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: BACKGROUND The psychological response to breast cancer , such as a fighting spirit or an attitude of helplessness and hopelessness toward the disease , has been suggested as a prognostic factor with an influence on survival . We have investigated the effect of psychological response on disease outcome in a large cohort of women with early-stage breast cancer . METHODS 578 women with early-stage breast cancer were enrolled in a prospect i ve survival study . Psychological response was measured by the  mental adjustment to cancer ( MAC ) scale , the Courtauld emotional control ( CEC ) scale  , and the  hospital anxiety and depression ( HAD ) scale 4 - 12 weeks and 12 months after diagnosis . The women were followed up for at least 5 years . Cox 's proportional-hazards regression was used to obtain the hazard ratios for the measures of psychological response , with adjustment for known clinical factors associated with survival . FINDINGS At 5 years , 395 women were alive and without relapse , 50 were alive with relapse , and 133 had died . There was a significantly increased risk of death from all causes by 5 years in women with a high score on the HAD scale category of depression ( hazard ratio 3.59 [ 95 % CI 1.39 - 9.24 ] ) . There was a significantly increased risk of relapse or death at 5 years in women with high scores on the helplessness and hopelessness category of the MAC scale compared with those with a low score in this category ( 1.55 [ 1.07 - 2.25 ] ) . There were no significant results found for the category of " fighting spirit " . INTERPRETATION For 5-year event-free survival a high helplessness/hopelessness score has a moderate but detrimental effect . A high score for depression is linked to a significantly reduced chance of survival ; however , this result is based on a small number of patients and should be interpreted with caution The question of whether stress poses a risk for cancer progression has been difficult to answer . A r and omized clinical trial tested the hypothesis that cancer patients coping with their recent diagnosis but receiving a psychologic intervention  would have improved survival compared with patients who were only assessed Abstract Objective : To evaluate a palliative care home support team based on an inpatient unit . Design : R and omised controlled trial with waiting list . Patients in the study group received the service immediately , those in the control group received it after one month . Main comparison point was at one month . Setting - A city of 300 000 people with a publicly funded home care service and about 200 general practitioners , most of whom provide home care . Main outcome measures : Pain and nausea levels were measured at entry to trial and at one month , as were quality of life for patients and care givers ' health . Results : Because of early deaths , problems with recruitment , and a low compliance rate for completion of question naires , the required sample size was not attained . Conclusion : In design ing evaluations of palliative care services , investigators should be prepared to deal with the following issues : attrition due to early death , opposition to r and omisation by patients and referral sources , ethical problems raised by r and omisation of dying patients , the appropriate timing of comparison points , and difficulties of collecting data from sick or exhausted patients and care givers . Investigators may choose to evaluate a service from various perspectives using different methods : controlled trials , qualitative studies , surveys , and audits . R and omised trials may prove to be impracticable for evaluation of palliative care AIM This paper is a report of a study to describe the efficacy of cognitive behavioural therapy for insomnia on fatigue , mood and quality of life in breast cancer survivors . BACKGROUND Women who receive primary treatment for breast cancer often complain of insomnia . Rarely evaluated in insomnia intervention studies is the effect of cognitive behavioural treatment on the psychosocial outcomes of fatigue , mood and quality of life . METHOD Data were collected between December 2002 and March 2004 with 72 women who were at least 3 months post-completion of primary treatment without current evidence of disease . Women were r and omly assigned to either the cognitive behavioural therapy for insomnia group , which received stimulus control instructions , sleep restriction therapy and sleep education and hygiene , or the component control group which received sleep education and hygiene only . The 10-week study consisted of 2 weeks of pre-treatment , 6 weeks of treatment and 2 weeks of post-treatment . Fatigue , mood and quality of life were measured at pre- and post-treatment . FINDINGS Women receiving cognitive behavioural therapy for insomnia had significant improvements in fatigue , trait anxiety , depression and quality of life . The component control group also had statistically significant increases in quality of life , with a trend suggestive of