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 : Cancer patients experience many physical and psychosocial problems for which they need support . WebChoice is an Internet-based , interactive health communication application that allows cancer patients to monitor their symptoms and problems , provides individually tailored information and self-management support , e-communication with expert cancer nurses , and an e-forum for group discussion with other patients . Objective : The objective of this study was to examine the effects of WebChoice on symptom distress ( primary outcome ) , depression , self-efficacy , health-related quality of life , and social support ( secondary outcomes ) . Methods : In this 1-year repeated- measures r and omized controlled trial , 325 breast and prostate cancer patients were r and omized into 1 experimental group  with access to WebChoice and 1 control group who received URLs of publicly available cancer Web sites . Results : Group differences on symptom distress were significant only for the global symptom distress index on the Memorial Symptom Assessment Scale ( slope estimate , −0.052 [ 95 % confidence interval , −0.101 to −0.004 ] ; t = 4.42 ; P = .037 ) . There were no significant group differences on secondary outcomes . Additional analyses showed significant within-group improvements in depression in the experimental group only . In the control group , self-efficacy and health-related quality of life deteriorated significantly over time . Conclusion : This r and omized controlled trial is one of the first to evaluate effects of an interactive health communication application to support cancer patients in illness management on symptoms . Although only 1 hypothesis was partially supported , the combined results show a clear trend toward better scores in the intervention group on most outcome measures . Implication s for Practice : If findings can be supported with additional research , WebChoice may become an important tool to support nursing care that can equip cancer patients to better manage their illness Background There are over 25 million people worldwide living with or beyond cancer and this number is increasing . Cancer survivors face a range of problems following primary treatment . One of the most frequently reported and distressing symptoms experienced by cancer survivors is fatigue . There is growing support for survivors who are experiencing problems after cancer treatment to engage in supported self-management . To date there is some evidence of effective interventions to manage fatigue in this population ; however , to our knowledge there are no online re sources that draw on this information to support self-management of fatigue . This paper describes the protocol for an exploratory r and omized controlled trial of an online intervention to support self-management of cancer-related fatigue after primary cancer treatment . Methods / design This is a parallel-group two-armed ( 1:1 ) exploratory r and omized controlled trial including 125 cancer survivors experiencing fatigue ( scoring ≥4 on a unidimensional 11-point numeric rating scale for fatigue intensity ) within five years of primary treatment completion with curative intent . Participants will be recruited from 13 NHS Trusts across the UK and r and omized to either the online intervention ( RESTORE ) , or a leaflet comparator ( Macmillan Cancer Backup , Coping with Fatigue ) . The primary outcome is a change in Perceived Self-Efficacy for Fatigue Self-Management ( as measured by the Perceived Self-Efficacy for Fatigue Self-Management Instrument ) . Secondary outcomes include impact on perception and experience of fatigue ( measured by the Brief Fatigue Inventory ) , and quality of life ( measured by the Functional Assessment of Cancer Therapy - General and the Personal Wellbeing Index ) . Outcome measures will be collected at baseline , 6 weeks ( completion of intervention ) , and 3 months . Process evaluation ( including telephone interviews with recruiting staff and participants ) will determine acceptability of the intervention and trial processes . Discussion Data from this trial will be used to refine the intervention and contribute to the design of an effectiveness trial . This intervention will be exp and ed to address other cancer-related problems important to cancer survivors following primary cancer treatment . Trial registration IS RCT This longitudinal study evaluated the effect a prostate cancer-specific online support group had for self-assessed quality of life .  Participants ( N = 40 ) were r and omly assigned to an online support group or the control group . Data consisted of four previously vali date d quality -of-life measurements . Analysis determined that over time , quality of life improved for those in the online group and decreased for those in the control group , but returned to baseline at eight weeks . Providing support using online methods is effective ; the length of time this intervention should be provided to patients will require further research Background : Internet-based methods for provision of psychological support and intervention to cancer survivors hold promise for increasing the public impact of such treatments . Purpose : The goal of this controlled pilot study was to examine the effect and potential mechanisms of action of a self-guided , Internet-based coping-skills training group on quality of life outcomes in women with early-stage breast cancer . Methods : Sixty-two women completed