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: In 1987 , the Division of Cancer Prevention and Control , National Cancer Institute ( NCI ) , funded a r and omized trial of a proactive counseling protocol to promote screening mammography among age-eligible female callers to the Cancer Information Service ( CIS ) . This protocol included interactive counseling by CIS counselors to help callers overcome barriers to screening mammography ;  this counseling was an extension of usual service and was combined with a 2-week follow-up mailout to reinforce the brief ( 6-minute ) proactive telephone-counseling protocol . The screening-mammography counseling intervention was tested in two regional CIS offices using a r and omized two-group design . Callers were r and omly assigned to the intervention or control group based on the week of their call to the CIS ( n = 1831 eligible female callers ) .  Self-reported adherence to NCI screening-mammography guidelines was assessed from telephone interviews conducted at 12 months ' follow-up ( 87 % response rate ) . Among all CIS callers enrolled in this study , self-reported adherence to screening-mammography guidelines at 12 months ' follow-up was 63.5 % . The most frequently cited barriers to screening mammography reported by CIS callers were inconvenience/being too busy ( 52 % ) , cost ( 36 % ) , lack of physician referral ( 34 % ) , no symptoms ( 34 % ) , and fear of radiation ( 29 % ) . A significant intervention effect on adherence behavior was found but only in one of the two test sites and only among CIS callers reporting total family income of $ 30,000 or more ( odds ratio = 1.38 , P = .04 ) . The vast majority ( 90 % ) of CIS callers ( both intervention and control subjects ) endorsed the concept of  proactive counseling  by the CIS . The implication s of these findings for the CIS and future research are discussed Purpose This study aims to examine the prevalence of psychosocial variables associated with anxiety and depression among partners and caregivers of cancer survivors , compare prevalence with community norms and report differences across cancer diagnosis . Methods A prospect i ve survey of partners and caregivers was undertaken to assess anxiety and depression and potential psychosocial variables associated with these outcomes at 6 and 12 months post-survivor diagnosis ( N = 436 ) . Results Although the proportion of anxious participants decreased over time ( p = 0.01 ) , the percentage of those depressed remained stable ( p = 0.68 ) . Most participants who were depressed were also anxious . To a certain extent , the prevalence of anxiety and depression exceeded community norms and varied across cancer types . Partners and caregivers particularly vulnerable included those of lung , haematological or head and neck survivors . High use of avoidant coping and interference in regular activities were associated with both anxiety and depression across time points . Of the different types of support measured , only lower emotional/informational support was associated with anxiety and depression at 6 months , whereas lower positive social interaction was associated with depression at 12 months . Additional variables associated with anxiety and depression at 12 months included higher unmet needs and involvement in personal and medical tasks , respectively . Conclusions Even at 12 months post-survivor diagnosis , almost a third of participants reported anxiety , a result partially predicted by high use of avoidant coping and interference in regular activities . Underst and ing variables associated with partners ’ and caregivers ’  anxiety and depression can lead to optimal referral to supportive care services and inform the tailoring of interventions to address those variables contributing to anxiety and depression at particular time points The Cancer Information Service ( CIS ) of the National Cancer Institute ( NCI ) is a health communications program that disseminates information through two channels : to individuals through a toll-free telephone service and to organizations ( serving primarily underserved population s ) through an outreach program . People call the 1 - 800 - 4-CANCER line to meet a variety of information needs . The information specialists who respond to these calls are prepared to answer questions ranging from cancer prevention to early detection , treatment , and survivorship . In a 1996 r and om sample survey , 2,489 callers were asked why they called , how they valued the information , and what health-related actions they took or decisions they made since their call . Results show the CIS is highly valued by its users , with satisfaction high across gender , age , education , and racial/ethnic groups . While differences in satisfaction were observed by caller type and subject of inquiry , nearly all respondents reported that contact with the CIS increased knowledge , provided reassurance , and influenced decisionmaking and health behavior . Overall , 95 % were satisfied with  CIS information , 98 % trusted the information , 92 % reported an increase in knowledge , 69 % felt reassured , and 73 % said the information helped them to better cope with their concerns . Eight out of 10 callers reported the information they received had a positive impact , with 56 % reporting taking a positive health action . Results demonstrate that health communications programs like the CIS can fill information gaps consumers must bridge to make informed health care decisions and can play an important public health role in motivating people to take actions to reduce risks and /or make decisions that lead to improved health status Summary A retrospective comparison of cancer incidence data and , where relevant , population data with 16 955 first-time users ( patients , relatives and friends ) of a national cancer information service ( CancerBACUP ) during the period April 1995 to March 1996 is presented . The number of events observed was compared with the number of events expected , were the national rates of cancer incidence and population demographics apply . St and ardized incidence ratios ( SIRs ) ( observed – expected ratios ) were used to indicate any differences . Statistically significant differences ( P < 0.001 ) in the observed and expected sex , age and primary site distribution of patients enquired about were found . Statistically significant differences ( P < 0.001 ) were also identified for the age , employment status , socioeconomic class and geographical location of first-time enquirers ( patients , relatives and friends ) . Enquiries about brain , testis and breast cancers and non-Hodgkin 's lymphoma ( NHL ) were substantially higher than expected ; enquiries about bladder , lung , stomach and colorectal cancers were much lower than expected . As the service is provided via a freephone number , it is available to all , and users might be expected to ber and omly distributed across the variables listed . The underlying reasons for the differences identified need to be investigated , and the role of information in the care of cancer patients should be formally evaluated Cancer Information Service ( CIS ) inquiries about cancer prevention and screening are an important opportunity to educate callers about primary or secondary cancer prevention , facilitate their decision-making , and , where appropriate , encourage action . An evaluation was conducted to assess whether these callers ' information needs are being satisfied and to determine if the information provided facilitates decisionmaking and subsequent risk reduction actions . A r and om sample of 2,489 callers was surveyed during a 5-week period , 3 to 6 weeks after their initial call to CIS ; prevention or screening was stated as the main reason for calling by 331 respondents . A series of questions was asked regarding level of satisfaction with CIS 's performance and how helpful the information provided was in terms of feeling more knowledgeable , making decisions , and taking action . The vast majority of respondents were satisfied with the information received , found it to be helpful , felt more knowledgeable as a result , and would call CIS again with subsequent questions . Although dem and characteristics are a possible source of bias , nearly three-quarters of the respondents reported subsequently discussing the information provided with someone else , and almost half sought additional information recommended by CIS . Nearly two-thirds of primary prevention respondents and about half of secondary prevention respondents indicated that they had taken some risk-reducing action subsequent to their interaction with CIS . The CIS is effectively satisfying the information needs of prevention and screening callers ; information it is providing is effectively facilitating decisionmaking and stimulating callers to take action Purpose To evaluate the utility of a telephone outcall program for cancer caregivers and to examine longitudinal changes in their distress levels and supportive care needs . Methods As part of the PROTECT trial , caregivers assigned to the intervention arm ( N = 108 ) received three telephone outcalls from a Cancer Council 13 11 20 nurse at three time points ( 7–10 days post-r and omization , 1 and 4 months later ) . During each call , caregivers were screened for distress using the Distress Thermometer ( range : 0–10 ) then six supportive care issues were raised for discussion . Participants completed a utility survey 1 month post-intervention . Results The outcall program was highly acceptable and perceived as beneficial by caregivers . Overall , 95 % reported it was worth their