lower depression at post-treatment . CONCLUSION Globally , as the number of survivors in this population continues to grow , it is imperative that nurses continue testing interventions that may positively affect quality of life and the commonly experienced symptoms of fatigue , anxiety and depression OBJECTIVES We evaluated recurrence and survival for 68 patients with malignant melanoma who participated in a 6-week structured psychiatric group intervention 5 to 6 years earlier , shortly after their diagnosis and initial surgical treatment . We also explored the role of several factors as possible predictors of outcome . DESIGN This was a r and omized controlled experimental study . The Cox proportion hazards regression model was used to quantify the relationship between treatment and the outcomes adjusted by the covariates ( age , sex , Breslow depth , tumor site , baseline Profile of Mood States Total Mood Disturbance , baseline active-behavioral coping , baseline natural killer cell activity , and treatment [ ie , group intervention ] ) . The stepwise procedure was used for covariate selection . RESULTS For control patients , there was a trend for recurrence ( 13/34 ) and a statistically significant greater rate of death ( 10/34 ) than for experimental patients ( 7/34 and 3/34 , respectively ) . We found that being male and having a greater Breslow depth predicted greater recurrence and poorer survival . Analysis of multiple covariates found that only Breslow depth and treatment ( ie , group intervention ) were significant . Adjusting for Breslow depth , treatment effect remained significant . Finally , baseline affective distress and baseline coping were significant psychobehavioral predictors for recurrence and survival . Surprisingly , higher levels of baseline distress as well as baseline coping and enhancement of active-behavioral coping over time were predictive of lower rates of recurrence and death . CONCLUSION Psychiatric interventions that enhance effective coping and reduce affective distress appear to have beneficial effects on survival but are not proposed as an alternative or independent treatment for cancer or any other illness or disease . However , the exact nature of this relationship warrants further investigation Cancer patients who had been treated for early stage breast cancer and were diagnosed with either positive axillary lymph nodes or distant metastases were r and omly assigned to either a 13-week experiential-existential group psychotherapy ( EEGP ) program or a waiting list control ( WLC ) condition .  Endocrine and immune measures were obtained before and after the intervention period . The findings of this study are that , after the 13 weeks of the experiment , patients in the EEGP group showed lower levels of plasma cortisol and lower levels of prolactin as well as lower percentages of natural killer cells , CD8 cells , and CD4 cells in addition to a lower proliferative response to pokeweed mitogen than patients in the WLC group . Importantly , this was only found in those breast cancer patients presenting relatively high endocrine and immune baseline levels , suggesting that the patients ' profile with regard to endocrine and immune function at the start of a program can have an important effect . If replicated on a larger scale , the current results may be relevant for the treatment of breast cancer Background : Individuals with cancer receiving chemotherapy suffer deterioration in physical functioning due to symptoms arising from the cancer disease process and its treatment . Objectives : To determine if age , chronic health conditions ( comorbidity ) , stage of cancer , depressive symptomatology , symptom limitations , sex , and site of cancer moderate the effects of cognitive behavioral intervention on physical function and to determine if symptom limitations mediate the effect of the intervention on physical functioning . Methods : Two hundred thirty-seven individuals with solid tumor cancer ( 118 experimental and 119 control group ) participated in this 10-contact , 18-week r and omized control trial . Cognitive behavioral theory guided the nurse-delivered problem-solving experimental intervention . The control group received conventional care . Interviews occurred at baseline and 10 , 20 , and 32 weeks . Results : Women with breast cancer had significantly better physical functioning than women with lung cancer . Chronic health conditions , symptom limitation , and depressive symptomatology at baseline were found to moderate the effect of intervention on physical function . Symptom limitation , however , was not found to mediate the effect of intervention on physical functioning . Discussion : The intervention was shown to affect physical function trajectories differently for individuals with different personal and health characteristics . Because poor physical functioning is strongly associated with mortality and poor quality of life , this information may be used by health professionals to target interventions to those who might be most responsive BACKGROUND We conducted a r and omised , controlled trial of cognitive-existential group therapy ( CEGT ) for women with early stage breast cancer receiving adjuvant chemotherapy with the aim of improving mood and mental attitude to cancer . METHODS Women were r and omised to 20 sessions of weekly group therapy plus 3 relaxation classes or to a control arm receiving 3 relaxation classes . Assessment s , independently done at baseline , 6 and 12 months , included a structured psychiatric interview and vali date d question naires covering mood , attitudes to cancer , family relationships , and satisfaction with therapy . RESULTS Three hundred and three of 491 ( 62 % ) eligible patients participated over 3 years .  