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 The purpose of this r and omized trial was to evaluate the efficacy of the Mindfulness-Based Stress Reduction for Breast Cancer ( MBSR[BC ] ) program in improving psychological and physical symptoms and quality of life among breast cancer survivors ( BCSs ) who completed treatment . Outcomes were assessed immediately after 6 weeks of MBSR(BC ) training and 6 weeks later to test efficacy over an extended timeframe . PATIENTS AND METHODS A total of 322 BCSs were r and omly assigned to either a 6-week  MBSR(BC ) program ( n = 155 ) or a usual care group ( n = 167 ) . Psychological ( depression , anxiety , stress , and fear of recurrence ) and physical symptoms ( fatigue and pain ) and quality of life ( as related to health ) were assessed at baseline and at 6 and 12 weeks . Linear mixed models were used to assess MBSR(BC ) effects over time , and participant characteristics at baseline were also tested as moderators of MBSR(BC ) effects . RESULTS Results demonstrated extended improvement for the MBSR(BC ) group compared with usual care in both psychological symptoms of anxiety , fear of recurrence overall , and fear of recurrence problems and physical symptoms of fatigue severity and fatigue interference ( P < .01 ) . Overall effect sizes were largest for fear of recurrence problems ( d = 0.35 ) and fatigue severity ( d = 0.27 ) . Moderation effects showed BCSs with the highest levels of stress at baseline experienced the greatest benefit from MBSR(BC ) . CONCLUSION The MBSR(BC ) program significantly improved a broad range of symptoms among BCSs up to 6 weeks after MBSR(BC ) training , with generally small to moderate overall effect sizes Purpose Cancer-related fatigue ( CRF ) is a frequent and distressing symptom experienced after cancer treatment . RESTORE is the first web-based re source design ed to enhance self-efficacy to manage CRF following curative-intent treatment . The aim of this study is to test the proof of concept and inform the design of an effectiveness trial . Methods A multi-centre parallel-group two-armed ( 1:1 ) exploratory r and omised controlled trial ( RCT ) with qualitative process evaluation was employed in the study . Participants ( ≥18 years ; ≤5 years post treatment with moderate to severe fatigue ) were recruited and r and omly assigned to RESTORE or a leaflet . Feasibility and acceptability were measured by recruitment , attrition , intervention adherence , completion of outcome measures and process evaluation . Change in self-efficacy to manage CRF was also explored . Outcome measures were completed at baseline ( T0 ) , 6 weeks ( T1 ) and 12 weeks ( T2 ) . Data were analysed using mixed-effects linear regression and directed content analysis . Results One hundred and sixty-three people participated in the trial and 19 in the process evaluation . The intervention was feasible ( 39 % of eligible patients consented ) and acceptable ( attrition rate 36 % ) . There was evidence of higher fatigue self-efficacy at T1 in the intervention group vs comparator ( mean difference 0.51 [ −0.08 to 1.11 ] ) , though the difference in groups decreased by 12 weeks . Time since diagnosis influenced perceived usefulness of the intervention . Modifications were suggested . Conclusion Proof of concept was achieved . The RESTORE intervention should be subject to a definitive trial with some adjustments . Provision of an effective supportive re source would empower cancer survivors to manage CRF after treatment completion . Trial registration IS RCT Background Fatigue is a common symptom in cancer patients that can persist beyond the curative treatment phase . Some evidence has been reported for interventions for fatigue during active treatment . However , to date , there is no systematic review on psychological interventions for fatigue after the completion of curative treatment for cancer . This is a protocol for a systematic review that aims to evaluate the effectiveness of psychological interventions for cancer-related fatigue in post-treatment cancer survivors . This systematic review protocol was registered with the International Prospect i ve Register of Systematic Review s ( PROSPERO ) data base . Methods / design We will search the Cochrane Central Register of Controlled Trials ( CENTRAL ; The Cochrane Library ) , PubMed , MEDLINE , EMBASE , CINAHL , PsycINFO , and relevant sources of grey literature . R and omised controlled trials ( RCTs ) which have evaluated psychological interventions in adult cancer patients after the completion of treatment , with fatigue as an outcome measure , will be