence , social support , physical functioning and leisure time activities . However , conservatively treated patients reported fewer arm problems ( P=0.04 ) and a shift , although borderline significant , in the direction of a benefit in body image ( P=0.06 ) . As QOL seems to be better after conservative treatment , such treatment is to be preferred in both elderly and younger patients OBJECTIVES To compare the impact of radical nephrectomy and nephron-sparing surgery ( NSS ) for localized renal cell carcinoma on quality of life ( QOL ) . METHODS Retrospectively , 357 patients who had undergone NSS ( n = 158 ) or radical nephrectomy ( n = 199 ) for localized renal cell carcinoma completed postal question naires , including measures 
    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: Background Despite the fact that the fear of cancer recurrence is to varying degrees almost universal in cancer survivors , there is a lack of vali date d multidimensional instruments to evaluate this issue specifically . Purpose The goal of this study was to develop and empirically vali date a multidimensional self-report scale for assessing the fear of cancer recurrence , the  Fear of Cancer Recurrence Inventory ( FCRI ) . Methods A provincial medical data bank was used to r and omly select a pool of 1,704 French-Canadian patients who had been treated for breast , prostate , lung , and colorectal cancer within the past 10 years . Of these , 300 patients were asked to complete the FCRI on two occasions . Results The factorial analysis conducted on the final 42-item scale revealed a seven-component solution ( 64 % of the variance ) including the following factors : triggers , severity , psychological distress , coping strategies , functioning impairments , insight , and reassurance . The results also supported the internal consistency ( α = 0.95 ) and the temporal stability ( r = 0.89 ) of the FCRI , as well as its construct validity with other self-report scales assessing fear of cancer recurrence ( r = 0.68 to 0.77 ) or related constructs such as psychological distress ( r = 0.43 to 0.77 ) and quality of life ( r = −0.20 to −0.36 ) . Conclusions This study suggests that the French-Canadian version of the FCRI is a reliable and valid instrument for evaluating the multidimensional aspects of the fear of cancer recurrence OBJECTIVES Considerable morbidity persists among survivors of breast cancer ( BC ) including high levels of psychological stress , anxiety , depression , fear of recurrence , and physical symptoms including pain , fatigue , and sleep disturbances , and impaired quality of life . Effective interventions are needed during this difficult transitional period . METHODS We conducted a r and omized controlled trial of 84 female BC survivors ( Stages 0-III ) recruited from the H. Lee Moffitt Cancer and Research Institute . All subjects were within 18 months of treatment completion with surgery and adjuvant radiation and /or chemotherapy .  Subjects were r and omly assigned to a 6-week Mindfulness-Based Stress Reduction ( MBSR ) program design ed to self-regulate arousal to stressful circumstances or symptoms ( n=41 ) or to usual care ( n=43 ) . Outcome measures compared at 6 weeks by r and om assignment included vali date d measures of psychological status ( depression , anxiety , perceived stress , fear of recurrence , optimism , social support ) and psychological and physical subscales of quality of life ( SF-36 ) . RESULTS Compared with usual care , subjects assigned to MBSR(BC ) had significantly lower ( two-sided p<0.05 ) adjusted mean levels of depression ( 6.3 vs 9.6 ) , anxiety ( 28.3 vs 33.0 ) , and fear of recurrence ( 9.3 vs 11.6 ) at 6 weeks , along with higher energy ( 53.5 vs 49.2 ) , physical functioning ( 50.1 vs 47.0 ) , and physical role functioning ( 49.1 vs 42.8 ) . In stratified analyses , subjects more compliant with MBSR tended to experience greater improvements in measures of energy and physical functioning . CONCLUSIONS Among BC survivors within 18 months of treatment completion , a 6-week MBSR(BC ) program result ed in significant improvements in psychological status and quality of life compared with usual care AIMS To evaluate the generic and condition-specific health-related quality of life ( HRQL ) of long-term survivors of extremity melanoma treated with isolated limb perfusion ( ILP ) .  METHODS Between 1978 and 2001 , 292 patients with melanoma of the limbs underwent ILP in our institution . Of these patients , 59 were alive and disease-free for at least six months prior to study entry . Fifty-one of these 59 patients completed a mailed question naire assessing generic HRQL ( SF-36 ) , condition-specific HRQL ( limb function , cosmetic results , fear of recurrence ) , and problems regarding work and insurance .  