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: 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 In a prospect i ve , r and omized study , an individual psychosocial support intervention performed by specially trained oncology nurses , or psychologists , were compared with st and ard care .  Consecutive primary breast cancer patients about to start adjuvant therapy ( n = 179 ) were included . Data were supplied by the question naires European Organisation for Research and Treatment of Cancer Quality of Life Study Group Core Quality of life question naire with 30 questions ( EORTC QLQ-C30 ) and Breast Cancer Module with 23 questions ( BR23 ) , the Hospital Anxiety and Depression Scale , Spielberger 's State-Trait Anxiety Inventory , and the Impact of Event Scale before r and omization and 1 , 3 , and 6 months later . Patient files provided data on utilization of psychosocial support offered in routine care . Global quality of life/health status , nausea and vomiting , and systemic therapy side effects were the subscales showing significant Group by Time interactions , favoring the interventions . Intervention groups improved statistically significantly more than the st and ard care group regarding insomnia , dyspnea , and financial difficulties . Nurse patients experienced less intrusion compared with the st and ard care group . All groups showed statistically and clinical ly significant improvements with time on several subscales . The intervention groups , however , improved to a greater extent . Fewer patients in the intervention groups used psychosocial hospital support compared with the st and ard care group . In conclusion , psychosocial support by specially trained nurses using techniques derived from cognitive behavioral therapy is beneficial for breast cancer patients and may be a realistic alternative in routine cancer care 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 OBJECTIVE Oral cancer elicits considerable distress in both the pre and post-treatment periods . This paper details the development , validation and pilot-testing of a psychoeducational intervention for oral cancer patients . METHOD An educational booklet covering information about oral cancer and its treatment and effective coping strategies was developed by a multi-disciplinary team . It was evaluated by patient focus groups and content/educational experts , delivered to subjects in pre and post-operative presentations by a health educator , and pilot-tested in a r and omized controlled trial versus st and ard care . RESULTS Pilot data from 19 subjects ( 10 psychoeducation , nine st and ard care )  indicates that the intervention is feasible and highly acceptable . At follow-up the intervention group showed a gain in knowledge , less body image disturbance , lower anxiety and a trend toward higher wellbeing . CONCLUSION This program , which is currently being evaluated in a larger RCT with extended follow-up , should prove useful in reducing the psychosocial burden of oral cancer and its treatment PURPOSE This r and omized clinical trial tests the hypothesis that a psychological intervention can reduce emotional distress , improve health behaviors and dose-intensity , and enhance immune responses . PATIENTS AND METHODS We studied 227 women who were surgically treated for regional breast cancer . Before adjuvant therapy , women completed interviews and question naires assessing emotional distress , social adjustment , and health behaviors . A 60-mL blood sample was drawn for immune assays . Patients were r and omly assigned to either the intervention group or assessment only group . The intervention was conducted in small patient groups , with one session per week for 4 months . The sessions included strategies to reduce stress , improve mood , alter health behaviors , and maintain adherence to cancer treatment and care . Re assessment occurred after completion of the intervention . RESULTS As predicted , patients receiving the intervention showed significant lowering of anxiety , improvements in perceived social support , improved dietary habits , and reduction in smoking ( all P < .05 ) . Analyses of adjuvant chemotherapy dose-intensity revealed significantly more variability ( ie , more dispersion in the dose-intensity values ) for the assessment arm ( P < .05 ) . Immune responses for the intervention patients paralleled their psychological and behavioral improvements . T-cell proliferation in response to phytohemagglutinin and concanavalin A remained stable or increased for the Intervention patients , whereas both responses declined for Assessment patients ; this effect was replicated across three concentrations for each assay ( all P < .01 ) . CONCLUSION These data show a convergence of significant psychological , health behavior , and biologic effects after a psychological intervention for cancer patients PURPOSE / OBJECTIVES To examine the effects of concrete objective information ( COI ) and relaxation instruction ( RI ) on patients undergoing radiation therapy  , as well as the