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: Melanoma accounts for > 79 % of skin cancer‐related deaths , although it accounts for only 4 % of skin cancer incidence . Given the potential for lethality , it is likely that patients with melanoma may experience significant emotional distress . The current study was design ed to determine the effect of a cognitive‐behavioral intervention on distress and health‐related quality of life ( HRQOL ) in patients with melanoma who had medium‐to‐high distress Background Despite evidence that up to 35 % of patients with cancer experience significant distress , access to effective psychosocial care is limited by lack of systematic approaches to assessment , a paucity of psychosocial services , and patient reluctance to accept treatment either because of perceived stigma or difficulties with access to specialist psycho-oncology services due to isolation or disease burden . This paper presents an overview of a r and omised study to evaluate the effectiveness of a brief tailored psychosocial Intervention delivered by health professionals in cancer care who undergo focused training and participate in clinical supervision . Methods / design Health professionals from the disciplines of nursing , occupational therapy , speech pathology , dietetics , physiotherapy or radiation therapy will participate in training to deliver the psychosocial Intervention focusing on core concepts of supportive-expressive , cognitive and dignity-conserving care . Health professional training will consist of completion of a self-directed manual and participation in a skills development session . Participating health professionals will be supported through structured clinical supervision whilst delivering the Intervention . In the stepped wedge design each of the 5 participating clinical sites will be allocated in r and om order from Control condition to Training then delivery of the Intervention . A total of 600 patients will be recruited across all sites . Based on level of distress or risk factors eligible patients will receive up to 4 sessions , each of up to 30 minutes in length , delivered face-to-face or by telephone . Participants will be assessed at baseline and 10-week follow-up . Patient outcome measures include anxiety and depression , quality of life , unmet psychological and supportive care needs . Health professional measures include psychological morbidity , stress and burnout . Process evaluation will be conducted to assess perceptions of participation in the study and the factors that may promote translation of learning into practice . Discussion This study will provide important information about the effectiveness of a brief tailored psychological Intervention for patients with cancer and the potential to prevent development of significant distress in patients considered at risk . It will yield data about the feasibility of this model of care in routine clinical practice and identify enablers and barriers to its systematic implementation in cancer setting s . Trial registration Background This trial aims to evaluate the effectiveness of a group cognitive behavioural intervention to alleviate menopausal symptoms ( hot flushes and night sweats ) in women who have had breast cancer treatment .  Hot flushes and night sweats are highly prevalent but challenging to treat in this population . Cognitive behaviour therapy has been found to reduce these symptoms in well women and results of an exploratory trial suggest that it might be effective for breast cancer patients . Two hypotheses are tested : Compared to usual care , group cognitive behavioural therapy will:1 . Significantly reduce the problem rating and frequency of hot flushes and nights sweats after six weeks of treatment and at six months post-r and omisation.2 . Improve mood and quality of life after six weeks of treatment and at six months post-r and omisation . Methods / Design Ninety-six women who have completed their main treatment for breast cancer and who have been experiencing problematic hot flushes and night sweats for over two months are recruited into the trial from oncology and breast clinics in South East London . They are r and omised to either six weekly group cognitive behavioural therapy ( Group CBT ) sessions or to usual care . Group CBT includes information and discussion about hot flushes and night sweats in the context of breast cancer , monitoring and modifying precipitants , relaxation and paced respiration , stress management , cognitive therapy for unhelpful thoughts and beliefs , managing sleep and night sweats and maintaining changes . Prior to r and omisation women attend a clinical interview , undergo 24-hour sternal skin conductance monitoring , and complete question naire measures of hot flushes and night sweats , mood , quality of life , hot flush beliefs and behaviours , optimism and somatic amplification . Post-treatment measures ( sternal skin conductance and question naires ) are collected six to eight weeks later and follow-up measures ( question naires and a use of medical services measure ) at six months post-r and omisation . Discussion MENOS 1 is the first r and omised controlled trial of cognitive behavioural therapy for hot flushes and night sweats that measures