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: Uncertainty is a central feature of long-term childhood cancer survivorship during which time it principally has to do with late effects . Therefore , the purpose s of this article are ( a ) to assess feasibility of a r and omized clinical trial of a telephone-delivered coping skills training ( CST ) intervention in terms of recruitment , retention , and timeline , as well as the performance of the study measures ; and ( b ) to demonstrate trends in change on outcomes within the context of a small pilot study . The results of this pilot study suggest that HEROS PLUS CST has clinical relevance and that in-person long-term follow-up plus telephone-delivered psychosocial care is a practical way to deliver integrated care to adolescent — young adult childhood cancer survivors and their parents Purpose The purpose of this study is to test the efficacy of the Survivor Health and Resilience Education Program intervention — a manualized , behavioral intervention focusing on bone health behaviors among adolescent survivors of childhood cancer . Methods Participants were 75 teens aged 11–21 years , one or more years post-treatment , and currently cancer-free . Teens were r and omized to a group-based intervention focusing on bone health or a wait-list control .  Bone health behaviors were assessed at baseline and 1-month post-intervention . Results Controlling for baseline outcome measures and theoretical predictors , milk consumption frequency ( p = 0.03 ) , past month calcium supplementation ( p < 0.001 ) , days in the past month with calcium supplementation ( p < 0.001 ) , and dietary calcium intake ( p = 0.04 ) were significantly greater at 1-month follow-up among intervention participants compared with control participants . Conclusions The intervention had a significant short-term impact on self-reported bone health behaviors among adolescent survivors of childhood cancer . Research examining long-term intervention effectiveness is warranted PURPOSE Cancer survivors smoke at rates that are only slightly lower than the general population . This article reports on the final outcomes of Partnership for Health , a smoking cessation intervention for smokers in the Childhood Cancer Survivors Study ( CCSS ) . METHODS This study is a r and omized control trial with follow-up at 8 and 12 months that involved smokers ( n = 796 ) enrolled onto the CCSS cohort . Participants were r and omly assigned to either a self-help or a peer-counseling program that included up to six telephone calls from a trained childhood cancer survivor , tailored and targeted material s , and free nicotine replacement therapy . The intervention was delivered by telephone and postal service mail . RESULTS The quit rate was significantly higher in the counseling group compared with the self-help group at both the 8-month ( 16.8 % v 8.5 % ; P < .01 ) and 12-month follow-ups ( 15 % v 9 % ; P < or = .01 ) . Controlling for baseline self-efficacy and readiness to change , the intervention group was twice as likely to quit smoking , compared with the self-help group . Smoking cessation rate increased with an increase in the number of counseling calls . The cost of delivering the intervention was approximately 300 dollars per participant . The incremental cost-effectiveness of the intervention compared with controls was 5,371 dollars per additional quit . CONCLUSION Interventions to prevent future illnesses are of critical importance to childhood cancer survivors . The Partnership for Health intervention result ed in a doubling of smoking cessation quit rates . Because of the seriousness of smoking among childhood cancer survivors , this intervention model may be appropriate as a multicomponent treatment program for survivors who smoke Background There are numerous published controlled trials assessing the safety and the benefits of physical activity ( PA ) for child and adult cancer survivors . However , trials exclusively comprised of adolescent cancer survivors aged 13 - 19 years , who may experience different health and quality of life ( QOL ) effects as a function of their developmental status , are lacking . Rather , some trials have included both adolescent and child cancer survivors together . Objective The aim of this systematic review was to synthesize the findings from r and omized controlled trails ( RCTs ) and controlled clinical trials ( CCTs ) investigating the effects of PA on health and QOL outcomes in sample s comprised of > 50 % adolescent cancer survivors to summarize the current state of evidence , identify knowledge gaps , and highlight areas in need of additional research within this population . Methods Using a search strategy developed for this review , 10 electronic data bases were search ed for RCTs and CCTs that reported on the effects of PA on at least 1 health and /or QOL outcome in sample s comprised of > 50 % adolescent cancer survivors . Results From the 2249 articles identified , 2 CCTs met the predetermined eligibility criteria and were included in this review . Combined , 28 adolescents ( of 41 participants ) who were receiving active treatment participated in the 2 studies review ed . A total of 4 health and QOL outcomes ( ie , bone mass , fatigue , grip strength , QOL ) were assessed pre- and post-PA intervention . Conclusions On the basis of the 2 studies review ed , PA appears to be safe and feasible .  