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: Abstract . Breast cancer patients ' utilisation of supportive care has been understudied . In this paper , results from a population -based survey are used to assess the role of physicians and nurses in providing supportive care to women . Participants for this study were women with histologically confirmed invasive breast cancer diagnosed 23–36 months prior to contact about the study , who were r and omly selected from the Ontario Cancer Registry . Patients for whom a physician approved contact were sent a survey question naire . There were two follow-up mailings . The survey included items related to patients ' perceptions of supportive care involvement of oncologists , surgeons , family physicians and nurses .  Among 1,119 eligible patients , 65 % returned completed question naires . A total of 72 % of these women reported having talked with an oncologist about one or more supportive care issues ; 78 % with a surgeon ; 73 % with a family physician ; and 45 % with a nurse . Factors linked to seeking supportive care from physicians and /or nurses included : younger age , working status , higher education , additional health insurance beyond that provided by government , higher household income , and receiving chemotherapy . Results indicate that physicians and nurses were providing important supportive care to most women with breast cancer . In a health care context where specialised supportive care services ( e.g. help from dietitians , psychologists , social workers ) are often unavailable or difficult to access , supportive care remains largely a responsibility of medical and nursing professionals . Even brief interventions may make an important difference to how patients deal with their illness over time A Roy adaptation model-based support and education intervention for women with early-stage breast cancer was tested in a three-group , three-phase r and omized clinical trial of a sample of 125 women . The experimental group received 13 months of combined individual telephone and in-person group support and education , Control Group 1 received 13 months of telephone-only individual support and education , and Control Group 2 received one-time mailed educational information . The experimental group and Control Group 1 reported less mood disturbance at the end of all three phases , less loneliness at the end of Phases II and III , and a higher- quality relationship with a significant other at the end of Phase II than did Control Group 2 . No group differences were found for cancer-related worry or well-being . The findings suggest that individual telephone support may provide an effective alternative to in-person support groups . Further study of telephone interventions is recommended using ethnically and economically heterogeneous sample One hundred and fifty‐two women undergoing mastectomy were r and omly assigned to routine care or routine care plus monitoring by a specialist nurse . The nurse detected and referred 76 % of her patients for psychiatric help . Only 15 % of the routine care subjects that warranted help were referred . Twelve to eighteen months after surgery , morbid anxiety and depression were less common in the monitored ( 5 % and 5 % ) than in the control ( 30 % and 50 % ) group . This difference appeared to be due primarily to psychiatric treatment which included antidepressant medication , anxiolytic drugs , and supportive psychotherapy . Few affective disorders remitted without such treatment . In a further study , the effects of  antidepressant medication plus cognitive therapy and cognitive therapy  alone were compared . Both treatments alleviated depression in the short term but the improvement was sustained in the long term only in those given combined treatment A controlled trial was conducted to determine if a specialist nurse improved the physical and social recovery of patients after mastectomy and helped them adapt to the breast loss . Seventy five patients were counselled by the nurse who also monitored their progress after discharge while 77 patients received the care normally given by the surgical unit . Twelve to eighteen months after surgery those helped by the nurse showed a greater social recovery , return to work , adaptation to breast loss and satisfaction with their breast prostheses . Eleven percent remained distressed by the mastectomy but most responded well to breast reconstruction . The nurse had little impact on physical disability . The morbidity found in the control group highlights the need to find ways of reducing it . While the appointment of a specialist nurse can achieve this the morbidity would probably also be much reduced if the breast was conserved when possible , reliable staging methods other than axillary clearance were developed and the adverse effects of cytotoxic drugs and radiotherapy were reduced PURPOSE S/ OBJECTIVES To test the hypothesis that women participating in a walking exercise program during radiation therapy treatment for breast cancer would demonstrate more adaptive responses as evidence d by higher levels of physical functioning and lower levels of symptom intensity than