contribution of symptom uncertainty and body awareness to the intervention effects . DESIGN Three-group r and omized trial . Assignment was stratified by cancer site . Data collectors were blinded to group assignments . SETTING University medical center radiation therapy department serving both urban and rural communities in the southeastern United States . SAMPLE 76 adults having radiation with curative intent for gynecologic , head and neck , or lung cancer . Most were Caucasian and had in situ to stage II disease . Mean age was 55 years . METHODS COI and RI were delivered by tape recordings . Outcome measures were indicators of usual activities and emotions at treatment week 3 and two and four weeks post-treatment . MAIN RESEARCH VARIABLES Intervention group ; social , household , and recreational activities ; anxiety , depression , and anger ; body awareness ; and symptom uncertainty . FINDINGS Participants receiving either intervention reported more social activity during treatment . Those given RI who were high in body awareness reported more household activity during treatment . No effects were found regarding emotion . Symptom uncertainty partially explained COI effects . CONCLUSIONS The findings provide additional support for the effectiveness of COI in helping patients to maintain more of their usual activities during radiation therapy . Instruction in progressive muscle relaxation also may help in maintaining activities . IMPLICATION S FOR NURSING COI helps patients to cope with treatment by reducing their uncertainty about symptoms . RI effects may vary by activity type and awareness of usual body sensations PURPOSE / OBJECTIVES To pilot a second support group intervention study promoting self-transcendence perspectives and activities and to document changes over time in well-being in support group participants compared with non participants . DESIGN Quasiexperimental , partial r and omization , preference trial design . SETTING An urban breast cancer re source center established by survivors . SAMPLE 41 women with newly diagnosed breast cancer were recruited , and 39 completed the study . 22 women participated in three intervention support groups ; 17 were in a comparison group . METHODS The intervention was an eight-week , closed support group based on self-transcendence theory . Data were collected three times during 14 months . MAIN RESEARCH VARIABLES Support group intervention , self-transcendence , and emotional and physical well-being . FINDINGS The intervention group had lower scores than the comparison group on self-transcendence and well-being variables at baseline ( time [ T ] 1 ) . Scores were higher for both groups postintervention ( T2 ) , with no differences between groups . One year postintervention ( T3 ) , intervention group scores again were lower than comparison group scores . Intervention group T3 scores were unchanged from T2 . CONCLUSIONS Most potential participants were unwilling to risk being r and omized into a nonpreferred group . Activities based on self-transcendence theory were associated with exp and ed perspectives and activities and an improved sense of well-being in support group participants at the end of the intervention , but not one year later . Findings from the pilot studies informed a study currently in progress . IMPLICATION S FOR NURSING Nurses should maintain awareness of local re sources for support and make that information available to women when they are newly diagnosed with breast cancer , during their treatment , and later 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 Objective : Nucare , a short-term psychoeducational coping skills training intervention was evaluated in a r and omized controlled clinical trial ( RCT ) of 225 newly diagnosed breast and colon cancer patients . Method : Measures of psychosocial distress , well being and optimism were evaluated every four months during a one-year period . Patients were r and omized to one of four arms : Nucare presented in an individual basis ; Nucare presented in a group format ; a non-directive supportive group ; and a no-intervention control . The interventions were provided in five sessions of ninety minutes each . Results : Patients with breast cancer who received Nucare  presented in an individual format showed more significant improvements in well-being over time compared to those in the control and group arms . Conclusions : We were unable to develop functioning groups within the RCT . Partial explanations for the latter finding include the structural limitations of the RCT : the groups were small , difficult to schedule and patients indicated that they would have preferred to choose whether or not to participate in a group . The positive changes in women with breast cancer who received Nucare persisted at 12 months PURPOSE Professionally administered psychosocial interventions have been shown to improve the quality of life of cancer patients undergoing chemotherapy . The present study sought to improve access to psychosocial interventions during chemotherapy treatment by evaluating the efficacy and costs of a patient self-administered form of stress management training that requires limited professional time or experience to deliver . PATIENTS AND METHODS Four hundred eleven patients about to start chemotherapy were r and omly assigned to receive usual psychosocial care only , a professionally administered form of stress management training , or a patient self-administered form of stress management training .  