Distress was high pre-intervention : 10 % were diagnosed as suffering from major depression , 27 % from minor depression and 9 % from anxiety disorders . On an intention-to-treat analysis , there was a trend for those receiving group therapy ( n=154 ) to have reduced anxiety ( p=0.05 , 2-sided ) compared to controls ( n=149 ) . Women in group therapy also showed a trend towards improved family functioning compared to controls ( p=0.07 , 2-sided ) . The women in the groups reported greater satisfaction with their therapy ( p<0.001 , 2-sided ) , appreciating the support and citing better coping , self-growth and increased knowledge about cancer and its treatment . They valued the CEGT therapy . Overall effect size for the group intervention was small ( d=0.25 ) , with cancer recurrence having a deleterious effect in three of the 19 therapy groups . Psychologists as a discipline achieved a moderate mean effect size ( d=0.52 ) . CONCLUSION CEGT is a useful adjuvant psychological therapy for women with early stage breast cancer . Interaction effects between group members and therapists are relevant to outcome . Group-as-a-whole effects are powerful , but the training and experience of the therapist is especially critical to an efficacious outcome PURPOSE The r and omized study aim ed to determine the efficacy of psychological intervention consisting of relaxation and guided imagery to reduce anxiety and depression in gynecologic and breast cancer patients undergoing brachytherapy during hospitalization . METHODS AND MATERIAL S Sixty-six patients programmed to receive brachytherapy in two hospitals in Barcelona ( Spain ) were included in this study . The patients were r and omly allocated to either the study group ( n=32 ) or the control group ( n=34 ) . Patients in both groups received training regarding brachytherapy , but only study group patients received training in relaxation and guided imagery . After collection of sociodemographic data , all patients were given a set of question naires on anxiety and depression : the Hospital Anxiety and Depression Scale ( HADS ) , and on quality of life : Cuestionario de Calidad de Vida QL-CA-AFex ( CCV ) , prior to , during and after brachytherapy . RESULTS The study group demonstrated a statistically significant reduction in anxiety ( p=0.008 ) , depression ( p=0.03 ) and body discomfort ( p=0.04 ) compared with the control group . CONCLUSIONS The use of relaxation techniques and guided imagery is effective in reducing the levels of anxiety , depression and body discomfort in patients who must remain isolated while undergoing brachytherapy . This simple and inexpensive intervention enhances the psychological wellness in patients undergoing brachytherapy . State : This study has passed Ethical Committee review The purpose of this study was to classify breast carcinomas based on variations in gene expression patterns derived from cDNA microarrays and to correlate tumor characteristics to clinical outcome . A total of 85 cDNA microarray experiments representing 78 cancers , three fibroadenomas , and four normal breast tissues were analyzed by hierarchical clustering . As reported previously , the cancers could be classified into a basal epithelial-like group , an ERBB2-overexpressing group and a normal breast-like group based on variations in gene expression . A novel finding was that the previously characterized luminal epithelial/estrogen receptor-positive group could be divided into at least two subgroups , each with a distinctive expression profile . These subtypes proved to be reasonably robust by clustering using two different gene sets : first , a set of 456 cDNA clones previously selected to reflect intrinsic properties of the tumors and , second , a gene set that highly correlated with patient outcome . Survival analyses on a subcohort of patients with locally advanced breast cancer uniformly treated in a prospect i ve study showed significantly different outcomes for the patients belonging to the various groups , including a poor prognosis for the basal-like subtype and a significant difference in outcome for the two estrogen receptor-positive groups Addressing psychosocial and quality of life needs is central to provision of excellent care for people with advanced cancer . This study tested a brief nurse-delivered intervention to address the needs of urban women 