baseline evaluations and were r and omized into either a small online coping group or a waiting-list control condition . Results : No main effects for treatment were observed at the 12-week follow up . However , there was a significant interaction between baseline self-reported health status and treatment , such that women with poorer self-perceived health status showed greater improvement in perceived health over time when assigned to the treatment condition . Linguistic analyses revealed that positive changes across quality of life variables were associated with greater expression of negative emotions such as sadness and anxiety , greater cognitive processing , and lower expression of health-related concerns . Conclusions : These results demonstrate the potential efficacy of self-guided Internet coping groups while highlighting the limitations of such groups Background Prostate cancer is the most common cancer affecting men in the United States . Management options for localized disease exist , yet an evidence -based criterion st and ard for treatment still has to emerge . Although 5-year survival rates approach 98 % , all treatment options carry the possibility for significant side effects , such as erectile dysfunction and urinary incontinence . It is therefore recommended that patients be actively involved in the treatment decision process . We have developed an Internet/CD-ROM-based multimedia Prostate Interactive Educational System ( PIES ) to enhance patients ’ treatment decision making . PIES virtually mirrors a health center to provide patients with information about prostate cancer and its treatment through an intuitive interface , using videos , animations , graphics , and texts . Objectives ( 1 ) To examine the acceptability and feasibility of the PIES intervention and to report preliminary outcomes of the program in a pilot trial among patients with a new prostate cancer diagnosis , and ( 2 ) to explore the potential impact of tailoring PIES treatment information to participants ’ information-seeking styles on study outcomes . Methods Participants ( n = 72 ) were patients with newly diagnosed localized prostate cancer who had not made a treatment decision . Patients were r and omly assigned to 3 experimental conditions : ( 1 ) control condition ( providing information through st and ard National Cancer Institute brochures ; 26 % ) , and PIES ( 2 ) with tailoring ( 43 % ) and ( 3 ) without tailoring to a patient ’s information-seeking style ( 31 % ) . Question naires were administrated before ( t1 ) and immediately after the intervention ( t2 ) . Measurements include evaluation and acceptability of the PIES intervention , monitoring/blunting information-seeking style , psychological distress , and decision-related variables ( eg , decisional confidence , feeling informed about prostate cancer and treatment , and treatment preference ) . Results The PIES program was well accepted by patients and did not interfere with the clinical routine . About 79 % of eligible patients ( 72/91 ) completed the pre- and post-PIES intervention assessment s. Patients in the PIES groups compared with those in the control condition were significantly more likely to report higher levels of confidence in their treatment choices , higher levels of helpfulness of the information they received in making a treatment decision , and that the information they received was emotionally reassuring . Patients in the PIES groups compared with those in the control condition were significantly less likely to need more information about treatment options , were less anxious about their treatment choices , and thought the information they received was clear ( P < .05 ) . Tailoring PIES information to information-seeking style was not related to decision-making variables . Conclusions This pilot study confirms that the implementation of PIES within a clinical practice is feasible and acceptable to patients with a recent diagnosis of prostate cancer . PIES improved key decision-making process variables and reduced the emotional impact of a difficult medical decision OBJECTIVES The psychosexual concerns of gynecologic cancer patients are often unaddressed and there are limited re sources available for women to deal with this highly sensitive topic . This feasibility study examines the participation rates and preliminary outcomes for an online support group design ed specifically for women who are sexually distressed subsequent to gynecologic cancer treatment METHODS A 12-week online intervention was developed to address the psychosexual impact of gynecologic cancer . This intervention included a professionally moderated , asynchronous discussion forum as well as the provision of psycho-educational material s addressing the psychosexual impact of gynecologic cancer . Each week , a new topic was introduced and relevant material was posted on the website . Women were encouraged to share their experiences related to the topic . Twenty-seven , sexually distressed , remitted gynecologic cancer patients were r and omly assigned to immediate treatment or a waitlist control condition . Participants completed question naires at baseline , 4-month and 8-month follow-ups assessing sexual distress as the primary outcome as well as anxiety , depression , and illness intrusiveness . RESULTS Participation rates differed between the two groups , with greater participation occurring in the second group . Exit interviews indicated that the majority of the participants were satisfied with