An age- and gender-matched , normative sample of the Dutch general population was available for comparison of SF-36 scores . RESULTS Mean age of patients was 57 years , 90 % female , with a median time since ILP of 14 years ( range 3 - 25 years ) . The SF-36 scores of the patient group were equal to or better than that of the general population , significantly for bodily pain , general health perceptions , and the physical and mental health component scores . Nevertheless , the patients reported a number of specific problems : complaints of limb function were reported by 49 - 55 % , cosmetic problems by 31 - 38 % and fear of local disease recurrence and distant metastases by 77 and 63 % of the patients , respectively . Less than 10 % of patients reported problems in obtaining a mortgage or life insurance . CONCLUSIONS The HRQL of long-term survivors of melanoma treated with ILP appears comparable to , and sometimes better than that of healthy peers within the general population . Nevertheless , this survivor group reports a number of specific problems that impact on daily life . Although these findings need to be confirmed with larger , prospect i ve studies , they suggest that rehabilitation should focus on improving limb functionality , and addressing chronic fear of disease recurrence OBJECTIVE Patient Reported Outcome ( PRO ) assessment s can assist health professionals to tailor their health practice s to the individual needs of patients and improve patient care over time . The present study assessed prospect i ve predictors of unmet supportive care needs in cancer patients over a six-month period . METHODS Participants were recruited from a regional cancer treatment centre in Australia and completed the Supportive Care Needs Survey ( SCNS )  at recruitment ( n=439 ; 61.4 % response rate ) and six months follow-up ( n=396 ) . Hierarchical logistic regression was used to identify predictors of change in unmet needs across each supportive care domain . Predictor variables were socio-demographic , treatment and psychosocial factors including depression , anxiety , social support , and patient satisfaction . RESULTS Unmet needs were reported by approximately two-thirds of patients at baseline and half of patients at six months follow-up . Having unmet needs at baseline was the strongest predictor of unmet needs at six months . Longer time since diagnosis was a consistent predictor of greater unmet needs , associated with change in physical/daily living , psychological and health system and information unmet needs over time . By contrast , a complex relationship was found in that patient satisfaction , psychosocial and treatment characteristics predicted higher needs in some domains and lower needs in others . CONCLUSIONS Unmet supportive care needs persist over time and psychological needs may emerge later in the illness continuum . Interventions to meet the needs of longer term cancer survivors are needed and should closely articulate with reported supportive care needs Anxiety and fear are often associated with chronic conditions such as cancer . This paper targets the cost-effectiveness analysis of a cognitive-behavioral group therapy ( CBT ) in comparison to a client-centered , supportive-experiential group therapy ( SET ) in cancer patients with dysfunctional fear of progression . An incremental cost-effectiveness analysis was performed using data from a r and omized controlled trial among cancer patients receiving inpatient rehabilitation . The means , 95 % confidence intervals [ 95 % CI ] , incremental cost-effectiveness graphic and acceptability curve were obtained from 1,000 bootstrap replications . A total of 174 patients were included in the economic evaluation . The estimated means [ 95 % CI ] of direct costs and reduction of fear of progression were € 9,045.03 [ 6,359.07 ; 12,091.87 ] and 1.41 [ 0.93 ; 1.92 ] for patients in the SET and € 6,682.78 [ 4,998.09 ; 8,440.95 ] and 1.44 [ 1.02 ; 1.09 ] for patients in the CBT . The incremental cost-effectiveness ratio [ 95 % CI ] amounts to minus € 78,741.66 [ −154,987.20 ; 110,486.32 ] for an additional unit of effect . Given the acceptability curve , there is a 92.4 % chance that the CBT , compared with the SET , is cost-effective without the need of additional costs to payers . Our main result is the superior cost-effectiveness of the cognitive-behavioral intervention program in comparison to the non-directive encounter group for our sample of cancer patients with high levels of anxiety Recurrence risk in orofacial cancer patients is relatively high in comparison to other cancers . Little information exists on whether patients are unduly concerned over the possibility of recurrence and the association of this concern with psychological morbidity . Aim of study was to assess fear of recurrence and psychological morbidity in orofacial cancer patients . Two sample s of patients with orofacial cancer were followed prospect ively . First sample ( n = 87 ) were consecutively drawn 3 months and 7 months following initial treatment . Second sample ( n = 100 ) were cross-sectionally drawn from out-patient list and followed 2 years later . A single question item was employed to assess fear of recurrence