    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: BACKGROUND The psychological response to breast cancer , such as a fighting spirit or an attitude of helplessness and hopelessness toward the disease , has been suggested as a prognostic factor with an influence on survival . We have investigated the effect of psychological response on disease outcome in a large cohort of women with early-stage breast cancer . METHODS 578 women with early-stage breast cancer were enrolled in a prospect i ve survival study . Psychological response was measured by the  mental adjustment to cancer ( MAC ) scale , the Courtauld emotional control ( CEC ) scale  , and the  hospital anxiety and depression ( HAD ) scale 4 - 12 weeks and 12 months after diagnosis . The women were followed up for at least 5 years . Cox 's proportional-hazards regression was used to obtain the hazard ratios for the measures of psychological response , with adjustment for known clinical factors associated with survival . FINDINGS At 5 years , 395 women were alive and without relapse , 50 were alive with relapse , and 133 had died . There was a significantly increased risk of death from all causes by 5 years in women with a high score on the HAD scale category of depression ( hazard ratio 3.59 [ 95 % CI 1.39 - 9.24 ] ) . There was a significantly increased risk of relapse or death at 5 years in women with high scores on the helplessness and hopelessness category of the MAC scale compared with those with a low score in this category ( 1.55 [ 1.07 - 2.25 ] ) . There were no significant results found for the category of " fighting spirit " . INTERPRETATION For 5-year event-free survival a high helplessness/hopelessness score has a moderate but detrimental effect . A high score for depression is linked to a significantly reduced chance of survival ; however , this result is based on a small number of patients and should be interpreted with caution The question of whether stress poses a risk for cancer progression has been difficult to answer . A r and omized clinical trial tested the hypothesis that cancer patients coping with their recent diagnosis but receiving a psychologic intervention  would have improved survival compared with patients who were only assessed Abstract Objective : To evaluate a palliative care home support team based on an inpatient unit . Design : R and omised controlled trial with waiting list . Patients in the study group received the service immediately , those in the control group received it after one month . Main comparison point was at one month . Setting - A city of 300 000 people with a publicly funded home care service and about 200 general practitioners , most of whom provide home care . Main outcome measures : Pain and nausea levels were measured at entry to trial and at one month , as were quality of life for patients and care givers ' health . Results : Because of early deaths , problems with recruitment , and a low compliance rate for completion of question naires , the required sample size was not attained . Conclusion : In design ing evaluations of palliative care services , investigators should be prepared to deal with the following issues : attrition due to early death , opposition to r and omisation by patients and referral sources , ethical problems raised by r and omisation of dying patients , the appropriate timing of comparison points , and difficulties of collecting data from sick or exhausted patients and care givers . Investigators may choose to evaluate a service from various perspectives using different methods : controlled trials , qualitative studies , surveys , and audits . R and omised trials may prove to be impracticable for evaluation of palliative care AIM This paper is a report of a study to describe the efficacy of cognitive behavioural therapy for insomnia on fatigue , mood and quality of life in breast cancer survivors . BACKGROUND Women who receive primary treatment for breast cancer often complain of insomnia . Rarely evaluated in insomnia intervention studies is the effect of cognitive behavioural treatment on the psychosocial outcomes of fatigue , mood and quality of life . METHOD Data were collected between December 2002 and March 2004 with 72 women who were at least 3 months post-completion of primary treatment without current evidence of disease . Women were r and omly assigned to either the cognitive behavioural therapy for insomnia group , which received stimulus control instructions , sleep restriction therapy and sleep education and hygiene , or the component control group which received sleep education and hygiene only . The 10-week study consisted of 2 weeks of pre-treatment , 6 weeks of treatment and 2 weeks of post-treatment . Fatigue , mood and quality of life were measured at pre- and post-treatment . FINDINGS Women receiving cognitive behavioural therapy for insomnia had significant improvements in fatigue , trait anxiety , depression and quality of life . The component control group also had statistically significant increases in quality of life , with a trend suggestive of lower