both self-reported and physiologically indexed symptoms . The results will inform future clinical practice by developing an evidence -based , non-medical treatment , which can be delivered by trained health professionals . Trial Registration Current Controlled Trials IS RCT Until now , little research has been conducted examining the reactive dimension , or the degree to which a symptom limits an individual 's life , in a multiplicity of symptoms . This research examines how problem-solving therapy organizes an intervention to decrease symptom limitations . The purpose was threefold : to determine if a cognitive behavioral intervention decreases the impact of symptom limitations among individuals newly diagnosed with cancer , who are receiving chemotherapy ; to determine , after adjusting for covariates , how symptom limitations change over time ; and to describe which symptoms are most limiting . This r and omized control trial was conducted in two comprehensive and four community cancer centers . Two hundred thirty-seven individuals , aged 31 - 87 , newly diagnosed with solid tumor cancers , participated . The experimental group ( 118 individuals ) received a 10-contact , 18-week cognitive behavioral intervention focused on cancer- and chemotherapy-related symptoms . The control group ( 119 individuals ) received conventional care . Interviews occurred at baseline , 10 , 20 , and 32 weeks . Data analysis used a two-level hierarchical linear model . Participants receiving the cognitive behavioral intervention had lower scores of symptom limitation than did participants in the control group . At the onset of the study , younger patients reported more symptom limitations than their older counterparts ; however , this was reversed by the end of the study . The cognitive behavioral intervention was key to decreasing symptom limitations . Findings also suggest that nursing interventions may be particularly helpful to younger individuals in managing cancer-related symptom limitations PURPOSE The trend toward personalized medicine will involve cancer treatment increasingly being tailored to the genetic characteristics of individuals . However , the availability of genetic information does not imply this information is desired or would impact treatment decision making . METHODS One hundred sixty breast cancer survivors ( BC group ) and 205 healthy controls ( HC group ) were r and omly assigned to respond to two different clinical scenarios varying in genetic-related risk of cognitive impairment ( CI ; little v very likely ) and severity of CI ( little v moderate problem ) after chemotherapy . Ratings of the importance of being told this genetic information ( information importance ) and the likelihood this information would affect their decision to receive chemotherapy ( information impact ) were obtained . RESULTS Results indicated the importance ascribed to genetic information was greatest when CI likelihood and severity were both high or low ( P < .05 ) . Information impact ratings were not sensitive to differences in CI likelihood or severity ; the BC group was less likely to indicate genetic information would affect their decision to receive chemotherapy than the HC group ( P < .001 ) . CONCLUSION Results suggest lessened enthusiasm for genetic information that maintains or increases uncertainty about a specific course of action and highlight the importance of including clinical ly relevant groups in treatment decision-making research that employs hypothetical scenarios . Although women generally believe it is important to receive genetic information , they might benefit from assistance ( eg , decision aid ) in the difficult task of integrating information about survival and risk for adverse late effects from cancer treatment PURPOSE To describe a r and omized trial of a cognitive behavioral intervention on reducing symptom severity among patients diagnosed with solid tumors and undergoing a first course of chemotherapy and to determine whether the intervention had an additive or interactive effect on symptom severity in the presence of supportive care medications . PATIENTS AND METHODS Patients ( N = 237 ) were accrued from comprehensive and community cancer centers , interviewed , and r and omly assigned to either the experimental intervention ( n = 118 ) or conventional care ( n = 119 ) . A symptom severity index , based on summed severity scores across 15 symptoms , was the primary outcome . Each patient 's site of cancer , stage at diagnosis , chemotherapy protocol s , and use of supportive medications were learned from medical records . RESULTS Groups were equivalent at baseline , and attrition by characteristics by group was not different . The proportion of patients not receiving chemotherapy at 10 and 20 weeks did not differ by group . At the 10- and 20-week observations , there was a significant interaction between the experimental group and baseline symptom severity . Patients in the experimental group who entered the trial with higher symptom severity reported significantly lower severity at 10 and 20 weeks . Controlling for chemotherapy treatment status at follow-up and supportive care medications did not alter the effect of the experimental intervention . CONCLUSION Compared