time to take part in the outcall program and 82 % stated that the program was very relevant to them . Level of distress and impact of distress decreased over time ( p = 0.0031 , p < 0.0001 , respectively ) . Average call duration decreased over time ( p < 0.0001 ) and was longer for female than male caregivers ( p = 0.0009 ) . The frequency of caregivers discussing issues related to psychological distress ( p = 0.0003 ) , health literacy ( p < 0.0001 ) , financial ( p = 0.0014 ) , and practical concerns ( p = 0.0121 ) decreased over time . Psychological distress was more often discussed by female than male caregivers ( p = 0.0153 ) , and family issues more often by younger ( < 55 years ) than older caregivers ( p = 0.0071 ) . Conclusions Utility of this outcall program was high . Caregivers ’ level of distress and unmet needs decreased over time . Gender and age differences emerged , which warrants the need for tailored support . Further research is necessary to identify the best method of improving access to 13 11 20 services for caregivers Background Informal caregivers provide extended support to people with cancer but they receive little support from the health care system to assist them in their caring role . The aim of this single-blind , multi-centre , r and omised controlled trial was to test the efficacy of a telephone outcall program to reduce caregiver burden and unmet needs , and improve psychological well-being  among cancer caregivers , as well as evaluating the potential impact on patient outcomes . Methods Cancer patient/caregiver dyads ( N = 216 ) were r and omised to a telephone outcall program ( n = 108 ) or attention control group ( n = 108 ) . The primary outcome was self-reported caregiver burden . Secondary endpoints included depressive symptoms , unmet needs , self-esteem , self-empowerment , and health literacy . Data were collected at baseline and at both 1 and 6 months post-intervention . An intention to treat analysis was performed . Results The intervention had no effect on the primary outcome ( caregiver burden ) , but reduced the number of caregiver unmet needs ( intervention group baseline , mean = 2.66 , 95 % confidence interval ( CI ) [ 1.91–3.54 ] ; intervention group 1 month post intervention , mean = 0.85 , 95%CI [ 0.42–1.44 ] ; control group baseline , mean = 1.30 95%CI [ 0.80–1.94 ] , control group 1 month post intervention , mean = 1.02 95%CI [ 0.52–1.69 ] ; p = 0.023 ) . For caregivers at risk for depression , the intervention had a significant effect on caregivers ’ confidence in having sufficient information to manage their health ( p = 0.040 ) . No effects were found for patients ’ depressive symptoms , unmet needs , self-empowerment , and other health literacy domains . Conclusions While caregiver burden was not reduced , the outcall program was effective in reducing unmet needs in caregivers . Provision of cancer information and support via a telephone service may represent a feasible approach to reducing unmet needs among cancer caregiver population s . Trial registration ACTRN12613000731796 ; prospect ively registered on 02/07/2013 PURPOSE / OBJECTIVES To compare the effectiveness of two low-intensity approaches for distressed patients with cancer and caregivers who had called cancer helplines seeking support . Baseline distress was hypothesized as a moderator of intervention effect . DESIGN R and omized trial . SETTING Community-based cancer helplines in Queensl and and New South Wales , Australia . SAMPLE 354 patients with cancer and 336 caregivers . METHODS Participants were r and omized to either a single session of nurse-led self-management intervention or a five-session psychologist cognitive behavioral intervention delivered by telephone . Assessment s were undertaken at baseline ( preintervention ) and at 3 , 6 , and 12 months . MAIN RESEARCH VARIABLES Psychological and cancer-specific distress and post-traumatic growth . FINDINGS No significant moderation by baseline cancer-specific distress was noted . For low-education patients , only the psychologist intervention was associated with a significant drop in distress . For all other participants , distress decreased over time in both arms with small to large effect sizes ( Cohen 's ds = 0.05 - 0.82 ) . Post-traumatic growth increased over time for all participants ( Cohen 's ds = 0.6 - 0.64 ) . CONCLUSIONS Many distressed patients with cancer and their caregivers may benefit significantly from a single session of a nurse psychoeducation intervention that can be delivered remotely by telephone and supported by self-management material s. Research is needed to develop an algorithm that moves beyond the use of distress as the only indicator for referral to specialist psychological services . Survivors and caregivers with low education and low literacy 