depression at post-treatment . CONCLUSION Globally , as the number of survivors in this population continues to grow , it is imperative that nurses continue testing interventions that may positively affect quality of life and the commonly experienced symptoms of fatigue , anxiety and depression OBJECTIVES We evaluated recurrence and survival for 68 patients with malignant melanoma who participated in a 6-week structured psychiatric group intervention 5 to 6 years earlier , shortly after their diagnosis and initial surgical treatment . We also explored the role of several factors as possible predictors of outcome . DESIGN This was a r and omized controlled experimental study . The Cox proportion hazards regression model was used to quantify the relationship between treatment and the outcomes adjusted by the covariates ( age , sex , Breslow depth , tumor site , baseline Profile of Mood States Total Mood Disturbance , baseline active-behavioral coping , baseline natural killer cell activity , and treatment [ ie , group intervention ] ) . The stepwise procedure was used for covariate selection . RESULTS For control patients , there was a trend for recurrence ( 13/34 ) and a statistically significant greater rate of death ( 10/34 ) than for experimental patients ( 7/34 and 3/34 , respectively ) . We found that being male and having a greater Breslow depth predicted greater recurrence and poorer survival . Analysis of multiple covariates found that only Breslow depth and treatment ( ie , group intervention ) were significant . Adjusting for Breslow depth , treatment effect remained significant . Finally , baseline affective distress and baseline coping were significant psychobehavioral predictors for recurrence and survival . Surprisingly , higher levels of baseline distress as well as baseline coping and enhancement of active-behavioral coping over time were predictive of lower rates of recurrence and death . CONCLUSION Psychiatric interventions that enhance effective coping and reduce affective distress appear to have beneficial effects on survival but are not proposed as an alternative or independent treatment for cancer or any other illness or disease . However , the exact nature of this relationship warrants further investigation Cancer patients who had been treated for early stage breast cancer and were diagnosed with either positive axillary lymph nodes or distant metastases were r and omly assigned to either a 13-week experiential-existential group psychotherapy ( EEGP ) program or a waiting list control ( WLC ) condition .  Endocrine and immune measures were obtained before and after the intervention period . The findings of this study are that , after the 13 weeks of the experiment , patients in the EEGP group showed lower levels of plasma cortisol and lower levels of prolactin as well as lower percentages of natural killer cells , CD8 cells , and CD4 cells in addition to a lower proliferative response to pokeweed mitogen than patients in the WLC group . Importantly , this was only found in those breast cancer patients presenting relatively high endocrine and immune baseline levels , suggesting that the patients ' profile with regard to endocrine and immune function at the start of a program can have an important effect . If replicated on a larger scale , the current results may be relevant for the treatment of breast cancer Background : Individuals with cancer receiving chemotherapy suffer deterioration in physical functioning due to symptoms arising from the cancer disease process and its treatment . Objectives : To determine if age , chronic health conditions ( comorbidity ) , stage of cancer , depressive symptomatology , symptom limitations , sex , and site of cancer moderate the effects of cognitive behavioral intervention on physical function and to determine if symptom limitations mediate the effect of the intervention on physical functioning . Methods : Two hundred thirty-seven individuals with solid tumor cancer ( 118 experimental and 119 control group ) participated in this 10-contact , 18-week r and omized control trial . Cognitive behavioral theory guided the nurse-delivered problem-solving experimental intervention . The control group received conventional care . Interviews occurred at baseline and 10 , 20 , and 32 weeks . Results : Women with breast cancer had significantly better physical functioning than women with lung cancer . Chronic health conditions , symptom limitation , and depressive symptomatology at baseline were found to moderate the effect of intervention on physical function . Symptom limitation , however , was not found to mediate the effect of intervention on physical functioning . Discussion : The intervention was shown to affect physical function trajectories differently for individuals with different personal and health characteristics . Because poor physical functioning is strongly associated with mortality and poor quality of life , this information may be used by health professionals to target interventions to those who might be most responsive BACKGROUND We conducted a r and omised , controlled trial of cognitive-existential group therapy ( CEGT ) for women with early stage breast cancer receiving adjuvant chemotherapy with the aim of improving mood and mental attitude to cancer . METHODS Women were r and omised to 20 sessions of weekly group therapy plus 3 relaxation classes or to a control arm receiving 3 relaxation classes . Assessment s , independently done at baseline , 6 and 12 months , included a structured psychiatric interview and vali date d question naires covering mood , attitudes to cancer , family relationships , and satisfaction with therapy . RESULTS Three hundred and three of 491 ( 62 % ) eligible patients participated over 3 years .  