with conventional care alone , the experimental intervention was effective among patients who entered the trial with higher levels of symptom severity . Age , sex , site or stage of cancer , and supportive medications did not modify the effect of this cognitive behavioral intervention on symptom severity OBJECTIVE Complaints of cognitive dysfunction are frequent among cancer patients . Many studies have identified neuropsychological compromise associated with cancer and cancer therapy ; however , the neuropsychological compromise was not related to self-reported cognitive dysfunction . In this prospect i ve study , the authors examined if confounding factors masked an underlying association of self-perceived cognitive function with actual cognitive performance . Determinants of self-perceived cognitive dysfunction were investigated . METHODS Self-perceived cognitive function and cognitive performance were assessed before treatment , at the end of treatment , and 1 year after baseline in 101 breast cancer patients r and omized to st and ard versus intensified chemotherapy .  Linear mixed-effects models were applied to test the relationships of performance on neuropsychological tests , patient characteristics , and treatment variables to self-reported cognitive function . Change of cognitive performance was tested as a predictor of change in self-reports . RESULTS Self-perceived cognitive function deteriorated during chemotherapy and had partially recovered 1 year after diagnosis . The personality trait negative affectivity , current depression , and chemotherapy regimen were consistently related to cognitive self-reports . No significant associations with performance in any of the 12 cognitive tests emerged . Change of cognitive performance was not reflected in self-reports of cognitive function . CONCLUSIONS Neuropsychological compromise and self-perceived cognitive dysfunction are independent phenomena in cancer patients . Generally , cancer-associated neuropsychological compromise is not noticed by affected patients , but negative affectivity and treatment burden induce pessimistic self- appraisal s of cognitive functioning regardless of the presence of neuropsychological compromise . Clinicians should consider this when determining adequate therapy for patients who complain of ' chemobrain ' Our purpose was to evaluate the late physical and psychosocial difficulties of premenpausal patients treated for a localized breast cancer and to weigh the impact of chemotherapy on long-term quality of life . Two self-administered question naires , the EORTC core QLQ-C30 and the breast module ( BR23 ) were mailed to 179 premenopausal node-negative women continuously disease-free , previously enrolled in a trial testing the efficacy of adjuvant CMF chemotherapy ( Espié et al , 1997 ) . The core question naire evaluates the physical , role , emotional , cognitive and social functioning and global health status . The breast module includes four functional scales : body image , sexual functioning , sexual enjoyment and future perspective . It also includes symptom scales such as arm or breast symptoms . Some specific professional and social states were added . 119 ( 68 % ) patients ( mean age 54 years , range 30–69 ) participated . Mean follow-up time since diagnosis was 9.6 years ( 4–16 ) . 68 % had conservative and 32 % radical surgery ( with reconstructive surgery in 50 % ) . CMF was given to 77 ( 65 % ) patients . Irradiation was administered in 75 % of patients irrespective of adjuvant therapy . QLQ-C30 scale scores were similar in patients who had or had not received chemotherapy .  Disturbance in body image , sex life and breast symptoms did not differ between patients who had or had not received adjuvant CMF . No major socioprofessional difficulties were reported except problems in borrowing from banks not related to past chemotherapy . With long follow-up , most premenopausal women treated for a localized breast cancer cope with the disease and its treatments . Adjuvant CMF chemotherapy does not appear to impair quality of life nor social and professional life in these patients . © 2000 Cancer Research PURPOSE To examine the impact of age and cognitive reserve on cognitive functioning in patients with breast cancer who are receiving adjuvant treatments .  PATIENTS AND METHODS Patients with breast cancer exposed to chemotherapy ( n = 60 ; mean age , 51.7 years ) were evaluated with a battery of neuropsychological and psychological tests before treatment and at 1 , 6 , and 18 months after treatment . Patients not exposed to chemotherapy ( n = 72 ; mean age , 56.6 years ) and healthy controls ( n = 45 ; mean age , 52.9 years ) were assessed at matched intervals . RESULTS Mixed-effects modeling revealed significant effects for the Processing Speed and Verbal Ability domains . For Processing Speed , a three-way interaction among treatment group , age , and baseline cognitive reserve ( P < .001 ) revealed that older patients with lower baseline cognitive reserve who were exposed to chemotherapy had lower performance on Processing Speed compared with patients not exposed to chemotherapy ( P = .003 ) and controls ( P < .001 ) . A significant group by time interaction for Verbal Ability ( P = 