women who did not participate . DESIGN Experimental , two-group pretest , post-test . SETTING Two university teaching hospital outpatient radiation therapy departments . SAMPLE 46 women beginning a six-week program of radiation therapy for early stage breast cancer . METHODS Following r and om assignment , subjects in the exercise group maintained an individualized , self-paced , home-based walking exercise program throughout treatment . The control group received usual care . Dependent variables were measured prior to and at the end of radiation therapy . In addition , symptoms were assessed at the end of three weeks of treatment . MAIN RESEARCH VARIABLES Participation in the walking exercise program , physical functioning fatigue , emotional distress , and difficulty sleeping . FINDINGS Hypothesis testing by multivariate analysis of covariance , with pretest scores as covariates , indicated significant differences between groups on outcome measures ( p < 0.001 ) . The exercise group scored significantly higher than the usual care group on physical functioning ( p = 0.003 ) and symptom intensity , particularly fatigue , anxiety , and difficulty sleeping . Fatigue was the most frequent and intense subjective symptom reported . CONCLUSIONS A self-paced , home-based walking exercise program can help manage symptoms and improve physical functioning during radiation therapy . IMPLICATION S FOR NURSING PRACTICE Nurse-prescribed and -monitored exercise is an effective , convenient , and low-cost self-care activity that reduces symptoms and facilitates adaptation to breast cancer diagnosis and treatment National guidance and clinical guidelines recommended multidisciplinary teams ( MDTs ) for cancer services in order to bring specialists in relevant disciplines together , ensure clinical decisions are fully informed , and to coordinate care effectively . However , the effectiveness of cancer teams was not previously evaluated systematic ally . A r and om sample of 72 breast cancer teams in Engl and was studied ( 548 members in six core disciplines ) , stratified by region and caseload . Information about team constitution , processes , effectiveness , clinical performance , and members ' mental well-being was gathered using appropriate instruments . Two input variables , team workload ( P=0.009 ) and the proportion of breast care nurses ( P=0.003 ) , positively predicted overall clinical performance in multivariate analysis using a two-stage regression model . There were significant correlations between individual team inputs , team composition variables , and clinical performance . Some disciplines consistently perceived their team 's effectiveness differently from the mean . Teams with shared leadership of their clinical decision-making were most effective . The mental well-being of team members appeared significantly better than in previous studies of cancer clinicians , the NHS , and the general population . This study established that team composition , working methods , and workloads are related to measures of effectiveness , including the quality of clinical care The purpose of this r and omized study was to investigate whether a nursing intervention using Orem 's self-care theory as a framework would affect subjective distress , side effects and quality of life as perceived by breast cancer patients receiving curative radiation therapy .  The intervention consisted of five 30-min sessions once a week during the treatment period and two follow-up sessions after completion of treatment . The experimental group consisted of 67 patients , as did the control group .  Measurements were collected five times : at baseline before commencement of treatment , at weeks 3 and 5 ( completion of treatment ) and follow-up periods of 2 weeks and 3 months . No measurable effect of the nursing intervention was found for side effects or quality of life but nursing intervention proved to have a positive effect in minimizing stress reactions ( p = < 0.05 ) . It is suggested that a nursing intervention should be implemented for breast cancer patients receiving curative radiation therapy Previous research indicates that younger women ( i.e. , ≤ 50 ) with breast carcinoma experience greater emotional distress than older women ( i.e. , > 50 ) and that coping style is significantly related to the psychosocial adjustment of women with this disease . The purpose of this study was to evaluate through a r and omized controlled trial the effectiveness of a problem‐solving training intervention design ed to empower women with breast carcinoma to cope with a range of difficulties when diagnosed in mid‐life The value of routine follow-up with frequent visits to a breast cancer specialist-both in terms of detection of recurrence and patient satisfaction-has been question ed . The aim of this study was to compare nurse-led follow-up on dem and versus physician follow-up after breast cancer treatment with regards to patients ' well-being , satisfaction , access to medical care and medical safety .  