Distress was high pre-intervention : 10 % were diagnosed as suffering from major depression , 27 % from minor depression and 9 % from anxiety disorders . On an intention-to-treat analysis , there was a trend for those receiving group therapy ( n=154 ) to have reduced anxiety ( p=0.05 , 2-sided ) compared to controls ( n=149 ) . Women in group therapy also showed a trend towards improved family functioning compared to controls ( p=0.07 , 2-sided ) . The women in the groups reported greater satisfaction with their therapy ( p<0.001 , 2-sided ) , appreciating the support and citing better coping , self-growth and increased knowledge about cancer and its treatment . They valued the CEGT therapy . Overall effect size for the group intervention was small ( d=0.25 ) , with cancer recurrence having a deleterious effect in three of the 19 therapy groups . Psychologists as a discipline achieved a moderate mean effect size ( d=0.52 ) . CONCLUSION CEGT is a useful adjuvant psychological therapy for women with early stage breast cancer . Interaction effects between group members and therapists are relevant to outcome . Group-as-a-whole effects are powerful , but the training and experience of the therapist is especially critical to an efficacious outcome PURPOSE The r and omized study aim ed to determine the efficacy of psychological intervention consisting of relaxation and guided imagery to reduce anxiety and depression in gynecologic and breast cancer patients undergoing brachytherapy during hospitalization . METHODS AND MATERIAL S Sixty-six patients programmed to receive brachytherapy in two hospitals in Barcelona ( Spain ) were included in this study . The patients were r and omly allocated to either the study group ( n=32 ) or the control group ( n=34 ) . Patients in both groups received training regarding brachytherapy , but only study group patients received training in relaxation and guided imagery . After collection of sociodemographic data , all patients were given a set of question naires on anxiety and depression : the Hospital Anxiety and Depression Scale ( HADS ) , and on quality of life : Cuestionario de Calidad de Vida QL-CA-AFex ( CCV ) , prior to , during and after brachytherapy . RESULTS The study group demonstrated a statistically significant reduction in anxiety ( p=0.008 ) , depression ( p=0.03 ) and body discomfort ( p=0.04 ) compared with the control group . CONCLUSIONS The use of relaxation techniques and guided imagery is effective in reducing the levels of anxiety , depression and body discomfort in patients who must remain isolated while undergoing brachytherapy . This simple and inexpensive intervention enhances the psychological wellness in patients undergoing brachytherapy . State : This study has passed Ethical Committee review The purpose of this study was to classify breast carcinomas based on variations in gene expression patterns derived from cDNA microarrays and to correlate tumor characteristics to clinical outcome . A total of 85 cDNA microarray experiments representing 78 cancers , three fibroadenomas , and four normal breast tissues were analyzed by hierarchical clustering . As reported previously , the cancers could be classified into a basal epithelial-like group , an ERBB2-overexpressing group and a normal breast-like group based on variations in gene expression . A novel finding was that the previously characterized luminal epithelial/estrogen receptor-positive group could be divided into at least two subgroups , each with a distinctive expression profile . These subtypes proved to be reasonably robust by clustering using two different gene sets : first , a set of 456 cDNA clones previously selected to reflect intrinsic properties of the tumors and , second , a gene set that highly correlated with patient outcome . Survival analyses on a subcohort of patients with locally advanced breast cancer uniformly treated in a prospect i ve study showed significantly different outcomes for the patients belonging to the various groups , including a poor prognosis for the basal-like subtype and a significant difference in outcome for the two estrogen receptor-positive groups Addressing psychosocial and quality of life needs is central to provision of excellent care for people with advanced cancer . This study tested a brief nurse-delivered intervention to address the needs of urban women 
    Output:
    