    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: In 1987 , the Division of Cancer Prevention and Control , National Cancer Institute ( NCI ) , funded a r and omized trial of a proactive counseling protocol to promote screening mammography among age-eligible female callers to the Cancer Information Service ( CIS ) . This protocol included interactive counseling by CIS counselors to help callers overcome barriers to screening mammography ;  this counseling was an extension of usual service and was combined with a 2-week follow-up mailout to reinforce the brief ( 6-minute ) proactive telephone-counseling protocol . The screening-mammography counseling intervention was tested in two regional CIS offices using a r and omized two-group design . Callers were r and omly assigned to the intervention or control group based on the week of their call to the CIS ( n = 1831 eligible female callers ) .  Self-reported adherence to NCI screening-mammography guidelines was assessed from telephone interviews conducted at 12 months ' follow-up ( 87 % response rate ) . Among all CIS callers enrolled in this study , self-reported adherence to screening-mammography guidelines at 12 months ' follow-up was 63.5 % . The most frequently cited barriers to screening mammography reported by CIS callers were inconvenience/being too busy ( 52 % ) , cost ( 36 % ) , lack of physician referral ( 34 % ) , no symptoms ( 34 % ) , and fear of radiation ( 29 % ) . A significant intervention effect on adherence behavior was found but only in one of the two test sites and only among CIS callers reporting total family income of $ 30,000 or more ( odds ratio = 1.38 , P = .04 ) . The vast majority ( 90 % ) of CIS callers ( both intervention and control subjects ) endorsed the concept of  proactive counseling  by the CIS . The implication s of these findings for the CIS and future research are discussed Purpose This study aims to examine the prevalence of psychosocial variables associated with anxiety and depression among partners and caregivers of cancer survivors , compare prevalence with community norms and report differences across cancer diagnosis . Methods A prospect i ve survey of partners and caregivers was undertaken to assess anxiety and depression and potential psychosocial variables associated with these outcomes at 6 and 12 months post-survivor diagnosis ( N = 436 ) . Results Although the proportion of anxious participants decreased over time ( p = 0.01 ) , the percentage of those depressed remained stable ( p = 0.68 ) . Most participants who were depressed were also anxious . To a certain extent , the prevalence of anxiety and depression exceeded community norms and varied across cancer types . Partners and caregivers particularly vulnerable included those of lung , haematological or head and neck survivors . High use of avoidant coping and interference in regular activities were associated with both anxiety and depression across time points . Of the different types of support measured , only lower emotional/informational support was associated with anxiety and depression at 6 months , whereas lower positive social interaction was associated with depression at 12 months . Additional variables associated with anxiety and depression at 12 months included higher unmet needs and involvement in personal and medical tasks , respectively . Conclusions Even at 12 months post-survivor diagnosis , almost a third of participants reported anxiety , a result partially predicted by high use of avoidant coping and interference in regular activities . Underst and ing variables associated with partners ’ and caregivers ’  anxiety and depression can lead to optimal referral to supportive care services and inform the tailoring of interventions to address those variables contributing to anxiety and depression at particular time points The Cancer Information Service ( CIS ) of the National Cancer Institute ( NCI ) is a health communications program that disseminates information through two channels : to individuals through a toll-free telephone service and to organizations ( serving primarily underserved population s ) through an outreach program . People call the 1 - 800 - 4-CANCER line to meet a variety of information needs . The information specialists who respond to these calls are prepared to answer questions ranging from cancer prevention to early detection , treatment , and survivorship . In a 1996 r and om sample survey , 2,489 callers were asked why they called , how they valued the information , and what health-related actions they took or decisions they made since their call . Results show the CIS is highly valued by its users , with satisfaction high across gender , age , education , and racial/ethnic groups . While differences in satisfaction were observed by caller type and subject of inquiry , nearly