Two hundred and sixty-four consecutively selected women with newly diagnosed breast cancer , classified as UICC stage I or stage II , were r and omised to follow-up at two hospitals in Sweden , either by routine medical follow-up , the physician group ( PG , n=131 ) , or on dem and by a specialist nurse , the nurse group ( NG , n=133 ) . Measures were done at baseline and twice a year over a period of 5 years by means of a question naire containing the Hospital Anxiety and Depression Scale ( HAD ) , and the Satisfaction and Accessibility ( SaaC ) scale . Number of contacts with the health care services , number of diagnostic procedures , and time to recurrence or death were monitored . The ratings of HAD and SaaC did not show any statistically significant differences between the groups . The levels of anxiety and depression were generally low and levels of patient satisfaction high . There were no differences between the groups concerning time to recurrence or death . This study indicates that women with breast cancer in stages I to II can be followed up by a specialist nurse with high patient satisfaction and good medical safety BACKGROUND We report a clinical trial comparing the effectiveness of education-based and peer discussion -based group interventions on adjustment to breast cancer . METHODS Women with stage I , II , or III breast cancer ( n = 312 ) were r and omly assigned to 1 of 4 group conditions : control , education , peer discussion , or education plus peer discussion ( combination ) . Seven groups ( each comprising 8 - 12 women ) were conducted in each of the 4 conditions ( 28 groups total ) . Adjustment was measured before the intervention , immediately after the intervention , and 6 months after the intervention . RESULTS Consistently positive effects on adjustment were seen in the education groups both immediately following and 6 months after the intervention . There were no benefits of participation in peer discussion groups , and some indications of adverse effects on adjustment at both follow-up examinations . The effects could be explained by changes in self-esteem , body image , and intrusive thoughts about the illness . CONCLUSIONS Education-based group interventions facilitated the initial adjustment of women diagnosed with early stage breast cancer . There was no evidence of benefits from peer discussion group interventions PURPOSE / OBJECTIVES To measure the effectiveness of customized guided imagery for increasing comfort in women with early stage breast cancer . DESIGN Experimental longitudinal , r and om assignment to groups . SETTING Two urban radiation oncology departments . SAMPLE 53 women ( 26 in the experimental group , 27 in the control group ) aged 37 - 81 ; 80 % European and 10 % African American with stage I or II breast cancer about to begin radiation therapy . METHODS The experimental group was to listen to a guided imagery audiotape once a day for the duration of the study . The  Radiation Therapy Comfort Question naire was self-administered at three time points : prior to the introduction of intervention and the beginning of radiation therapy ( Time 1 ) , three weeks later ( Time 2 ) , and three weeks after completing radiation therapy ( Time 3 ) . The  State Anxiety Inventory  was administered at Time 1 only . MAIN RESEARCH VARIABLES The effect of use of guided imagery on comfort with anxiety as a control variable . FINDINGS Pooled data indicated a significant overall increase in differences in comfort between the treatment and control group , with the treatment group having higher comfort over time . The data also revealed a significant linear trend in differences between groups . No significant interaction of group and time existed . CONCLUSIONS Guided imagery is an effective intervention for enhancing comfort of women undergoing radiation therapy for early stage breast cancer . The intervention was especially salient in the first three weeks of therapy . IMPLICATION S FOR NURSING PRACTICE Guided imagery audiotapes specifically design ed for this population were re source effective in terms of cost , personnel , and time Increasing numbers of women with breast cancer are seeking alternatives to st and ard group support in coping with their illness . This study examines outcomes for 181 women with breast cancer r and omized to either a 12-week st and ard group support or a 12-week complementary and alternative medicine ( CAM ) support intervention .  Participants in the CAM group were taught the use of meditation , affirmation , imagery and ritual . The st and ard group combined cognitive-behavioral approaches with group sharing and support . Both interventions were found to be associated with improved quality of life ( CAM , P=0.008 ; St and ard , P=0.006 ) , decreased depression ( CAM , P=0.004 ; St and ard , P=0.02 ) , decreased anxiety ( CAM , P=0.0003 ; St and ard , P=0.02 ) and increased " spiritual well-being " ( CAM , P=002 ; St and ard , P=0.003 ) . Only the CAM group showed increases in measures of Spiritual Integration ( P=0.001 ) which were also significant between groups ( P=0.003 ) . The St and ard group was associated with decreased confusion ( P=0.01 ) and decreased helplessness/hopelessness ( P=0.01 ) , while the CAM group was associated with decreased avoidance ( P=0. 