Quality -of-life assessment s were conducted before r and omization and before the second , third , and fourth treatment cycles . Intervention costs were estimated from both payer and societal perspectives . RESULTS Compared with patients who received usual care only , patients receiving the self-administered intervention reported significantly ( P < or = .05 ) better physical functioning , greater vitality , fewer role limitations because of emotional problems , and better mental health . In contrast , patients who received the professionally administered intervention fared no better in terms of quality of life than patients receiving usual care only . Costs of the self-administered intervention were estimated to be 66 % ( from a payer perspective ) to 68 % ( from a societal perspective ) less than the average costs of professionally administered psychosocial interventions for patients starting chemotherapy . CONCLUSION Evidence regarding the efficacy and favorable costs of self-administered stress management training suggests that this intervention has the potential to greatly improve patient access to psychosocial intervention during chemotherapy treatment Abstract This study aim ed to investigate the psychophysiological outcomes of different psychosocial interventions for breast cancer patients . Participants were r and omly assigned into 3 intervention groups , namely , Body-Mind-Spirit ( BMS ) , Supportive-Expressive ( SE ) , and Social Support Self-Help ( SS ) groups ; a no-intervention group was used as control .  Salivary cortisol was used as the physiological stress marker . Distress level , mental adjustment , emotional control , and social support were measured . Data were collected at baseline , 4 month , and 8 month . Preliminary results indicated that BMS intervention produced the greatest and the most sustained effects . It enhanced positive social support , reduced psychological distress , emotional control , and negative mental adjustment . Total salivary cortisol was lowered after 8 months . Most participants 
    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: 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 In a prospect i ve , r and omized study , an individual psychosocial support intervention performed by specially trained oncology nurses , or psychologists , were compared with st and ard care .  Consecutive primary breast cancer patients about to start adjuvant therapy ( n = 179 ) were included . Data were supplied by the question naires European Organisation for Research and Treatment of Cancer Quality of Life Study Group Core Quality of life question naire with 30 questions ( EORTC QLQ-C30 ) and Breast Cancer Module with 23 questions ( BR23 ) , the Hospital Anxiety and Depression Scale , Spielberger 's State-Trait Anxiety Inventory , and the Impact of Event Scale before r and omization and 1 , 3 , and 6 months later . Patient files provided data on utilization of psychosocial support offered in routine care . Global quality of life/health status , nausea and vomiting , and systemic therapy side effects were the subscales showing significant Group by Time interactions , favoring the interventions . Intervention groups improved statistically significantly more than the st and ard care group regarding insomnia , dyspnea , and financial difficulties . Nurse patients experienced less intrusion compared with the st and ard care group . All groups showed statistically and clinical ly significant improvements with time on several subscales . The intervention groups , however , improved to a greater extent . Fewer patients in the intervention groups used psychosocial hospital support compared with the st and ard care group . In conclusion , psychosocial support by specially trained nurses using techniques derived from cognitive behavioral therapy is beneficial for breast cancer patients and may be a realistic alternative in routine cancer care 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 OBJECTIVE Oral cancer elicits considerable distress in both the pre and post-treatment periods . This paper details the development , validation and pilot-testing of a psychoeducational intervention for oral cancer patients . METHOD An educational booklet covering information about oral cancer and its treatment and effective coping strategies was developed by a multi-disciplinary team . It was evaluated by patient focus groups and content/educational experts , delivered to subjects in pre and post-operative presentations by a health educator , and pilot-tested in a r and omized controlled trial versus st