the intervention . Intent-to-treat analyses suggest a small effect for reduction in sexual distress CONCLUSIONS This feasibility study suggests that women find this intervention acceptable . Further research is required to determine efficacy To compare the benefits of the Internet generally versus a focused system of services , 257 breast cancer patients were r and omly assigned to a control group , access to the Internet with links to high- quality breast cancer sites , or access to an eHealth system ( Comprehensive Health Enhancement Support System , CHESS ) that integrated information , support , and decision and analysis tools . The intervention lasted 5 months , and self-report data on quality of life , health-care competence , and social support were collected at pretest and at 2- , 4- , and 9-month posttests . CHESS subjects logged on more overall than Internet subjects and accessed more health re sources , but the latter used non health-related sites more . Subjects with access to the Internet alone experienced no better outcomes than controls at any of the 3 time points , compared to pretest levels . Subjects with CHESS experienced greater social support during the intervention period and had higher scores on all 3 outcomes at 9 months , 4 months after the intervention ended . CHESS subjects also scored higher than those with Internet access during the intervention period but not significantly after the intervention ended . Thus , CHESS ( with one simple interface and integrated information , communication , and skills services ) helped newly diagnosed breast cancer patients even after computers were removed . In contrast , patients received little benefit from Internet access , despite having links to a variety of high- quality sites OBJECTIVES Telemedicine applications carry the potential to enhance the quality of life of patients , but studies evaluating telemedicine applications are still scarce . The evidence regarding the effectiveness of telemedicine is limited and not yet conclusive . This study investigated whether telemedicine could be beneficial to the quality of life of cancer patients . DESIGN AND MEASUREMENTS Between 1999 and 2002 , we conducted a prospect i ve controlled trial evaluating the effects of a telemedicine application on the quality of life of patients with cancer involving the head and neck , using quality of life question naires that covered 22 quality of life parameters . All patients had undergone surgery for head and neck cancer at the Erasmus MC , a tertiary university hospital in The Netherl and s. Patients in the intervention group were given access to an electronic health information support system for a period of six weeks , starting at discharge from the hospital . RESULTS In total , we included 145 patients in the control group and 39 in the intervention group . At 6 weeks , the end of the intervention , the intervention group had significantly improved QoL in 5 of the 22 studied parameters . Only one of these five quality of life parameters remained significantly different at 12 weeks . CONCLUSIONS This study adds to the sparse evidence that telemedicine may be beneficial for the quality of life of cancer patients Background Psychological distress ( i.e. depression and anxiety ) is a strong predictor of functional status and other aspects of quality of life in autologous stem cell transplantation following high-dose chemotherapy . Treatment of psychological distress is hypothesized to result in improvement of functional status and other aspects of quality of life . The aim is to evaluate the outcome of stepped care for psychological distress on functional status and other aspects of quality of life in patients with hematological malignancy treated with autologous stem cell transplantation . Methods / Design The study is design ed as a r and omized clinical trial with 2 treatment arms : a stepped care intervention program versus care as usual .  Patients are r and omized immediately pre transplant .  Stepped care and care as usual are initiated after a 6 weeks buffer period . Outcome is evaluated at 13 , 30 , and 42 weeks post transplant . In the experimental group , the first step includes an Internet-based self-help program . If psychological distress persists after the self-help intervention , the second step of the program is executed , i.e. a diagnostic evaluation and a st and ardized interview , yielding a problem analysis . Based on this information , a contract is made with the patient and treatment is provided consisting of individual face-to-face counseling , medication , or referral to other services . Care as usual comprises an interview with the patient , on ad hoc basis ; emotional support and advice , on ad hoc basis ; if urgent problems emerge , the patient is referred to other services . Primary outcome variables are psychological distress and functional status . Data are analyzed according to the intention to treat-principle . Discussion This study has several innovative characteristics . First , the outcome of the intervention for psychological distress in patients with hematological malignancy treated with autologous stem cell transplantation is evaluated in a r and omized controlled study . Second , the impact of the intervention on functional status is evaluated : it is hypothesized that reduction of psychological distress results in improved functional status . Furthermore , the intervention concerns an Internet-based treatment in the first step . Finally , 