    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: Abstract . Breast cancer patients ' utilisation of supportive care has been understudied . In this paper , results from a population -based survey are used to assess the role of physicians and nurses in providing supportive care to women . Participants for this study were women with histologically confirmed invasive breast cancer diagnosed 23–36 months prior to contact about the study , who were r and omly selected from the Ontario Cancer Registry . Patients for whom a physician approved contact were sent a survey question naire . There were two follow-up mailings . The survey included items related to patients ' perceptions of supportive care involvement of oncologists , surgeons , family physicians and nurses .  Among 1,119 eligible patients , 65 % returned completed question naires . A total of 72 % of these women reported having talked with an oncologist about one or more supportive care issues ; 78 % with a surgeon ; 73 % with a family physician ; and 45 % with a nurse . Factors linked to seeking supportive care from physicians and /or nurses included : younger age , working status , higher education , additional health insurance beyond that provided by government , higher household income , and receiving chemotherapy . Results indicate that physicians and nurses were providing important supportive care to most women with breast cancer . In a health care context where specialised supportive care services ( e.g. help from dietitians , psychologists , social workers ) are often unavailable or difficult to access , supportive care remains largely a responsibility of medical and nursing professionals . Even brief interventions may make an important difference to how patients deal with their illness over time A Roy adaptation model-based support and education intervention for women with early-stage breast cancer was tested in a three-group , three-phase r and omized clinical trial of a sample of 125 women . The experimental group received 13 months of combined individual telephone and in-person group support and education , Control Group 1 received 13 months of telephone-only individual support and education , and Control Group 2 received one-time mailed educational information . The experimental group and Control Group 1 reported less mood disturbance at the end of all three phases , less loneliness at the end of Phases II and III , and a higher- quality relationship with a significant other at the end of Phase II than did Control Group 2 . No group differences were found for cancer-related worry or well-being . The findings suggest that individual telephone support may provide an effective alternative to in-person support groups . Further study of telephone interventions is recommended using ethnically and economically heterogeneous sample One hundred and fifty‐two women undergoing mastectomy were r and omly assigned to routine care or routine care plus monitoring by a specialist nurse . The nurse detected and referred 76 % of her patients for psychiatric help . Only 15 % of the routine care subjects that warranted help were referred . Twelve to eighteen months after surgery , morbid anxiety and depression were less common in the monitored ( 5 % and 5 % ) than in the control ( 30 % and 50 % ) group . This difference appeared to be due primarily to psychiatric treatment which included antidepressant medication , anxiolytic drugs , and supportive psychotherapy . Few affective disorders remitted without such treatment . In a further study , the effects of  antidepressant medication plus cognitive therapy and cognitive therapy  alone were compared . Both treatments alleviated depression in the short term but the improvement was sustained in the long term only in those given combined treatment A controlled trial was conducted to determine if a specialist nurse improved the physical and social recovery of patients after mastectomy and helped them adapt to the breast loss . Seventy five patients were counselled by the nurse who also monitored their progress after discharge while 77 patients received the care normally given by the surgical unit . Twelve to eighteen months after surgery those helped by the nurse showed a greater social recovery , return to work , adaptation to breast loss and satisfaction with their breast prostheses . Eleven percent remained distressed by the mastectomy but most responded well to breast reconstruction . The nurse had little impact on physical disability . The morbidity found in the control group highlights the need to find ways of reducing it . While the appointment of a specialist nurse can achieve this the morbidity would probably also be much reduced if the breast was conserved when possible , reliable staging methods other than axillary clearance were developed and the adverse effects of cytotoxic drugs and radiotherapy were reduced PURPOSE S/ OBJECTIVES To test the hypothesis that women participating in a walking exercise program during radiation therapy treatment for breast cancer would demonstrate more adaptive responses as evidence d by higher levels of physical functioning and lower levels of symptom intensity than women