used in previous work . Hospital Anxiety and Depression Scale was adopted as the measure of psychological morbidity . A prospect i ve survey design was employed . Over 80 % of patients expressed concern over the possibility of recurrence at 3 months post treatment . This level reduced to 72 % at 7 months ( P=0.06 ) . Approximately two-thirds of patients sample d cross-sectionally were concerned at both assessment occasions . Psychological morbidity was greatest at 3 months post treatment ( possible cases : anxiety 37 % and depression 28 % ) . Women were more likely to report anxiety ( at possible case level ) than men 3 months following treatment ( P<0.05 ) . Patients aged 65 or more years were less concerned about recurrence . This effect was significant on both occasions that sample two patients were assessed ( P's<0.002 ) . Very few patients who expressed no concern about recurrence , at 3 months , were found to report anxiety or depression sufficient to be recognized as a possible case ( 3 and 0 % respectively ) . The positive association between psychological morbidity and fears of recurrence was significant at the majority of data collection points , with the exception that depression was more independent of these concerns OBJECTIVE To examine : ( 1 ) daily religious and spiritual experiences among localized prostate cancer patients as compared to a national age and race-matched male sample ; ( 2 ) cognitive-affective and clinical predictors of prostate cancer diagnosis-related increases in religiosity and spirituality ; ( 3 ) short-term impact of daily religious and spiritual experiences on cancer recurrence worry . METHODS Analyses of data from a longitudinal question naire study among patients ( N = 254 ) diagnosed with localized prostate cancer and data from a r and om sample ( N = 238 ) of respondents to the national General Social Survey . RESULTS Compared to the national sample , prostate cancer patients reported higher levels of daily spiritual experiences . Patients with higher worry about prostate cancer and elevated levels of prostate-related symptoms around diagnosis were more likely to report a diagnosis-related increase in religiosity and spirituality . Positive benefits ( reduced recurrence worry ) of religious coping/ practice s were restricted to those patients with higher versus lower level of postdiagnosis increase in religiosity ; patients not reporting postdiagnosis increases in religion who are not engaging in religious coping/ practice adjusted equally well . Results suggest that the development of religious/spiritual interventions is premature . SIGNIFICANCE OF RESULTS This is the first prospect i ve study to report on the prevalence and influence of  daily spiritual and religious experiences  among prostate cancer patients Mastectomy and breast-conserving treatment have proven equally effective in terms of survival in early breast cancer , but studies continue to provide evidence that patients undergoing breast-conserving procedures  have a better quality of life ( QOL ) . Age is not considered to be a contraindication for breast-conserving treatment , but retrospective studies have indicated that elderly patients are less likely to be treated conservatively . In the present study , survival , QOL and treatment preference have been investigated in a multicentre , r and omised clinical trial of elderly patients with early breast cancer undergoing mastectomy or tumour excision plus tamoxifen . Eligible patients were aged 70 years or more and had histologically- or cytologically-confirmed operable breast cancer . A QOL question naire consisting of 36 items was constructed covering 9 scales assessing different QOL domains . Patients completed their assessment between 2 and 12 months after r and omisation . 136 patients ( 65 in the mastectomy arm and 71 in the local excision arm ) from six centres filled out a QOL form during the first year of follow-up . No significant difference in the duration of survival between the two treatment arms was observed when including patients included in the QOL sub- study ( P=0.33 ) . Patients undergoing tumour excision and tamoxifen did not differ from those undergoing mastectomy in terms of fatigue , emotional functioning , fear of recurrence , social support , physical functioning and leisure time activities . However , conservatively treated patients reported fewer arm problems ( P=0.04 ) and a shift , although borderline significant , in the direction of a benefit in body image ( P=0.06 ) . As QOL seems to be better after conservative treatment , such treatment is to be preferred in both elderly and younger patients OBJECTIVES To compare the impact of radical nephrectomy and nephron-sparing surgery ( NSS ) for localized renal cell carcinoma on quality of life ( QOL ) . METHODS Retrospectively , 357 patients who had undergone NSS ( n = 158 ) or radical nephrectomy ( n = 199 ) for localized renal cell carcinoma completed postal question naires , including measures 
    Output:
    