included . Two review authors will independently extract data from the selected studies and assess the method ological quality using the Cochrane Collaboration Risk of Bias Tool . Discussion Most existing evidence on cancer-related fatigue is from those in active cancer treatment . This systematic review and meta- analysis will build upon previous evaluations of psychological interventions in people during and after cancer treatment . With the growing need for stage-specific research in cancer , this review seeks to highlight a gap in current practice and to strengthen the evidence base of r and omised controlled trials in the area . Systematic review registration PROSPERO CRD42014015219 Background We aim ed to evaluate the potential benefits of the Leadership and Coaching for Health ( LEACH ) program on physical activity ( PA ) , dietary habits , and distress management in cancer survivors . Methods We r and omly assigned 248 cancer survivors with an allocation ratio of two-to-one to the LEACH program ( LP ) group , coached by long-term survivors , or the usual care ( UC ) group .  At baseline , 3 , 6 , and 12 months , we used PA scores , the intake of vegetables and fruits ( VF ) , and the Post Traumatic Growth Inventory ( PTGI ) as primary outcomes and , for secondary outcomes , the Ten Rules for Highly Effective Health Behavior adhered to and quality of life ( QOL ) , the Hospital Anxiety and Depression Scale ( HADS ) , and the European Organization for Research and Treatment of Cancer Quality of Life Question naire ( EORTC QLQ-C30 ) . Results For primary outcomes , the two groups did not significantly differ in PA scores or VF intake but differed marginally in PTGI . For secondary outcomes , the LP group showed a significantly greater improvement in the HADS anxiety score , the social functioning score , and the appetite loss and financial difficulties scores of the EORTC QLQ-C30 scales from baseline to 3 months . From baseline to 12 months , the LP group showed a significantly greater decrease in the EORTC QLQ-C30 fatigue score and a significantly greater increase in the number of the Ten Rules for Highly Effective Health Behavior . Conclusion Our findings indicate that the LEACH program , coached by long-term survivors , can provide effective management of the QOL of cancer survivors but not of their PA or dietary habits . Trial registration Clinical trial information can be found for the following : NCT01527409 ( the date when the trial was registered : February 2012 ) Background Approximately one third of all patients who have been successfully treated for cancer suffer from chronic cancer-related fatigue ( CCRF ) . Effective and easily accessible interventions are needed for these patients . Objective The current paper reports on the results of a 3-armed r and omized controlled trial investigating the clinical effectiveness of two different guided Web-based interventions for reducing CCRF compared to an active control condition . Methods Severely fatigued cancer survivors were recruited via online and offline channels , and self-registered on an open-access website . After eligibility checks , 167 participants were r and omized via an embedded automated r and omization function into : ( 1 ) physiotherapist-guided Ambulant Activity Feedback ( AAF ) therapy encompassing the use of an accelerometer ( n=62 ) ; ( 2 ) psychologist-guided Web-based mindfulness-based cognitive therapy ( eMBCT ; n=55 ) ; or ( 3 ) an unguided active control condition receiving psycho-educational emails ( n=50 ) . All interventions lasted nine weeks . Fatigue severity was self-assessed using the Checklist Individual Strength - Fatigue Severity subscale ( primary outcome ) six times from baseline ( T0b ) to six months ( T2 ) . Mental health was self-assessed three times using the Hospital Anxiety and Depression Scale and Positive and Negative Affect Schedule ( secondary outcome ) . Treatment dropout was investigated . Results Multiple group latent growth curve analysis , corrected for individual time between assessment s , showed that fatigue severity decreased significantly more in the AAF and eMBCT groups compared to the psycho-educational group . The analyses were checked by a research er who was blind to allocation . Clinical ly relevant changes in fatigue severity were observed in 66 % ( 41/62 ) of patients in AAF , 49 % ( 27/55 ) of patients in eMBCT , and 12 % ( 6/50 ) of patients in psycho-education . Dropout was 18 % ( 11/62 ) in AAF , mainly due to technical problems and poor usability of the accelerometer , and 38 % ( 21/55 ) in eMBCT , mainly due to the perceived high intensity