who did not participate . DESIGN Experimental , two-group pretest , post-test . SETTING Two university teaching hospital outpatient radiation therapy departments . SAMPLE 46 women beginning a six-week program of radiation therapy for early stage breast cancer . METHODS Following r and om assignment , subjects in the exercise group maintained an individualized , self-paced , home-based walking exercise program throughout treatment . The control group received usual care . Dependent variables were measured prior to and at the end of radiation therapy . In addition , symptoms were assessed at the end of three weeks of treatment . MAIN RESEARCH VARIABLES Participation in the walking exercise program , physical functioning fatigue , emotional distress , and difficulty sleeping . FINDINGS Hypothesis testing by multivariate analysis of covariance , with pretest scores as covariates , indicated significant differences between groups on outcome measures ( p < 0.001 ) . The exercise group scored significantly higher than the usual care group on physical functioning ( p = 0.003 ) and symptom intensity , particularly fatigue , anxiety , and difficulty sleeping . Fatigue was the most frequent and intense subjective symptom reported . CONCLUSIONS A self-paced , home-based walking exercise program can help manage symptoms and improve physical functioning during radiation therapy . IMPLICATION S FOR NURSING PRACTICE Nurse-prescribed and -monitored exercise is an effective , convenient , and low-cost self-care activity that reduces symptoms and facilitates adaptation to breast cancer diagnosis and treatment National guidance and clinical guidelines recommended multidisciplinary teams ( MDTs ) for cancer services in order to bring specialists in relevant disciplines together , ensure clinical decisions are fully informed , and to coordinate care effectively . However , the effectiveness of cancer teams was not previously evaluated systematic ally . A r and om sample of 72 breast cancer teams in Engl and was studied ( 548 members in six core disciplines ) , stratified by region and caseload . Information about team constitution , processes , effectiveness , clinical performance , and members ' mental well-being was gathered using appropriate instruments . Two input variables , team workload ( P=0.009 ) and the proportion of breast care nurses ( P=0.003 ) , positively predicted overall clinical performance in multivariate analysis using a two-stage regression model . There were significant correlations between individual team inputs , team composition variables , and clinical performance . Some disciplines consistently perceived their team 's effectiveness differently from the mean . Teams with shared leadership of their clinical decision-making were most effective . The mental well-being of team members appeared significantly better than in previous studies of cancer clinicians , the NHS , and the general population . This study established that team composition , working methods , and workloads are related to measures of effectiveness , including the quality of clinical care The purpose of this r and omized study was to investigate whether a nursing intervention using Orem 's self-care theory as a framework would affect subjective distress , side effects and quality of life as perceived by breast cancer patients receiving curative radiation therapy .  The intervention consisted of five 30-min sessions once a week during the treatment period and two follow-up sessions after completion of treatment . The experimental group consisted of 67 patients , as did the control group .  Measurements were collected five times : at baseline before commencement of treatment , at weeks 3 and 5 ( completion of treatment ) and follow-up periods of 2 weeks and 3 months . No measurable effect of the nursing intervention was found for side effects or quality of life but nursing intervention proved to have a positive effect in minimizing stress reactions ( p = < 0.05 ) . It is suggested that a nursing intervention should be implemented for breast cancer patients receiving curative radiation therapy Previous research indicates that younger women ( i.e. , ≤ 50 ) with breast carcinoma experience greater emotional distress than older women ( i.e. , > 50 ) and that coping style is significantly related to the psychosocial adjustment of women with this disease . The purpose of this study was to evaluate through a r and omized controlled trial the effectiveness of a problem‐solving training intervention design ed to empower women with breast carcinoma to cope with a range of difficulties when diagnosed in mid‐life The value of routine follow-up with frequent visits to a breast cancer specialist-both in terms of detection of recurrence and patient satisfaction-has been question ed . The aim of this study was to compare nurse-led follow-up on dem and versus physician follow-up after breast cancer treatment with regards to patients ' well-being , satisfaction , access to medical care and medical safety .  