PA also shows promise to mitigate reductions in bone mass and might be a viable strategy to improve fatigue , grip strength , and QOL . High- quality controlled trials with larger sample s exclusively comprised of adolescent cancer survivors that assess a wide range of outcomes are needed to determine the effects of PA on health and QOL outcomes in this population PURPOSE In this r and omized controlled trial , we sought to determine whether a risk counseling intervention would increase knowledge and perceived vulnerability to tobacco-related health risks and decrease future intentions to use tobacco among preadolescents and adolescents previously treated for cancer . PATIENT AND METHODS Participants included 103 cancer survivors between the ages of 10 and 18 years who were r and omly assigned to either a  st and ard care control ( SCC ) group or a tobacco intervention ( TI ) group .  Patients in the SCC group received st and ard advice about the risks of tobacco use . Patients in the TI group received more intensive late effects risk counseling in addition to an educational video , goal setting , written physician feedback , smoking literature , and follow-up telephone counseling . The effect of our intervention was assessed by self-reported knowledge , perceived vulnerability , and intentions at baseline , 6 , and 12 months . RESULTS Compared with the SCC group , patients who received our intervention had significantly higher knowledge scores , higher perceived vulnerability scores , and lower intention scores at 12 months . No significant differences between the SCC and TI groups at 6 months , across all measures , were found . CONCLUSION Pediatric survivors '  knowledge , perceived vulnerability to health risks , and intentions to use tobacco can be modified by a risk counseling intervention . The delayed effect of our intervention indicates that these changes may evolve over time . Implication s for health care providers who engage in tobacco counseling with young cancer survivors are discussed . Additional longitudinal studies are needed to determine definitive long-term intervention effects on actual tobacco use in this high-risk population Purpose Long-term survivors of pediatric cancer have an increased risk of post-traumatic stress symptoms ( PTSS ) and dysfunctional anxiety . However , there is a lack of evidence -based psychotherapy tailored to the needs of this target group . In this single-arm pilot study , an Internet-based psychological intervention ( “ Onco-STEP ” ) for adolescent and young adult survivors was developed , and its efficacy in reducing PTSS and anxiety was evaluated . Methods Former patients of pediatric cancer older than 15 years manifesting clinical ly relevant PTSS or anxiety were eligible . The cognitive-behavioral treatment consists of ten writing sessions and comprises two modules : the first aim ing to reprocess the traumatic cancer-related experiences and the second aim ing to build coping strategies with current cancer-related fears . Treatment was delivered via written messages on a secure Internet platform . Outcomes were assessed by the Post-traumatic Stress Diagnostic Scale , the Hospital Anxiety and Depression Scale , and the Fear of Progression/Relapse Question naire . Results A total of 20 participants completed the intervention ( mean age 27.3 ± 4.8 years at study ; 13.8 ± 4.7 years since diagnosis ; 70 % female )  . PTSS , anxiety , and fear of progression/relapse significantly declined at the end of the intervention , with pre – post effect sizes of 0.63 , 0.74 , and 0.48 . In addition , we found a significant decrease in symptoms of depression . Except for the improvement in depression , all effects were sustained 3 months after the end of treatment . Conclusions The results show that the intervention is efficacious in reducing symptoms of post-traumatic stress and anxiety . Onco-STEP is a promising new way to treat young adult long-term survivors of pediatric cancer with late psychological effects . Future efforts need to focus on investigating specific evidence of the intervention in a r and omized controlled trial Purpose : Young adults who have been treated for cancer face several health and psychosocial risks . To minimize these risks , is it imperative that they address any modifiable risk