of the program . Conclusions Both the AAF and eMBCT interventions are effective for managing fatigue severity compared to receiving psycho-educational emails . Trial Registration Trialregister.nl NTR3483 ; http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=3483 ( Archived by WebCite at http://www.webcitation.org/6NWZqon3o Purpose The web-based computer-tailored Kanker Nazorg Wijzer ( Cancer Aftercare Guide ) supports cancer survivors with psychosocial issues during cancer recovery . The current study investigates whether the 6-month effects in increasing emotional and social functioning and reducing depression and fatigue hold at 12 months from baseline . Moreover , it explores whether patient characteristics moderate the 6- and 12-month intervention effectiveness . Methods Cancer survivors from 21 Dutch hospitals ( November 2013–June 2014 ) were r and omized to an intervention ( n = 231 ) or a wait-list control group ( n = 231 ) . Intervention effects on emotional and social functioning ( EORTC QLQ-C30 ) , depression ( HADS ) , and fatigue ( CIS ) were evaluated through multilevel linear regression analyses . Results At 12 months from baseline , the intervention group no longer differed from the control group in emotional and social functioning , depression , and fatigue . Moderator analyses indicated that , at 6 months , the intervention was effective in improving social functioning for men ( d = 0.34 ) , reducing fatigue for participants ≤56 years ( d = 0.44 ) , and reducing depression for participants who received chemotherapy ( d = 0.36 ) . At 12 months , participants with a medium educational level reported higher social functioning ( d = 0.19 ) , while participants with a low educational level reported lower social functioning ( d = 0.22 ) than participants with a similar educational level in the control group . Conclusions The intervention gave cancer patients a head start to psychological recovery after the end of cancer treatment . The control group caught up in the long run . Implication s for cancer survivorsThe Cancer Aftercare Guide expedited recovery after cancer treatment . Being a low intensity , easy accessible , and relatively low cost intervention , it could serve as a relevant step in recovery and stepped care CONTEXT Cancer-related fatigue is prevalent and disabling . When persistent and unexplained , it is termed post-cancer fatigue ( PCF ) . Cognitive behavioral therapy ( CBT ) and grade d exercise therapy ( GET ) may improve symptoms and functional outcomes . OBJECTIVES To evaluate the outcomes of a r and omized controlled trial , which assigned patients with post-cancer fatigue to education , or 12 weeks of integrated cognitive-behavioral therapy ( CBT ) and grade d exercise therapy ( GET ) . METHODS Three months after treatment for breast or colon cancer , eligible patients had clinical ly significant fatigue , no comorbid medical or psychiatric conditions that explained the fatigue , and no evidence of recurrence . The CBT/GET arm included individually tailored consultations at approximately two weekly intervals . The education arm included a single visit with clinicians describing the principles of CBT/GET and a booklet . The primary outcome was clinical ly significant improvement in self-reported fatigue ( Somatic and Psychological HEalth REport 0 - 12 ) , design ated a priori as greater than one SD of improvement in fatigue score . The secondary outcome was associated improvement in function ( role limitation due to physical health problems-36-Item Short Form Health Survey 0 - 100 ) comparing baseline , end treatment ( 12 weeks ) , and follow-up ( 24 weeks ) . RESULTS There were 46 patients enrolled , including 43 women ( 94 % ) , with a mean age of 51 years .  Fatigue severity improved in all subjects from a mean of 5.2 ( ±3.1 ) at baseline to 3.9 ( ±2.8 ) at 12 weeks , suggesting a natural history of improvement . Clinical ly significant improvement was observed in 7 of 22 subjects in the intervention group compared with 2 of 24 in the education group ( P < 0.05 , χ2 ) . These subjects also had improvement in functional status compared with nonresponders ( P < 0.01 , t-test ) . CONCLUSION Combined CBT/GET improves fatigue and functional outcomes for a subset of patients with post-cancer fatigue . Further studies to improve the response rate and the magnitude of the benefit are warranted To investigate prevalence and severity of symptoms and symptom clustering in breast cancer survivors who attended MBSR(BC ) .  Women were r and omly assigned into MBSR(BC ) or Usual Care ( UC ) . Eligible women were ≥ 21 years , 