    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: Melanoma accounts for > 79 % of skin cancer‐related deaths , although it accounts for only 4 % of skin cancer incidence . Given the potential for lethality , it is likely that patients with melanoma may experience significant emotional distress . The current study was design ed to determine the effect of a cognitive‐behavioral intervention on distress and health‐related quality of life ( HRQOL ) in patients with melanoma who had medium‐to‐high distress Background Despite evidence that up to 35 % of patients with cancer experience significant distress , access to effective psychosocial care is limited by lack of systematic approaches to assessment , a paucity of psychosocial services , and patient reluctance to accept treatment either because of perceived stigma or difficulties with access to specialist psycho-oncology services due to isolation or disease burden . This paper presents an overview of a r and omised study to evaluate the effectiveness of a brief tailored psychosocial Intervention delivered by health professionals in cancer care who undergo focused training and participate in clinical supervision . Methods / design Health professionals from the disciplines of nursing , occupational therapy , speech pathology , dietetics , physiotherapy or radiation therapy will participate in training to deliver the psychosocial Intervention focusing on core concepts of supportive-expressive , cognitive and dignity-conserving care . Health professional training will consist of completion of a self-directed manual and participation in a skills development session . Participating health professionals will be supported through structured clinical supervision whilst delivering the Intervention . In the stepped wedge design each of the 5 participating clinical sites will be allocated in r and om order from Control condition to Training then delivery of the Intervention . A total of 600 patients will be recruited across all sites . Based on level of distress or risk factors eligible patients will receive up to 4 sessions , each of up to 30 minutes in length , delivered face-to-face or by telephone . Participants will be assessed at baseline and 10-week follow-up . Patient outcome measures include anxiety and depression , quality of life , unmet psychological and supportive care needs . Health professional measures include psychological morbidity , stress and burnout . Process evaluation will be conducted to assess perceptions of participation in the study and the factors that may promote translation of learning into practice . Discussion This study will provide important information about the effectiveness of a brief tailored psychological Intervention for patients with cancer and the potential to prevent development of significant distress in patients considered at risk . It will yield data about the feasibility of this model of care in routine clinical practice and identify enablers and barriers to its systematic implementation in cancer setting s . Trial registration Background This trial aims to evaluate the effectiveness of a group cognitive behavioural intervention to alleviate menopausal symptoms ( hot flushes and night sweats ) in women who have had breast cancer treatment .  Hot flushes and night sweats are highly prevalent but challenging to treat in this population . Cognitive behaviour therapy has been found to reduce these symptoms in well women and results of an exploratory trial suggest that it might be effective for breast cancer patients . Two hypotheses are tested : Compared to usual care , group cognitive behavioural therapy will:1 . Significantly reduce the problem rating and frequency of hot flushes and nights sweats after six weeks of treatment and at six months post-r and omisation.2 . Improve mood and quality of life after six weeks of treatment and at six months post-r and omisation . Methods / Design Ninety-six women who have completed their main treatment for breast cancer and who have been experiencing problematic hot flushes and night sweats for over two months are recruited into the trial from oncology and breast clinics in South East London . They are r and omised to either six weekly group cognitive behavioural therapy ( Group CBT ) sessions or to usual care . Group CBT includes information and discussion about hot flushes and night sweats in the context of breast cancer , monitoring and modifying precipitants , relaxation and paced respiration , stress management , cognitive therapy for unhelpful thoughts and beliefs , managing sleep and night sweats and maintaining changes . Prior to r and omisation women attend a clinical interview , undergo 24-hour sternal skin conductance monitoring , and complete question naire measures of hot flushes and night sweats , mood , quality of life , hot flush beliefs and behaviours , optimism and somatic amplification . Post-treatment measures ( sternal skin conductance and question naires ) are collected six to eight weeks later and follow-up measures ( question naires and a use of medical services measure ) at six months post-r and omisation . Discussion MENOS 1 is the first r and omised controlled trial of cognitive behavioural therapy for hot flushes and night sweats that measures both