***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: A r and omised controlled pilot study was carried out to examine the effects of adjunctive aromatherapy massage on mood , quality of life and physical symptoms in patients with cancer attending a specialist unit . Participants were r and omised  to conventional day care alone or day care plus weekly aromatherapy massage using a st and ardised blend of oils for four weeks . At baseline and at weekly intervals , patients rated their mood , quality of life and the intensity and bother of two symptoms most important to them . Forty-six patients were recruited to the study . Due to a large number of withdrawals , only 11 of 23 ( 48 % ) patients in the aromatherapy group and 18 of 23 ( 78 % ) in the control group completed all four weeks . Mood , physical symptoms and quality of life improved in both groups . There was no statistically significant difference between groups in any of the outcome measures . Despite a lack of measurable benefit , all patients were satisfied with the aromatherapy and wished to continue . Whilst this pilot study has shown that a r and omised controlled trial of complementary therapy is feasible , it has also identified several areas that would require further consideration when design ing future studies , e.g. , the recruitment and retention of appropriate numbers of patients and the outcome measures used AIM The objective of this study was to determine whether reflexology has an impact on the quality of life of patients in the palliative stage of cancer . METHOD Twelve patients in the palliative stage of cancer with various tumour types were r and omised into two groups . They were r and omly assigned to receive either reflexology or placebo reflexology . All participants completed a linear analogue self- assessment scale relating to quality of life . All participants then received three sessions of either reflexology or placebo reflexology . The same person , a qualified reflexologist , provided the interventions for both groups . The participants were not aware of which intervention they were receiving . All participants then completed a second linear analogue self- assessment scale relating to quality of life . RESULTS All participants felt that their quality of life had improved , even those who had received the placebo treatment . The reflexology group , however , reported more benefit than the placebo group . There was a significant difference ( p = 0.004 ) between the reflexology group and the placebo group . CONCLUSION This study showed that reflexology does have an impact on the quality of life of patients in the palliative stage of cancer AIMS To examine the effects of aromatherapy massage on anxiety and sleep quality in patients undergoing colorectal surgery in the preoperative period . BACKGROUND In recent years , there has been an increase in the number of studies conducted on aromatherapy massage . It is stated that studies conducted on aromatherapy massage for anxiety and sleep quality reveal contradictory results and that more research is required on the issue . DESIGN A r and omized controlled trial . METHODS Eighty patients undergoing colorectal surgery were r and omly assigned to experimental and control group . To the experimental group ( n = 40 ) , aromatherapy massage was applied in accordance with the " Back Massage Guide " using 5 % lavender oil ( Lav and ula Hybrida ) for ten minutes before surgery and the morning of surgery . The control group received st and ard nursing care in compliance with the hospital procedure . Data were obtained by the State Anxiety Inventory ( SAI ) and Richard-Campbell Sleep Question naire ( RCSQ ) . Results were analyzed using the t-test , Chi-square test or Fisher 's exact test . RESULTS There was no baseline difference between the groups . A statistically significant difference was found between the experimental and control group in terms of the SAI and RCSQ mean scores recorded on the morning of surgery . It was determined that the SAI and RCSQ mean score of the experimental group after aromatherapy massage on the morning of surgery decreased when compared to that of the evening before surgery . CONCLUSIONS It was found that aromatherapy massage with lavender oil increased the sleep quality and reduced the level of anxiety in patients with colorectal surgery in the preoperative period Nonpharmacological methods of pain relief such as acupressure are becoming increasingly popular worldwide . Practitioners often cl aim that such methods are highly effective and less invasive than analgesic drugs , but available empirical evidence is largely inconclusive . This study aim ed to test the hypothesis that , postacupressure intervention , the amount of pain experienced by sample d leukemia patients , who received acupressure in addition to st and ard care , will reduce substantially compared to patients who received only routine treatment . This controlled trial was undertaken with hospitalized leukemia patients between February and June 2015 . Our primary sample consisted of 100 participants who were r and omly allocated to 2 groups . One ( intervention ) group underwent 12 acupressure sessions in addition to st and ard treatment while the control group received no intervention apart from being given the st and ard treatment for leukemia . The visual analogue scale was used to measure the levels of pain experienced . No significant differences were found between the 2 groups across 12 interventions . However , each group reported significantly different pain level changes before and after each intervention , suggested that the acupressure method was effective in reducing pain in the short term . Nurses are able to apply this complementary therapy alongside other procedures to manage these patients ' pain . It is recommended that further studies be conducted to better underst and the specific conditions under which acupressure can provide effective pain relief This r and omized controlled clinical study aim ed to determine the effect of 2 foot massage methods on symptom control in people with colorectal cancer who received chemoradiotherapy .  