    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 The purpose of this r and omized trial was to evaluate the efficacy of the Mindfulness-Based Stress Reduction for Breast Cancer ( MBSR[BC ] ) program in improving psychological and physical symptoms and quality of life among breast cancer survivors ( BCSs ) who completed treatment . Outcomes were assessed immediately after 6 weeks of MBSR(BC ) training and 6 weeks later to test efficacy over an extended timeframe . PATIENTS AND METHODS A total of 322 BCSs were r and omly assigned to either a 6-week  MBSR(BC ) program ( n = 155 ) or a usual care group ( n = 167 ) . Psychological ( depression , anxiety , stress , and fear of recurrence ) and physical symptoms ( fatigue and pain ) and quality of life ( as related to health ) were assessed at baseline and at 6 and 12 weeks . Linear mixed models were used to assess MBSR(BC ) effects over time , and participant characteristics at baseline were also tested as moderators of MBSR(BC ) effects . RESULTS Results demonstrated extended improvement for the MBSR(BC ) group compared with usual care in both psychological symptoms of anxiety , fear of recurrence overall , and fear of recurrence problems and physical symptoms of fatigue severity and fatigue interference ( P < .01 ) . Overall effect sizes were largest for fear of recurrence problems ( d = 0.35 ) and fatigue severity ( d = 0.27 ) . Moderation effects showed BCSs with the highest levels of stress at baseline experienced the greatest benefit from MBSR(BC ) . CONCLUSION The MBSR(BC ) program significantly improved a broad range of symptoms among BCSs up to 6 weeks after MBSR(BC ) training , with generally small to moderate overall effect sizes Purpose Cancer-related fatigue ( CRF ) is a frequent and distressing symptom experienced after cancer treatment . RESTORE is the first web-based re source design ed to enhance self-efficacy to manage CRF following curative-intent treatment . The aim of this study is to test the proof of concept and inform the design of an effectiveness trial . Methods A multi-centre parallel-group two-armed ( 1:1 ) exploratory r and omised controlled trial ( RCT ) with qualitative process evaluation was employed in the study . Participants ( ≥18 years ; ≤5 years post treatment with moderate to severe fatigue ) were recruited and r and omly assigned to RESTORE or a leaflet . Feasibility and acceptability were measured by recruitment , attrition , intervention adherence , completion of outcome measures and process evaluation . Change in self-efficacy to manage CRF was also explored . Outcome measures were completed at baseline ( T0 ) , 6 weeks ( T1 ) and 12 weeks ( T2 ) . Data were analysed using mixed-effects linear regression and directed content analysis . Results One hundred and sixty-three people participated in the trial and 19 in the process evaluation . The intervention was feasible ( 39 % of eligible patients consented ) and acceptable ( attrition rate 36 % ) . There was evidence of higher fatigue self-efficacy at T1 in the intervention group vs comparator ( mean difference 0.51 [ −0.08 to 1.11 ] ) , though the difference in groups decreased by 12 weeks . Time since diagnosis influenced perceived usefulness of the intervention . Modifications were suggested . Conclusion Proof of concept was achieved . The RESTORE intervention should be subject to a definitive trial with some adjustments . Provision of an effective supportive re source would empower cancer survivors to manage CRF after treatment completion . Trial registration IS RCT Background Fatigue is a common symptom in cancer patients that can persist beyond the curative treatment phase . Some evidence has been reported for interventions for fatigue during active treatment . However , to date , there is no systematic review on psychological interventions for fatigue after the completion of curative treatment for cancer . This is a protocol for a systematic review that aims to evaluate the effectiveness of psychological interventions for cancer-related fatigue in post-treatment cancer survivors . This systematic review protocol was registered with the International Prospect i ve Register of Systematic Review s ( PROSPERO ) data base . Methods / design We will search the Cochrane Central Register of Controlled Trials ( CENTRAL ; The Cochrane Library ) , PubMed , MEDLINE , EMBASE , CINAHL , PsycINFO , and relevant sources of grey literature . R and omised controlled trials ( RCTs ) which have evaluated psychological interventions in adult cancer patients after the completion of treatment , with fatigue as an outcome measure , will be included . Two review authors will independently extract data from the selected studies and assess the method ological quality using the Cochrane Collaboration Risk of Bias Tool . Discussion Most existing evidence on cancer-related fatigue is from those in active cancer treatment . This systematic review and meta- analysis will build upon previous evaluations of psychological interventions in people during and after cancer treatment . With the growing need for stage-specific research in cancer , this review seeks to highlight a gap in current practice and to strengthen the evidence base of r and omised controlled trials in the area . Systematic review registration PROSPERO CRD42014015219 Background We aim ed to evaluate the potential benefits of the Leadership and Coaching for Health ( LEACH ) program on physical activity ( PA ) , dietary habits , and distress management in cancer survivors . Methods We r and omly assigned 248 cancer survivors with an allocation ratio of two-to-one to the LEACH program ( LP ) group , coached by long-term survivors , or the usual care ( UC ) group .  At baseline , 3 , 6 , and 12 months , we used PA scores , the intake of vegetables and fruits ( VF ) , and the Post Traumatic Growth Inventory ( PTGI ) as primary outcomes and , for secondary outcomes , the Ten Rules for Highly Effective Health Behavior adhered to and quality of life ( QOL ) , the Hospital Anxiety and Depression Scale ( HADS ) , and the European Organization for Research and Treatment of Cancer Quality of Life Question naire ( EORTC QLQ-C30 ) . Results For primary outcomes , the two groups did not significantly differ in PA scores or VF intake but differed marginally in PTGI . For secondary outcomes , the LP group showed a significantly greater improvement in the HADS anxiety score , the social functioning score , and the appetite loss and financial difficulties scores of the EORTC QLQ-C30 scales from baseline to 3 months . From baseline to 12 months , the LP group showed a significantly greater decrease in the EORTC QLQ-C30 fatigue score and a significantly greater increase in the number of the Ten Rules for Highly Effective Health Behavior . Conclusion Our findings indicate that the LEACH program , coached by long-term survivors , can provide effective management of the QOL of cancer survivors but not of their PA or dietary habits . Trial registration Clinical trial information can be found for the following : NCT01527409 ( the date when the trial was registered : February 2012 ) Background Approximately one third of all patients who have been successfully treated for cancer suffer from chronic cancer-related fatigue ( CCRF ) . Effective and easily accessible interventions are needed for these patients . Objective The current paper reports on the results of a 3-armed r and omized controlled trial investigating the clinical effectiveness of two different guided Web-based interventions for reducing CCRF compared to an active control condition . Methods Severely fatigued cancer survivors were recruited via online and offline channels , and self-registered on an open-access website . After eligibility checks , 167 participants were r and omized via an embedded automated r and omization function into : ( 1 ) physiotherapist-guided Ambulant Activity Feedback ( AAF ) therapy encompassing the use of an accelerometer ( n=62 ) ; ( 2 ) psychologist-guided Web-based mindfulness-based cognitive therapy ( eMBCT ; n=55 ) ; or ( 3 ) an unguided active control condition receiving psycho-educational emails ( n=50 ) . All interventions lasted nine weeks . Fatigue severity was self-assessed using the Checklist Individual Strength - Fatigue Severity subscale ( primary outcome ) six times from baseline ( T0b ) to six months ( T2 ) . Mental health was self-assessed three times using the Hospital Anxiety and Depression Scale and Positive and Negative Affect Schedule ( secondary outcome ) . Treatment dropout was investigated . Results Multiple group latent growth curve analysis , corrected for individual time between assessment s , showed that fatigue severity decreased significantly more in the AAF and eMBCT groups compared to the psycho-educational group . The analyses were checked by a research er who was blind to allocation . Clinical ly relevant changes in fatigue severity were observed in 66 % ( 41/62 ) of patients in AAF , 49 % ( 27/55 ) of patients in eMBCT , and 12 % ( 6/50 ) of patients in psycho-education . Dropout was 18 % ( 11/62 ) in AAF , mainly due to technical problems and poor usability of the accelerometer , and 38 % ( 21/55 ) in eMBCT , mainly due to the perceived high intensity of