    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 : Cancer patients experience many physical and psychosocial problems for which they need support . WebChoice is an Internet-based , interactive health communication application that allows cancer patients to monitor their symptoms and problems , provides individually tailored information and self-management support , e-communication with expert cancer nurses , and an e-forum for group discussion with other patients . Objective : The objective of this study was to examine the effects of WebChoice on symptom distress ( primary outcome ) , depression , self-efficacy , health-related quality of life , and social support ( secondary outcomes ) . Methods : In this 1-year repeated- measures r and omized controlled trial , 325 breast and prostate cancer patients were r and omized into 1 experimental group  with access to WebChoice and 1 control group who received URLs of publicly available cancer Web sites . Results : Group differences on symptom distress were significant only for the global symptom distress index on the Memorial Symptom Assessment Scale ( slope estimate , −0.052 [ 95 % confidence interval , −0.101 to −0.004 ] ; t = 4.42 ; P = .037 ) . There were no significant group differences on secondary outcomes . Additional analyses showed significant within-group improvements in depression in the experimental group only . In the control group , self-efficacy and health-related quality of life deteriorated significantly over time . Conclusion : This r and omized controlled trial is one of the first to evaluate effects of an interactive health communication application to support cancer patients in illness management on symptoms . Although only 1 hypothesis was partially supported , the combined results show a clear trend toward better scores in the intervention group on most outcome measures . Implication s for Practice : If findings can be supported with additional research , WebChoice may become an important tool to support nursing care that can equip cancer patients to better manage their illness Background There are over 25 million people worldwide living with or beyond cancer and this number is increasing . Cancer survivors face a range of problems following primary treatment . One of the most frequently reported and distressing symptoms experienced by cancer survivors is fatigue . There is growing support for survivors who are experiencing problems after cancer treatment to engage in supported self-management . To date there is some evidence of effective interventions to manage fatigue in this population ; however , to our knowledge there are no online re sources that draw on this information to support self-management of fatigue . This paper describes the protocol for an exploratory r and omized controlled trial of an online intervention to support self-management of cancer-related fatigue after primary cancer treatment . Methods / design This is a parallel-group two-armed ( 1:1 ) exploratory r and omized controlled trial including 125 cancer survivors experiencing fatigue ( scoring ≥4 on a unidimensional 11-point numeric rating scale for fatigue intensity ) within five years of primary treatment completion with curative intent . Participants will be recruited from 13 NHS Trusts across the UK and r and omized to either the online intervention ( RESTORE ) , or a leaflet comparator ( Macmillan Cancer Backup , Coping with Fatigue ) . The primary outcome is a change in Perceived Self-Efficacy for Fatigue Self-Management ( as measured by the Perceived Self-Efficacy for Fatigue Self-Management Instrument ) . Secondary outcomes include impact on perception and experience of fatigue ( measured by the Brief Fatigue Inventory ) , and quality of life ( measured by the Functional Assessment of Cancer Therapy - General and the Personal Wellbeing Index ) . Outcome measures will be collected at baseline , 6 weeks ( completion of intervention ) , and 3 months . Process evaluation ( including telephone interviews with recruiting staff and participants ) will determine acceptability of the intervention and trial processes . Discussion Data from this trial will be used to refine the intervention and contribute to the design of an effectiveness trial . This intervention will be exp and ed to address other cancer-related problems important to cancer survivors following primary cancer treatment . Trial registration IS RCT This longitudinal study evaluated the effect a prostate cancer-specific online support group had for self-assessed quality of life .  Participants ( N = 40 ) were r and omly assigned to an online support group or the control group . Data consisted of four previously vali date d quality -of-life measurements . Analysis determined that over time , quality of life improved for those in the online group and decreased for those in the control group , but returned to baseline at eight weeks . Providing support using online methods is effective ; the length of time this intervention should be provided to patients will require further research Background : Internet-based methods for provision of psychological support and intervention to cancer survivors hold promise for increasing the public impact of such treatments . Purpose : The goal of this controlled pilot study was to examine the effect and potential mechanisms of action of a self-guided , Internet-based coping-skills training group on quality of life outcomes in women with early-stage breast cancer . Methods : Sixty-two women completed baseline