self-reported and physiologically indexed symptoms . The results will inform future clinical practice by developing an evidence -based , non-medical treatment , which can be delivered by trained health professionals . Trial Registration Current Controlled Trials IS RCT Until now , little research has been conducted examining the reactive dimension , or the degree to which a symptom limits an individual 's life , in a multiplicity of symptoms . This research examines how problem-solving therapy organizes an intervention to decrease symptom limitations . The purpose was threefold : to determine if a cognitive behavioral intervention decreases the impact of symptom limitations among individuals newly diagnosed with cancer , who are receiving chemotherapy ; to determine , after adjusting for covariates , how symptom limitations change over time ; and to describe which symptoms are most limiting . This r and omized control trial was conducted in two comprehensive and four community cancer centers . Two hundred thirty-seven individuals , aged 31 - 87 , newly diagnosed with solid tumor cancers , participated . The experimental group ( 118 individuals ) received a 10-contact , 18-week cognitive behavioral intervention focused on cancer- and chemotherapy-related symptoms . The control group ( 119 individuals ) received conventional care . Interviews occurred at baseline , 10 , 20 , and 32 weeks . Data analysis used a two-level hierarchical linear model . Participants receiving the cognitive behavioral intervention had lower scores of symptom limitation than did participants in the control group . At the onset of the study , younger patients reported more symptom limitations than their older counterparts ; however , this was reversed by the end of the study . The cognitive behavioral intervention was key to decreasing symptom limitations . Findings also suggest that nursing interventions may be particularly helpful to younger individuals in managing cancer-related symptom limitations PURPOSE The trend toward personalized medicine will involve cancer treatment increasingly being tailored to the genetic characteristics of individuals . However , the availability of genetic information does not imply this information is desired or would impact treatment decision making . METHODS One hundred sixty breast cancer survivors ( BC group ) and 205 healthy controls ( HC group ) were r and omly assigned to respond to two different clinical scenarios varying in genetic-related risk of cognitive impairment ( CI ; little v very likely ) and severity of CI ( little v moderate problem ) after chemotherapy . Ratings of the importance of being told this genetic information ( information importance ) and the likelihood this information would affect their decision to receive chemotherapy ( information impact ) were obtained . RESULTS Results indicated the importance ascribed to genetic information was greatest when CI likelihood and severity were both high or low ( P < .05 ) . Information impact ratings were not sensitive to differences in CI likelihood or severity ; the BC group was less likely to indicate genetic information would affect their decision to receive chemotherapy than the HC group ( P < .001 ) . CONCLUSION Results suggest lessened enthusiasm for genetic information that maintains or increases uncertainty about a specific course of action and highlight the importance of including clinical ly relevant groups in treatment decision-making research that employs hypothetical scenarios . Although women generally believe it is important to receive genetic information , they might benefit from assistance ( eg , decision aid ) in the difficult task of integrating information about survival and risk for adverse late effects from cancer treatment PURPOSE To describe a r and omized trial of a cognitive behavioral intervention on reducing symptom severity among patients diagnosed with solid tumors and undergoing a first course of chemotherapy and to determine whether the intervention had an additive or interactive effect on symptom severity in the presence of supportive care medications . PATIENTS AND METHODS Patients ( N = 237 ) were accrued from comprehensive and community cancer centers , interviewed , and r and omly assigned to either the experimental intervention ( n = 118 ) or conventional care ( n = 119 ) . A symptom severity index , based on summed severity scores across 15 symptoms , was the primary outcome . Each patient 's site of cancer , stage at diagnosis , chemotherapy protocol s , and use of supportive medications were learned from medical records . RESULTS Groups were equivalent at baseline , and attrition by characteristics by group was not different . The proportion of patients not receiving chemotherapy at 10 and 20 weeks did not differ by group . At the 10- and 20-week observations , there was a significant interaction between the experimental group and baseline symptom severity . Patients in the experimental group who entered the trial with higher symptom severity reported significantly lower severity at 10 and 20 weeks . Controlling for chemotherapy treatment status at follow-up and supportive care medications did not alter the effect of the experimental intervention . CONCLUSION Compared with