factors , such as sedentary lifestyle . Unfortunately , more than half of young adult cancer survivors remain sedentary . To facilitate the adoption of physical activity ( PA ) in this population -potentially reducing health and psychosocial risks-we developed and pilot tested an internet-based PA intervention for young survivors . Patients and methods : Eighteen young adults , aged 18 to 39 , who had been diagnosed with cancer in the past 10 years were recruited . Participants were r and omized to receive access to the PA website for 12 weeks or information about other cancer-related websites . Intervention feasibility and acceptability was assessed only among those in the PA website group ; PA and psychosocial outcomes ( mood , fatigue ) were assessed in both groups . Results : Findings revealed that 86 % of participants in the PA website group would recommend the intervention to others and most ( 71 % ) were " satisfied " or " very satisfied " with it . Further , 100 % rated getting onto the website as " very easy " and 86 % rated the information on the site as " very easy " to underst and . The logging feature , followed by the goal - setting feature , were most often accessed by participants . Participants also rated the graphing and stage-matched manual features as helpful . Estimates of effect sizes for between-group differences at 12 weeks were medium for PA outcomes and large for psychosocial outcomes . Conclusions : This internet-based PA intervention targeting young adult cancer survivors is feasible and acceptable and may benefit this population BACKGROUND Improved cure rates for childhood cancer have produced a growing population of survivors at risk for late toxicities of chemotherapy and radiation therapy . Healthy behaviors can modify these risks . We initiated a controlled prospect i ve trial to determine if a multi-component behavioral intervention could induce change in childhood cancer survivors ' health knowledge , health perceptions , and practice of health-protective behaviors . PROCEDURE Adolescent cancer survivors attending a long-term follow-up clinic were r and omized to receive st and ard follow-up care or st and ard care plus the educational intervention . Baseline measures were obtained at r and omization ( T(0 ) ) and repeated 1 year ( T(1 ) ) later during the survivors ' annual check-up . RESULTS Of 272 patients enrolled and r and omized , 251 are evaluable at both time points . Treatment and control groups were similar in regards to diagnosis , gender , race , and age . The change in outcome measures over the year ( T(1)-T(0 ) ) was not significantly different between the two groups as assessed by a two- sample pooled t test . However , additional exploratory analyses indicated a significant gender difference in knowledge with female survivors in the intervention group having higher scores . In addition , patients who choose certain individual health goals , such as breast/testicular self-examination , showed improved practice of the health behavior . In addition , in a very exploratory analysis , a gender difference in response to the intervention was noted , with females exhibiting a greater improvement in knowledge scores than did males . CONCLUSIONS Although the multi-behavioral educational intervention did not induce change in health knowledge , perceptions , and behaviors of childhood cancer survivors for the treatment group as a whole , gender differences and specific health goal differences were found . These findings suggest that future interventions should be tailored to reflect gender differences and the nature of the health goal under assessment PURPOSE / OBJECTIVES To test the effects of a  decision-making and risk-reduction program  for cancer-surviving adolescents . DESIGN Prospect i ve clinical trial using a quasi-experimental pretest/post-test design with repeated measures . SETTING Two survivor follow-up clinics and a camp for children and adolescents with cancer located in upstate New York . SAMPLE A convenience sample of 64 survivors ( 13 - 21 years of age ) . The intervention group consisted of  21 survivors who attended a workshop  , and the comparison group consisted of 43 survivors who did not attend the workshop .  METHODS Intervention-integrated information specific to survivorship , decision-making skills , risk behaviors , and social support from peers and healthcare professionals . The educational component of the program lasted one day ( five one-hour units ) , and the social component lasted overnight . A single , semistructured interview at the time of the previous yearly evaluation visit was used for baseline data . Testing was conducted during home visits at 1 , 6 , and 12 months . MAIN RESEARCH VARIABLES Decision making , risk motivation , and risk behaviors ( i.e. , smoking , alcohol use , and illicit drug use ) . FINDING 