Two hundred and sixty-four consecutively selected women with newly diagnosed breast cancer , classified as UICC stage I or stage II , were r and omised to follow-up at two hospitals in Sweden , either by routine medical follow-up , the physician group ( PG , n=131 ) , or on dem and by a specialist nurse , the nurse group ( NG , n=133 ) . Measures were done at baseline and twice a year over a period of 5 years by means of a question naire containing the Hospital Anxiety and Depression Scale ( HAD ) , and the Satisfaction and Accessibility ( SaaC ) scale . Number of contacts with the health care services , number of diagnostic procedures , and time to recurrence or death were monitored . The ratings of HAD and SaaC did not show any statistically significant differences between the groups . The levels of anxiety and depression were generally low and levels of patient satisfaction high . There were no differences between the groups concerning time to recurrence or death . This study indicates that women with breast cancer in stages I to II can be followed up by a specialist nurse with high patient satisfaction and good medical safety BACKGROUND We report a clinical trial comparing the effectiveness of education-based and peer discussion -based group interventions on adjustment to breast cancer . METHODS Women with stage I , II , or III breast cancer ( n = 312 ) were r and omly assigned to 1 of 4 group conditions : control , education , peer discussion , or education plus peer discussion ( combination ) . Seven groups ( each comprising 8 - 12 women ) were conducted in each of the 4 conditions ( 28 groups total ) . Adjustment was measured before the intervention , immediately after the intervention , and 6 months after the intervention . RESULTS Consistently positive effects on adjustment were seen in the education groups both immediately following and 6 months after the intervention . There were no benefits of participation in peer discussion groups , and some indications of adverse effects on adjustment at both follow-up examinations . The effects could be explained by changes in self-esteem , body image , and intrusive thoughts about the illness . CONCLUSIONS Education-based group interventions facilitated the initial adjustment of women diagnosed with early stage breast cancer . There was no evidence of benefits from peer discussion group interventions PURPOSE / OBJECTIVES To measure the effectiveness of customized guided imagery for increasing comfort in women with early stage breast cancer . DESIGN Experimental longitudinal , r and om assignment to groups . SETTING Two urban radiation oncology departments . SAMPLE 53 women ( 26 in the experimental group , 27 in the control group ) aged 37 - 81 ; 80 % European and 10 % African American with stage I or II breast cancer about to begin radiation therapy . METHODS The experimental group was to listen to a guided imagery audiotape once a day for the duration of the study . The  Radiation Therapy Comfort Question naire was self-administered at three time points : prior to the introduction of intervention and the beginning of radiation therapy ( Time 1 ) , three weeks later ( Time 2 ) , and three weeks after completing radiation therapy ( Time 3 ) . The  State Anxiety Inventory  was administered at Time 1 only . MAIN RESEARCH VARIABLES The effect of use of guided imagery on comfort with anxiety as a control variable . FINDINGS Pooled data indicated a significant overall increase in differences in comfort between the treatment and control group , with the treatment group having higher comfort over time . The data also revealed a significant linear trend in differences between groups . No significant interaction of group and time existed . CONCLUSIONS Guided imagery is an effective intervention for enhancing comfort of women undergoing radiation therapy for early stage breast cancer . The intervention was especially salient in the first three weeks of therapy . IMPLICATION S FOR NURSING PRACTICE Guided imagery audiotapes specifically design ed for this population were re source effective in terms of cost , personnel , and time Increasing numbers of women with breast cancer are seeking alternatives to st and ard group support in coping with their illness . This study examines outcomes for 181 women with breast cancer r and omized to either a 12-week st and ard group support or a 12-week complementary and alternative medicine ( CAM ) support intervention .  Participants in the CAM group were taught the use of meditation , affirmation , imagery and ritual . The st and ard group combined cognitive-behavioral approaches with group sharing and support . Both interventions were found to be associated with improved quality of life ( CAM , P=0.008 ; St and ard , P=0.006 ) , decreased depression ( CAM , P=0.004 ; St and ard , P=0.02 ) , decreased anxiety ( CAM , P=0.0003 ; St and ard , P=0.02 ) and increased " spiritual well-being " ( CAM , P=002 ; St and ard , P=0.003 ) . Only the CAM group showed increases in measures of Spiritual Integration ( P=0.001 ) which were also significant between groups ( P=0.003 ) . The St and ard group was associated with decreased confusion ( P=0.01 ) and decreased helplessness/hopelessness ( P=0.01 ) , while the CAM group was associated with decreased avoidance ( P=0. 
    Output:
    