and ard care . RESULTS Pilot data from 19 subjects ( 10 psychoeducation , nine st and ard care )  indicates that the intervention is feasible and highly acceptable . At follow-up the intervention group showed a gain in knowledge , less body image disturbance , lower anxiety and a trend toward higher wellbeing . CONCLUSION This program , which is currently being evaluated in a larger RCT with extended follow-up , should prove useful in reducing the psychosocial burden of oral cancer and its treatment PURPOSE This r and omized clinical trial tests the hypothesis that a psychological intervention can reduce emotional distress , improve health behaviors and dose-intensity , and enhance immune responses . PATIENTS AND METHODS We studied 227 women who were surgically treated for regional breast cancer . Before adjuvant therapy , women completed interviews and question naires assessing emotional distress , social adjustment , and health behaviors . A 60-mL blood sample was drawn for immune assays . Patients were r and omly assigned to either the intervention group or assessment only group . The intervention was conducted in small patient groups , with one session per week for 4 months . The sessions included strategies to reduce stress , improve mood , alter health behaviors , and maintain adherence to cancer treatment and care . Re assessment occurred after completion of the intervention . RESULTS As predicted , patients receiving the intervention showed significant lowering of anxiety , improvements in perceived social support , improved dietary habits , and reduction in smoking ( all P < .05 ) . Analyses of adjuvant chemotherapy dose-intensity revealed significantly more variability ( ie , more dispersion in the dose-intensity values ) for the assessment arm ( P < .05 ) . Immune responses for the intervention patients paralleled their psychological and behavioral improvements . T-cell proliferation in response to phytohemagglutinin and concanavalin A remained stable or increased for the Intervention patients , whereas both responses declined for Assessment patients ; this effect was replicated across three concentrations for each assay ( all P < .01 ) . CONCLUSION These data show a convergence of significant psychological , health behavior , and biologic effects after a psychological intervention for cancer patients PURPOSE / OBJECTIVES To examine the effects of concrete objective information ( COI ) and relaxation instruction ( RI ) on patients undergoing radiation therapy  , as well as the contribution of symptom uncertainty and body awareness to the intervention effects . DESIGN Three-group r and omized trial . Assignment was stratified by cancer site . Data collectors were blinded to group assignments . SETTING University medical center radiation therapy department serving both urban and rural communities in the southeastern United States . SAMPLE 76 adults having radiation with curative intent for gynecologic , head and neck , or lung cancer . Most were Caucasian and had in situ to stage II disease . Mean age was 55 years . METHODS COI and RI were delivered by tape recordings . Outcome measures were indicators of usual activities and emotions at treatment week 3 and two and four weeks post-treatment . MAIN RESEARCH VARIABLES Intervention group ; social , household , and recreational activities ; anxiety , depression , and anger ; body awareness ; and symptom uncertainty . FINDINGS Participants receiving either intervention reported more social activity during treatment . Those given RI who were high in body awareness reported more household activity during treatment . No effects were found regarding emotion . Symptom uncertainty partially explained COI effects . CONCLUSIONS The findings provide additional support for the effectiveness of COI in helping patients to maintain more of their usual activities during radiation therapy . Instruction in progressive muscle relaxation also may help in maintaining activities . IMPLICATION S FOR NURSING COI helps patients to cope with treatment by reducing their uncertainty about symptoms . RI effects may vary by activity type and awareness of usual body sensations PURPOSE / OBJECTIVES To pilot a second support group intervention study promoting self-transcendence perspectives and activities and to document changes over time in well-being in support group participants compared with non participants . DESIGN Quasiexperimental , partial r and omization , preference trial design . SETTING An urban breast cancer re source center established by survivors . SAMPLE 41 women with newly diagnosed breast cancer were recruited , and 39 completed the study . 