evaluations and were r and omized into either a small online coping group or a waiting-list control condition . Results : No main effects for treatment were observed at the 12-week follow up . However , there was a significant interaction between baseline self-reported health status and treatment , such that women with poorer self-perceived health status showed greater improvement in perceived health over time when assigned to the treatment condition . Linguistic analyses revealed that positive changes across quality of life variables were associated with greater expression of negative emotions such as sadness and anxiety , greater cognitive processing , and lower expression of health-related concerns . Conclusions : These results demonstrate the potential efficacy of self-guided Internet coping groups while highlighting the limitations of such groups Background Prostate cancer is the most common cancer affecting men in the United States . Management options for localized disease exist , yet an evidence -based criterion st and ard for treatment still has to emerge . Although 5-year survival rates approach 98 % , all treatment options carry the possibility for significant side effects , such as erectile dysfunction and urinary incontinence . It is therefore recommended that patients be actively involved in the treatment decision process . We have developed an Internet/CD-ROM-based multimedia Prostate Interactive Educational System ( PIES ) to enhance patients ’ treatment decision making . PIES virtually mirrors a health center to provide patients with information about prostate cancer and its treatment through an intuitive interface , using videos , animations , graphics , and texts . Objectives ( 1 ) To examine the acceptability and feasibility of the PIES intervention and to report preliminary outcomes of the program in a pilot trial among patients with a new prostate cancer diagnosis , and ( 2 ) to explore the potential impact of tailoring PIES treatment information to participants ’ information-seeking styles on study outcomes . Methods Participants ( n = 72 ) were patients with newly diagnosed localized prostate cancer who had not made a treatment decision . Patients were r and omly assigned to 3 experimental conditions : ( 1 ) control condition ( providing information through st and ard National Cancer Institute brochures ; 26 % ) , and PIES ( 2 ) with tailoring ( 43 % ) and ( 3 ) without tailoring to a patient ’s information-seeking style ( 31 % ) . Question naires were administrated before ( t1 ) and immediately after the intervention ( t2 ) . Measurements include evaluation and acceptability of the PIES intervention , monitoring/blunting information-seeking style , psychological distress , and decision-related variables ( eg , decisional confidence , feeling informed about prostate cancer and treatment , and treatment preference ) . Results The PIES program was well accepted by patients and did not interfere with the clinical routine . About 79 % of eligible patients ( 72/91 ) completed the pre- and post-PIES intervention assessment s. Patients in the PIES groups compared with those in the control condition were significantly more likely to report higher levels of confidence in their treatment choices , higher levels of helpfulness of the information they received in making a treatment decision , and that the information they received was emotionally reassuring . Patients in the PIES groups compared with those in the control condition were significantly less likely to need more information about treatment options , were less anxious about their treatment choices , and thought the information they received was clear ( P < .05 ) . Tailoring PIES information to information-seeking style was not related to decision-making variables . Conclusions This pilot study confirms that the implementation of PIES within a clinical practice is feasible and acceptable to patients with a recent diagnosis of prostate cancer . PIES improved key decision-making process variables and reduced the emotional impact of a difficult medical decision OBJECTIVES The psychosexual concerns of gynecologic cancer patients are often unaddressed and there are limited re sources available for women to deal with this highly sensitive topic . This feasibility study examines the participation rates and preliminary outcomes for an online support group design ed specifically for women who are sexually distressed subsequent to gynecologic cancer treatment METHODS A 12-week online intervention was developed to address the psychosexual impact of gynecologic cancer . This intervention included a professionally moderated , asynchronous discussion forum as well as the provision of psycho-educational material s addressing the psychosexual impact of gynecologic cancer . Each week , a new topic was introduced and relevant material was posted on the website . Women were encouraged to share their experiences related to the topic . Twenty-seven , sexually distressed , remitted gynecologic cancer patients were r and omly assigned to immediate treatment or a waitlist control condition . Participants completed question naires at baseline , 4-month and 8-month follow-ups assessing sexual distress as the primary outcome as well as anxiety , depression , and illness intrusiveness . RESULTS Participation rates differed between the two groups , with greater participation occurring in the second group . Exit interviews indicated that the majority of the participants were satisfied with the