    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: Uncertainty is a central feature of long-term childhood cancer survivorship during which time it principally has to do with late effects . Therefore , the purpose s of this article are ( a ) to assess feasibility of a r and omized clinical trial of a telephone-delivered coping skills training ( CST ) intervention in terms of recruitment , retention , and timeline , as well as the performance of the study measures ; and ( b ) to demonstrate trends in change on outcomes within the context of a small pilot study . The results of this pilot study suggest that HEROS PLUS CST has clinical relevance and that in-person long-term follow-up plus telephone-delivered psychosocial care is a practical way to deliver integrated care to adolescent — young adult childhood cancer survivors and their parents Purpose The purpose of this study is to test the efficacy of the Survivor Health and Resilience Education Program intervention — a manualized , behavioral intervention focusing on bone health behaviors among adolescent survivors of childhood cancer . Methods Participants were 75 teens aged 11–21 years , one or more years post-treatment , and currently cancer-free . Teens were r and omized to a group-based intervention focusing on bone health or a wait-list control .  Bone health behaviors were assessed at baseline and 1-month post-intervention . Results Controlling for baseline outcome measures and theoretical predictors , milk consumption frequency ( p = 0.03 ) , past month calcium supplementation ( p < 0.001 ) , days in the past month with calcium supplementation ( p < 0.001 ) , and dietary calcium intake ( p = 0.04 ) were significantly greater at 1-month follow-up among intervention participants compared with control participants . Conclusions The intervention had a significant short-term impact on self-reported bone health behaviors among adolescent survivors of childhood cancer . Research examining long-term intervention effectiveness is warranted PURPOSE Cancer survivors smoke at rates that are only slightly lower than the general population . This article reports on the final outcomes of Partnership for Health , a smoking cessation intervention for smokers in the Childhood Cancer Survivors Study ( CCSS ) . METHODS This study is a r and omized control trial with follow-up at 8 and 12 months that involved smokers ( n = 796 ) enrolled onto the CCSS cohort . Participants were r and omly assigned to either a self-help or a peer-counseling program that included up to six telephone calls from a trained childhood cancer survivor , tailored and targeted material s , and free nicotine replacement therapy . The intervention was delivered by telephone and postal service mail . RESULTS The quit rate was significantly higher in the counseling group compared with the self-help group at both the 8-month ( 16.8 % v 8.5 % ; P < .01 ) and 12-month follow-ups ( 15 % v 9 % ; P < or = .01 ) . Controlling for baseline self-efficacy and readiness to change , the intervention group was twice as likely to quit smoking , compared with the self-help group . Smoking cessation rate increased with an increase in the number of counseling calls . The cost of delivering the intervention was approximately 300 dollars per participant . The incremental cost-effectiveness of the intervention compared with controls was 5,371 dollars per additional quit . CONCLUSION Interventions to prevent future illnesses are of critical importance to childhood cancer survivors . The Partnership for Health intervention result ed in a doubling of smoking cessation quit rates . Because of the seriousness of smoking among childhood cancer survivors , this intervention model may be appropriate as a multicomponent treatment program for survivors who smoke Background There are numerous published controlled trials assessing the safety and the benefits of physical activity ( PA ) for child and adult cancer survivors . However , trials exclusively comprised of adolescent cancer survivors aged 13 - 19 years , who may experience different health and quality of life ( QOL ) effects as a function of their developmental status , are lacking . Rather , some trials have included both adolescent and child cancer survivors together . Objective The aim of this systematic review was to synthesize the findings from r and omized controlled trails ( RCTs ) and controlled clinical trials ( CCTs ) investigating the effects of PA on health and QOL outcomes in sample s comprised of > 50 % adolescent cancer survivors to summarize the current state of evidence , identify knowledge gaps , and highlight areas in need of additional research within this population . Methods Using a search strategy developed for this review , 10 electronic data bases were search ed for RCTs and CCTs that reported on the effects of PA on at least 1 health and /or QOL outcome in sample s comprised of > 50 % adolescent cancer survivors . Results From the 2249 articles identified , 2 CCTs met the predetermined eligibility criteria and were included in this review . Combined , 28 adolescents ( of 41 participants ) who were receiving active treatment participated in the 2 studies review ed . A total of 4 health and QOL outcomes ( ie , bone mass , fatigue , grip strength , QOL ) were assessed pre- and post-PA intervention . Conclusions On the basis of the 2 studies review ed , PA appears to be safe and feasible .  