conventional care alone , the experimental intervention was effective among patients who entered the trial with higher levels of symptom severity . Age , sex , site or stage of cancer , and supportive medications did not modify the effect of this cognitive behavioral intervention on symptom severity OBJECTIVE Complaints of cognitive dysfunction are frequent among cancer patients . Many studies have identified neuropsychological compromise associated with cancer and cancer therapy ; however , the neuropsychological compromise was not related to self-reported cognitive dysfunction . In this prospect i ve study , the authors examined if confounding factors masked an underlying association of self-perceived cognitive function with actual cognitive performance . Determinants of self-perceived cognitive dysfunction were investigated . METHODS Self-perceived cognitive function and cognitive performance were assessed before treatment , at the end of treatment , and 1 year after baseline in 101 breast cancer patients r and omized to st and ard versus intensified chemotherapy .  Linear mixed-effects models were applied to test the relationships of performance on neuropsychological tests , patient characteristics , and treatment variables to self-reported cognitive function . Change of cognitive performance was tested as a predictor of change in self-reports . RESULTS Self-perceived cognitive function deteriorated during chemotherapy and had partially recovered 1 year after diagnosis . The personality trait negative affectivity , current depression , and chemotherapy regimen were consistently related to cognitive self-reports . No significant associations with performance in any of the 12 cognitive tests emerged . Change of cognitive performance was not reflected in self-reports of cognitive function . CONCLUSIONS Neuropsychological compromise and self-perceived cognitive dysfunction are independent phenomena in cancer patients . Generally , cancer-associated neuropsychological compromise is not noticed by affected patients , but negative affectivity and treatment burden induce pessimistic self- appraisal s of cognitive functioning regardless of the presence of neuropsychological compromise . Clinicians should consider this when determining adequate therapy for patients who complain of ' chemobrain ' Our purpose was to evaluate the late physical and psychosocial difficulties of premenpausal patients treated for a localized breast cancer and to weigh the impact of chemotherapy on long-term quality of life . Two self-administered question naires , the EORTC core QLQ-C30 and the breast module ( BR23 ) were mailed to 179 premenopausal node-negative women continuously disease-free , previously enrolled in a trial testing the efficacy of adjuvant CMF chemotherapy ( Espié et al , 1997 ) . The core question naire evaluates the physical , role , emotional , cognitive and social functioning and global health status . The breast module includes four functional scales : body image , sexual functioning , sexual enjoyment and future perspective . It also includes symptom scales such as arm or breast symptoms . Some specific professional and social states were added . 119 ( 68 % ) patients ( mean age 54 years , range 30–69 ) participated . Mean follow-up time since diagnosis was 9.6 years ( 4–16 ) . 68 % had conservative and 32 % radical surgery ( with reconstructive surgery in 50 % ) . CMF was given to 77 ( 65 % ) patients . Irradiation was administered in 75 % of patients irrespective of adjuvant therapy . QLQ-C30 scale scores were similar in patients who had or had not received chemotherapy .  Disturbance in body image , sex life and breast symptoms did not differ between patients who had or had not received adjuvant CMF . No major socioprofessional difficulties were reported except problems in borrowing from banks not related to past chemotherapy . With long follow-up , most premenopausal women treated for a localized breast cancer cope with the disease and its treatments . Adjuvant CMF chemotherapy does not appear to impair quality of life nor social and professional life in these patients . © 2000 Cancer Research PURPOSE To examine the impact of age and cognitive reserve on cognitive functioning in patients with breast cancer who are receiving adjuvant treatments .  PATIENTS AND METHODS Patients with breast cancer exposed to chemotherapy ( n = 60 ; mean age , 51.7 years ) were evaluated with a battery of neuropsychological and psychological tests before treatment and at 1 , 6 , and 18 months after treatment . Patients not exposed to chemotherapy ( n = 72 ; mean age , 56.6 years ) and healthy controls ( n = 45 ; mean age , 52.9 years ) were assessed at matched intervals . RESULTS Mixed-effects modeling revealed significant effects for the Processing Speed and Verbal Ability domains . For Processing Speed , a three-way interaction among treatment group , age , and baseline cognitive reserve ( P < .001 ) revealed that older patients with lower baseline cognitive reserve who were exposed to chemotherapy had lower performance on Processing Speed compared with patients not exposed to chemotherapy ( P = .003 ) and controls ( P < .001 ) . A significant group by time interaction for Verbal Ability ( P = 
    Output:
    