all respondents reported that contact with the CIS increased knowledge , provided reassurance , and influenced decisionmaking and health behavior . Overall , 95 % were satisfied with  CIS information , 98 % trusted the information , 92 % reported an increase in knowledge , 69 % felt reassured , and 73 % said the information helped them to better cope with their concerns . Eight out of 10 callers reported the information they received had a positive impact , with 56 % reporting taking a positive health action . Results demonstrate that health communications programs like the CIS can fill information gaps consumers must bridge to make informed health care decisions and can play an important public health role in motivating people to take actions to reduce risks and /or make decisions that lead to improved health status Summary A retrospective comparison of cancer incidence data and , where relevant , population data with 16 955 first-time users ( patients , relatives and friends ) of a national cancer information service ( CancerBACUP ) during the period April 1995 to March 1996 is presented . The number of events observed was compared with the number of events expected , were the national rates of cancer incidence and population demographics apply . St and ardized incidence ratios ( SIRs ) ( observed – expected ratios ) were used to indicate any differences . Statistically significant differences ( P < 0.001 ) in the observed and expected sex , age and primary site distribution of patients enquired about were found . Statistically significant differences ( P < 0.001 ) were also identified for the age , employment status , socioeconomic class and geographical location of first-time enquirers ( patients , relatives and friends ) . Enquiries about brain , testis and breast cancers and non-Hodgkin 's lymphoma ( NHL ) were substantially higher than expected ; enquiries about bladder , lung , stomach and colorectal cancers were much lower than expected . As the service is provided via a freephone number , it is available to all , and users might be expected to ber and omly distributed across the variables listed . The underlying reasons for the differences identified need to be investigated , and the role of information in the care of cancer patients should be formally evaluated Cancer Information Service ( CIS ) inquiries about cancer prevention and screening are an important opportunity to educate callers about primary or secondary cancer prevention , facilitate their decision-making , and , where appropriate , encourage action . An evaluation was conducted to assess whether these callers ' information needs are being satisfied and to determine if the information provided facilitates decisionmaking and subsequent risk reduction actions . A r and om sample of 2,489 callers was surveyed during a 5-week period , 3 to 6 weeks after their initial call to CIS ; prevention or screening was stated as the main reason for calling by 331 respondents . A series of questions was asked regarding level of satisfaction with CIS 's performance and how helpful the information provided was in terms of feeling more knowledgeable , making decisions , and taking action . The vast majority of respondents were satisfied with the information received , found it to be helpful , felt more knowledgeable as a result , and would call CIS again with subsequent questions . Although dem and characteristics are a possible source of bias , nearly three-quarters of the respondents reported subsequently discussing the information provided with someone else , and almost half sought additional information recommended by CIS . Nearly two-thirds of primary prevention respondents and about half of secondary prevention respondents indicated that they had taken some risk-reducing action subsequent to their interaction with CIS . The CIS is effectively satisfying the information needs of prevention and screening callers ; information it is providing is effectively facilitating decisionmaking and stimulating callers to take action Purpose To evaluate the utility of a telephone outcall program for cancer caregivers and to examine longitudinal changes in their distress levels and supportive care needs . Methods As part of the PROTECT trial , caregivers assigned to the intervention arm ( N = 108 ) received three telephone outcalls from a Cancer Council 13 11 20 nurse at three time points ( 7–10 days post-r and omization , 1 and 4 months later ) . During each call , caregivers were screened for distress using the Distress Thermometer ( range : 0–10 ) then six supportive care issues were raised for discussion . Participants completed a utility survey 1 month post-intervention . Results The outcall program was highly acceptable and perceived as beneficial by caregivers . Overall , 95 % reported it was worth their time to