PA also shows promise to mitigate reductions in bone mass and might be a viable strategy to improve fatigue , grip strength , and QOL . High- quality controlled trials with larger sample s exclusively comprised of adolescent cancer survivors that assess a wide range of outcomes are needed to determine the effects of PA on health and QOL outcomes in this population PURPOSE In this r and omized controlled trial , we sought to determine whether a risk counseling intervention would increase knowledge and perceived vulnerability to tobacco-related health risks and decrease future intentions to use tobacco among preadolescents and adolescents previously treated for cancer . PATIENT AND METHODS Participants included 103 cancer survivors between the ages of 10 and 18 years who were r and omly assigned to either a  st and ard care control ( SCC ) group or a tobacco intervention ( TI ) group .  Patients in the SCC group received st and ard advice about the risks of tobacco use . Patients in the TI group received more intensive late effects risk counseling in addition to an educational video , goal setting , written physician feedback , smoking literature , and follow-up telephone counseling . The effect of our intervention was assessed by self-reported knowledge , perceived vulnerability , and intentions at baseline , 6 , and 12 months . RESULTS Compared with the SCC group , patients who received our intervention had significantly higher knowledge scores , higher perceived vulnerability scores , and lower intention scores at 12 months . No significant differences between the SCC and TI groups at 6 months , across all measures , were found . CONCLUSION Pediatric survivors '  knowledge , perceived vulnerability to health risks , and intentions to use tobacco can be modified by a risk counseling intervention . The delayed effect of our intervention indicates that these changes may evolve over time . Implication s for health care providers who engage in tobacco counseling with young cancer survivors are discussed . Additional longitudinal studies are needed to determine definitive long-term intervention effects on actual tobacco use in this high-risk population Purpose Long-term survivors of pediatric cancer have an increased risk of post-traumatic stress symptoms ( PTSS ) and dysfunctional anxiety . However , there is a lack of evidence -based psychotherapy tailored to the needs of this target group . In this single-arm pilot study , an Internet-based psychological intervention ( “ Onco-STEP ” ) for adolescent and young adult survivors was developed , and its efficacy in reducing PTSS and anxiety was evaluated . Methods Former patients of pediatric cancer older than 15 years manifesting clinical ly relevant PTSS or anxiety were eligible . The cognitive-behavioral treatment consists of ten writing sessions and comprises two modules : the first aim ing to reprocess the traumatic cancer-related experiences and the second aim ing to build coping strategies with current cancer-related fears . Treatment was delivered via written messages on a secure Internet platform . Outcomes were assessed by the Post-traumatic Stress Diagnostic Scale , the Hospital Anxiety and Depression Scale , and the Fear of Progression/Relapse Question naire . Results A total of 20 participants completed the intervention ( mean age 27.3 ± 4.8 years at study ; 13.8 ± 4.7 years since diagnosis ; 70 % female )  . PTSS , anxiety , and fear of progression/relapse significantly declined at the end of the intervention , with pre – post effect sizes of 0.63 , 0.74 , and 0.48 . In addition , we found a significant decrease in symptoms of depression . Except for the improvement in depression , all effects were sustained 3 months after the end of treatment . Conclusions The results show that the intervention is efficacious in reducing symptoms of post-traumatic stress and anxiety . Onco-STEP is a promising new way to treat young adult long-term survivors of pediatric cancer with late psychological effects . Future efforts need to focus on investigating specific evidence of the intervention in a r and omized controlled trial Purpose : Young adults who have been treated for cancer face several health and psychosocial risks . To minimize these risks , is it imperative that they address any modifiable risk factors , such as sedentary lifestyle . Unfortunately , more than half of young adult cancer survivors remain sedentary . To facilitate the adoption of physical activity ( PA ) in this population -potentially reducing health and psychosocial risks-we developed and pilot tested an internet-based PA intervention for young survivors . Patients and methods : Eighteen young adults , aged 18 to 39 , who had been diagnosed with cancer in the past 10 years were recruited . Participants were r and omized to receive access to the PA website for 12 weeks or information about other cancer-related websites . Intervention feasibility and acceptability was assessed only among those in the PA website group ; PA and psychosocial outcomes ( mood , fatigue ) were assessed in both groups . Results : Findings revealed that 86 % of participants in the PA website group would recommend the intervention to others and most ( 71 % ) were " satisfied " or " very satisfied " with it . Further , 100 % rated getting onto the website as " very easy " and 86 % rated the information on the site as " very easy " to underst and . The logging feature , followed by the goal - setting feature , were most often accessed by participants . Participants also rated the graphing and stage-matched manual features as helpful . Estimates of effect sizes for between-group differences at 12 weeks were medium for PA outcomes and large for psychosocial outcomes . Conclusions : This internet-based PA intervention targeting young adult cancer survivors is feasible and acceptable and may benefit this population BACKGROUND Improved cure rates for childhood cancer have produced a growing population of survivors at risk for late toxicities of chemotherapy and radiation therapy . Healthy behaviors can modify these risks . We initiated a controlled prospect i ve trial to determine if a multi-component behavioral intervention could induce change in childhood cancer survivors ' health knowledge , health perceptions , and practice of health-protective behaviors . PROCEDURE Adolescent cancer survivors attending a long-term follow-up clinic were r and omized to receive st and ard follow-up care or st and ard care plus the educational intervention . Baseline measures were obtained at r and omization ( T(0 ) ) and repeated 1 year ( T(1 ) ) later during the survivors ' annual check-up . RESULTS Of 272 patients enrolled and r and omized , 251 are evaluable at both time points . Treatment and control groups were similar in regards to diagnosis , gender , race , and age . The change in outcome measures over the year ( T(1)-T(0 ) ) was not significantly different between the two groups as assessed by a two- sample pooled t test . However , additional exploratory analyses indicated a significant gender difference in knowledge with female survivors in the intervention group having higher scores . In addition , patients who choose certain individual health goals , such as breast/testicular self-examination , showed improved practice of the health behavior . In addition , in a very exploratory analysis , a gender difference in response to the intervention was noted , with females exhibiting a greater improvement in knowledge scores than did males . CONCLUSIONS Although the multi-behavioral educational intervention did not induce change in health knowledge , perceptions , and behaviors of childhood cancer survivors for the treatment group as a whole , gender differences and specific health goal differences were found . These findings suggest that future interventions should be tailored to reflect gender differences and the nature of the health goal under assessment PURPOSE / OBJECTIVES To test the effects of a  decision-making and risk-reduction program  for cancer-surviving adolescents . DESIGN Prospect i ve clinical trial using a quasi-experimental pretest/post-test design with repeated measures . SETTING Two survivor follow-up clinics and a camp for children and adolescents with cancer located in upstate New York . SAMPLE A convenience sample of 64 survivors ( 13 - 21 years of age ) . The intervention group consisted of  21 survivors who attended a workshop  , and the comparison group consisted of 43 survivors who did not attend the workshop .  METHODS Intervention-integrated information specific to survivorship , decision-making skills , risk behaviors , and social support from peers and healthcare professionals . The educational component of the program lasted one day ( five one-hour units ) , and the social component lasted overnight . A single , semistructured interview at the time of the previous yearly evaluation visit was used for baseline data . Testing was conducted during home visits at 1 , 6 , and 12 months . MAIN RESEARCH VARIABLES Decision making , risk motivation , and risk behaviors ( i.e. , smoking , alcohol use , and illicit drug use ) . FINDING 
    Output:
    