22 women participated in three intervention support groups ; 17 were in a comparison group . METHODS The intervention was an eight-week , closed support group based on self-transcendence theory . Data were collected three times during 14 months . MAIN RESEARCH VARIABLES Support group intervention , self-transcendence , and emotional and physical well-being . FINDINGS The intervention group had lower scores than the comparison group on self-transcendence and well-being variables at baseline ( time [ T ] 1 ) . Scores were higher for both groups postintervention ( T2 ) , with no differences between groups . One year postintervention ( T3 ) , intervention group scores again were lower than comparison group scores . Intervention group T3 scores were unchanged from T2 . CONCLUSIONS Most potential participants were unwilling to risk being r and omized into a nonpreferred group . Activities based on self-transcendence theory were associated with exp and ed perspectives and activities and an improved sense of well-being in support group participants at the end of the intervention , but not one year later . Findings from the pilot studies informed a study currently in progress . IMPLICATION S FOR NURSING Nurses should maintain awareness of local re sources for support and make that information available to women when they are newly diagnosed with breast cancer , during their treatment , and later 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 Objective : Nucare , a short-term psychoeducational coping skills training intervention was evaluated in a r and omized controlled clinical trial ( RCT ) of 225 newly diagnosed breast and colon cancer patients . Method : Measures of psychosocial distress , well being and optimism were evaluated every four months during a one-year period . Patients were r and omized to one of four arms : Nucare presented in an individual basis ; Nucare presented in a group format ; a non-directive supportive group ; and a no-intervention control . The interventions were provided in five sessions of ninety minutes each . Results : Patients with breast cancer who received Nucare  presented in an individual format showed more significant improvements in well-being over time compared to those in the control and group arms . Conclusions : We were unable to develop functioning groups within the RCT . Partial explanations for the latter finding include the structural limitations of the RCT : the groups were small , difficult to schedule and patients indicated that they would have preferred to choose whether or not to participate in a group . The positive changes in women with breast cancer who received Nucare persisted at 12 months PURPOSE Professionally administered psychosocial interventions have been shown to improve the quality of life of cancer patients undergoing chemotherapy . The present study sought to improve access to psychosocial interventions during chemotherapy treatment by evaluating the efficacy and costs of a patient self-administered form of stress management training that requires limited professional time or experience to deliver . PATIENTS AND METHODS Four hundred eleven patients about to start chemotherapy were r and omly assigned to receive usual psychosocial care only , a professionally administered form of stress management training , or a patient self-administered form of stress management training .  Quality -of-life assessment s were conducted before r and omization and before the second , third , and fourth treatment cycles . Intervention costs were estimated from both payer and societal perspectives . RESULTS Compared with patients who received usual care only , patients receiving the self-administered intervention reported significantly ( P < or = .05 ) better physical functioning , greater vitality , fewer role limitations because of emotional problems , and better mental health . In contrast , patients who received the professionally administered intervention fared no better in terms of quality of life than patients receiving usual care only . Costs of the self-administered intervention were estimated to be 66 % ( from a payer perspective ) to 68 % ( from a societal perspective ) less than the average costs of professionally administered psychosocial interventions for patients starting chemotherapy . CONCLUSION Evidence regarding the efficacy and favorable costs of self-administered stress management training suggests that this intervention has the potential to greatly improve patient access to psychosocial intervention during chemotherapy treatment Abstract This study aim ed to investigate the psychophysiological outcomes of different psychosocial interventions for breast cancer patients . Participants were r and omly assigned into 3 intervention groups , namely , Body-Mind-Spirit ( BMS ) , Supportive-Expressive ( SE ) , and Social Support Self-Help ( SS ) groups ; a no-intervention group was used as control .  Salivary cortisol was used as the physiological stress marker . Distress level , mental adjustment , emotional control , and social support were measured . Data were collected at baseline , 4 month , and 8 month . Preliminary results indicated that BMS intervention produced the greatest and the most sustained effects . It enhanced positive social support , reduced psychological distress , emotional control , and negative mental adjustment . Total salivary cortisol was lowered after 8 months . Most participants 
    Output:
    