take part in the outcall program and 82 % stated that the program was very relevant to them . Level of distress and impact of distress decreased over time ( p = 0.0031 , p < 0.0001 , respectively ) . Average call duration decreased over time ( p < 0.0001 ) and was longer for female than male caregivers ( p = 0.0009 ) . The frequency of caregivers discussing issues related to psychological distress ( p = 0.0003 ) , health literacy ( p < 0.0001 ) , financial ( p = 0.0014 ) , and practical concerns ( p = 0.0121 ) decreased over time . Psychological distress was more often discussed by female than male caregivers ( p = 0.0153 ) , and family issues more often by younger ( < 55 years ) than older caregivers ( p = 0.0071 ) . Conclusions Utility of this outcall program was high . Caregivers ’ level of distress and unmet needs decreased over time . Gender and age differences emerged , which warrants the need for tailored support . Further research is necessary to identify the best method of improving access to 13 11 20 services for caregivers Background Informal caregivers provide extended support to people with cancer but they receive little support from the health care system to assist them in their caring role . The aim of this single-blind , multi-centre , r and omised controlled trial was to test the efficacy of a telephone outcall program to reduce caregiver burden and unmet needs , and improve psychological well-being  among cancer caregivers , as well as evaluating the potential impact on patient outcomes . Methods Cancer patient/caregiver dyads ( N = 216 ) were r and omised to a telephone outcall program ( n = 108 ) or attention control group ( n = 108 ) . The primary outcome was self-reported caregiver burden . Secondary endpoints included depressive symptoms , unmet needs , self-esteem , self-empowerment , and health literacy . Data were collected at baseline and at both 1 and 6 months post-intervention . An intention to treat analysis was performed . Results The intervention had no effect on the primary outcome ( caregiver burden ) , but reduced the number of caregiver unmet needs ( intervention group baseline , mean = 2.66 , 95 % confidence interval ( CI ) [ 1.91–3.54 ] ; intervention group 1 month post intervention , mean = 0.85 , 95%CI [ 0.42–1.44 ] ; control group baseline , mean = 1.30 95%CI [ 0.80–1.94 ] , control group 1 month post intervention , mean = 1.02 95%CI [ 0.52–1.69 ] ; p = 0.023 ) . For caregivers at risk for depression , the intervention had a significant effect on caregivers ’ confidence in having sufficient information to manage their health ( p = 0.040 ) . No effects were found for patients ’ depressive symptoms , unmet needs , self-empowerment , and other health literacy domains . Conclusions While caregiver burden was not reduced , the outcall program was effective in reducing unmet needs in caregivers . Provision of cancer information and support via a telephone service may represent a feasible approach to reducing unmet needs among cancer caregiver population s . Trial registration ACTRN12613000731796 ; prospect ively registered on 02/07/2013 PURPOSE / OBJECTIVES To compare the effectiveness of two low-intensity approaches for distressed patients with cancer and caregivers who had called cancer helplines seeking support . Baseline distress was hypothesized as a moderator of intervention effect . DESIGN R and omized trial . SETTING Community-based cancer helplines in Queensl and and New South Wales , Australia . SAMPLE 354 patients with cancer and 336 caregivers . METHODS Participants were r and omized to either a single session of nurse-led self-management intervention or a five-session psychologist cognitive behavioral intervention delivered by telephone . Assessment s were undertaken at baseline ( preintervention ) and at 3 , 6 , and 12 months . MAIN RESEARCH VARIABLES Psychological and cancer-specific distress and post-traumatic growth . FINDINGS No significant moderation by baseline cancer-specific distress was noted . For low-education patients , only the psychologist intervention was associated with a significant drop in distress . For all other participants , distress decreased over time in both arms with small to large effect sizes ( Cohen 's ds = 0.05 - 0.82 ) . Post-traumatic growth increased over time for all participants ( Cohen 's ds = 0.6 - 0.64 ) . CONCLUSIONS Many distressed patients with cancer and their caregivers may benefit significantly from a single session of a nurse psychoeducation intervention that can be delivered remotely by telephone and supported by self-management material s. Research is needed to develop an algorithm that moves beyond the use of distress as the only indicator for referral to specialist psychological services . Survivors and caregivers with low education and low literacy 
    Output:
    