the program . Conclusions Both the AAF and eMBCT interventions are effective for managing fatigue severity compared to receiving psycho-educational emails . Trial Registration Trialregister.nl NTR3483 ; http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=3483 ( Archived by WebCite at http://www.webcitation.org/6NWZqon3o Purpose The web-based computer-tailored Kanker Nazorg Wijzer ( Cancer Aftercare Guide ) supports cancer survivors with psychosocial issues during cancer recovery . The current study investigates whether the 6-month effects in increasing emotional and social functioning and reducing depression and fatigue hold at 12 months from baseline . Moreover , it explores whether patient characteristics moderate the 6- and 12-month intervention effectiveness . Methods Cancer survivors from 21 Dutch hospitals ( November 2013–June 2014 ) were r and omized to an intervention ( n = 231 ) or a wait-list control group ( n = 231 ) . Intervention effects on emotional and social functioning ( EORTC QLQ-C30 ) , depression ( HADS ) , and fatigue ( CIS ) were evaluated through multilevel linear regression analyses . Results At 12 months from baseline , the intervention group no longer differed from the control group in emotional and social functioning , depression , and fatigue . Moderator analyses indicated that , at 6 months , the intervention was effective in improving social functioning for men ( d = 0.34 ) , reducing fatigue for participants ≤56 years ( d = 0.44 ) , and reducing depression for participants who received chemotherapy ( d = 0.36 ) . At 12 months , participants with a medium educational level reported higher social functioning ( d = 0.19 ) , while participants with a low educational level reported lower social functioning ( d = 0.22 ) than participants with a similar educational level in the control group . Conclusions The intervention gave cancer patients a head start to psychological recovery after the end of cancer treatment . The control group caught up in the long run . Implication s for cancer survivorsThe Cancer Aftercare Guide expedited recovery after cancer treatment . Being a low intensity , easy accessible , and relatively low cost intervention , it could serve as a relevant step in recovery and stepped care CONTEXT Cancer-related fatigue is prevalent and disabling . When persistent and unexplained , it is termed post-cancer fatigue ( PCF ) . Cognitive behavioral therapy ( CBT ) and grade d exercise therapy ( GET ) may improve symptoms and functional outcomes . OBJECTIVES To evaluate the outcomes of a r and omized controlled trial , which assigned patients with post-cancer fatigue to education , or 12 weeks of integrated cognitive-behavioral therapy ( CBT ) and grade d exercise therapy ( GET ) . METHODS Three months after treatment for breast or colon cancer , eligible patients had clinical ly significant fatigue , no comorbid medical or psychiatric conditions that explained the fatigue , and no evidence of recurrence . The CBT/GET arm included individually tailored consultations at approximately two weekly intervals . The education arm included a single visit with clinicians describing the principles of CBT/GET and a booklet . The primary outcome was clinical ly significant improvement in self-reported fatigue ( Somatic and Psychological HEalth REport 0 - 12 ) , design ated a priori as greater than one SD of improvement in fatigue score . The secondary outcome was associated improvement in function ( role limitation due to physical health problems-36-Item Short Form Health Survey 0 - 100 ) comparing baseline , end treatment ( 12 weeks ) , and follow-up ( 24 weeks ) . RESULTS There were 46 patients enrolled , including 43 women ( 94 % ) , with a mean age of 51 years .  Fatigue severity improved in all subjects from a mean of 5.2 ( ±3.1 ) at baseline to 3.9 ( ±2.8 ) at 12 weeks , suggesting a natural history of improvement . Clinical ly significant improvement was observed in 7 of 22 subjects in the intervention group compared with 2 of 24 in the education group ( P < 0.05 , χ2 ) . These subjects also had improvement in functional status compared with nonresponders ( P < 0.01 , t-test ) . CONCLUSION Combined CBT/GET improves fatigue and functional outcomes for a subset of patients with post-cancer fatigue . Further studies to improve the response rate and the magnitude of the benefit are warranted To investigate prevalence and severity of symptoms and symptom clustering in breast cancer survivors who attended MBSR(BC ) .  Women were r and omly assigned into MBSR(BC ) or Usual Care ( UC ) . Eligible women were ≥ 21 years , 
    Output:
    