intervention . Intent-to-treat analyses suggest a small effect for reduction in sexual distress CONCLUSIONS This feasibility study suggests that women find this intervention acceptable . Further research is required to determine efficacy To compare the benefits of the Internet generally versus a focused system of services , 257 breast cancer patients were r and omly assigned to a control group , access to the Internet with links to high- quality breast cancer sites , or access to an eHealth system ( Comprehensive Health Enhancement Support System , CHESS ) that integrated information , support , and decision and analysis tools . The intervention lasted 5 months , and self-report data on quality of life , health-care competence , and social support were collected at pretest and at 2- , 4- , and 9-month posttests . CHESS subjects logged on more overall than Internet subjects and accessed more health re sources , but the latter used non health-related sites more . Subjects with access to the Internet alone experienced no better outcomes than controls at any of the 3 time points , compared to pretest levels . Subjects with CHESS experienced greater social support during the intervention period and had higher scores on all 3 outcomes at 9 months , 4 months after the intervention ended . CHESS subjects also scored higher than those with Internet access during the intervention period but not significantly after the intervention ended . Thus , CHESS ( with one simple interface and integrated information , communication , and skills services ) helped newly diagnosed breast cancer patients even after computers were removed . In contrast , patients received little benefit from Internet access , despite having links to a variety of high- quality sites OBJECTIVES Telemedicine applications carry the potential to enhance the quality of life of patients , but studies evaluating telemedicine applications are still scarce . The evidence regarding the effectiveness of telemedicine is limited and not yet conclusive . This study investigated whether telemedicine could be beneficial to the quality of life of cancer patients . DESIGN AND MEASUREMENTS Between 1999 and 2002 , we conducted a prospect i ve controlled trial evaluating the effects of a telemedicine application on the quality of life of patients with cancer involving the head and neck , using quality of life question naires that covered 22 quality of life parameters . All patients had undergone surgery for head and neck cancer at the Erasmus MC , a tertiary university hospital in The Netherl and s. Patients in the intervention group were given access to an electronic health information support system for a period of six weeks , starting at discharge from the hospital . RESULTS In total , we included 145 patients in the control group and 39 in the intervention group . At 6 weeks , the end of the intervention , the intervention group had significantly improved QoL in 5 of the 22 studied parameters . Only one of these five quality of life parameters remained significantly different at 12 weeks . CONCLUSIONS This study adds to the sparse evidence that telemedicine may be beneficial for the quality of life of cancer patients Background Psychological distress ( i.e. depression and anxiety ) is a strong predictor of functional status and other aspects of quality of life in autologous stem cell transplantation following high-dose chemotherapy . Treatment of psychological distress is hypothesized to result in improvement of functional status and other aspects of quality of life . The aim is to evaluate the outcome of stepped care for psychological distress on functional status and other aspects of quality of life in patients with hematological malignancy treated with autologous stem cell transplantation . Methods / Design The study is design ed as a r and omized clinical trial with 2 treatment arms : a stepped care intervention program versus care as usual .  Patients are r and omized immediately pre transplant .  Stepped care and care as usual are initiated after a 6 weeks buffer period . Outcome is evaluated at 13 , 30 , and 42 weeks post transplant . In the experimental group , the first step includes an Internet-based self-help program . If psychological distress persists after the self-help intervention , the second step of the program is executed , i.e. a diagnostic evaluation and a st and ardized interview , yielding a problem analysis . Based on this information , a contract is made with the patient and treatment is provided consisting of individual face-to-face counseling , medication , or referral to other services . Care as usual comprises an interview with the patient , on ad hoc basis ; emotional support and advice , on ad hoc basis ; if urgent problems emerge , the patient is referred to other services . Primary outcome variables are psychological distress and functional status . Data are analyzed according to the intention to treat-principle . Discussion This study has several innovative characteristics . First , the outcome of the intervention for psychological distress in patients with hematological malignancy treated with autologous stem cell transplantation is evaluated in a r and omized controlled study . Second , the impact of the intervention on functional status is evaluated : it is hypothesized that reduction of psychological distress results in improved functional status . Furthermore , the intervention concerns an Internet-based treatment in the first step . Finally , 
    Output:
    