Data were collected between June 16 , 2015 , and February 10 , 2016 , in the Department of Radiation Oncology of an oncology training and research hospital . The sample comprised 60 participants . Data were collected using an introductory information form , common terminology criteria for adverse events and European Organization for Research and Treatment of Cancer Quality of Life Question naires C30 and CR29 . Participants were r and omly allocated to 3 groups : classical foot massage , reflexology , and st and ard care control . The classical massage group received foot massage using classical massage techniques , and the reflexology group received foot reflexology focusing on symptom-oriented reflexes twice a week during a 5-week chemoradiotherapy treatment schedule . The control group received neither classical massage nor reflexology . All patients were provided with the same clinic routine care . The classical massage was effective in reducing pain level and distension incidence while foot reflexology was effective in reducing pain and fatigue level , lowering incidence of distension and urinary frequency and improving life quality Observational studies and pragmatic trials can complement classical r and omized controlled trials ( RCTs ) by providing data more relevant to the circumstances under which medicine is routinely practice d , thereby providing practical guidance for clinicians . The bearing of RCT findings on day-to-day practice can be weighted and the data more meaningfully interpreted by practicing clinicians if evidence is integrated from a variety of different study design s and method ologies . The advent of observational studies and pragmatic trials , often referred to as " real-life studies , " has met with a degree of cynicism , but their role and value is gaining widespread recognition and support among clinicians . This article discusses where observational studies and pragmatic trials have utility , namely : in addressing clinical questions that are unanswered and /or unanswerable by RCTs ; in testing new hypotheses and possible license extensions ; and in helping to differentiate between available therapies for a given indication . Moreover , it seeks to highlight how the different approaches fit within a conceptual framework of evidence relevant to clinical practice , a step-change in the traditional view of medical evidence Many specialist palliative care services are under pressure to provide therapies such as aromatherapy , acupuncture or reflexology either by paid staff or volunteers . The evidence to justify the provision of such treatment , however , remains largely anecdotal as controlled clinical trials are difficult to design . Reflexology involves the application of pressure to ` reflex ’ areas of the h and s or feet with the intention of producing specific effects elsewhere in the body . The reflexologist palpates tender or painful areas that , it is suggested , indicate functional imbalance . As well as treatment of specific conditions , it is suggested that reflexology can relax the patient , which may aid selfhealing and prevention of disease . We have therefore conducted a pilot study with a r and omized controlled design to compare reflexology with simple foot massage Background : Anxiety has negative effects on mental and physical performance , quality of life , duration of hospitalization , and even on the treatment of patients with cancer . Objectives : Today acupressure is widely used to treat anxiety . Thus , the present study aim ed to investigate the effects of acupressure on anxiety in patients with cancer . Patients and Methods : A double-blind r and omized clinical trial was conducted on 85 patients hospitalized with 3 groups including acupressure group ( n = 27 ) , sham group ( n = 28 ) , and control group ( n = 30 ) in the hematologic ward of Shahid Beheshti Hospital of Hamadan , Iran , in 2013 . The sampling permuted-block r and omization with triple block was used . The anxiety of the patients in the experimental , sham , and control groups were measured with Spielberger ’s State-Trait Anxiety Inventory ( STAI ) . Then , real acupressure was performed in the experimental group and fake acupressure in the sham group , and only routine care was provided for the control group . Anxiety of the patients was also assessed at 5 and 10 days after the intervention . Statistical analysis of the data was performed by SPSS software using repeated measures analysis of variance ( ANOVA ) and post hoc least significant difference ( LSD ) test . Results : According to the findings , the mean level of anxiety before the intervention between groups were matched ( P > 0.05 ) . Acupressure had a significant influence on the anxiety in the experimental group at 5 ( 45.30 ± 7.14 ) and 10 days ( 43.48 ± 6.82 ) after the intervention ( P < 0.05 ) . However , it did not have a significant impact on their covert anxiety ( 45.48 ± 7.92 at 5th day vs 45.63 ± 8.08 at 10th day , P > 0.05 ) . No significant differences were observed in the fake points regarding overt and covert anxiety of patients in the sham group ( overt anxiety ; 47.57 ± 7.85 at 5th day vs. 46.71 ± 7.32 at 10th day , P > 0.05 ) ( covert anxiety ; 47.96 ± 6.33 at 5th day vs. 46.89 ± 6.94 at 10th day , P > 0.05 ) . Moreover , the routine care provided for the control group did not have any effect on the overt and covert anxiety of the patients ( P > 0.05 ) . Conclusions : Acupressure is recommended as a complementary therapy to reduce anxiety in patients with cancer because of its low cost , safety , and simplicity Research suggests that patients with cancer , particularly in the palliative care setting , are increasingly using aromatherapy and massage . There is good evidence that these therapies may be helpful for anxiety reduction for short periods , but few studies have looked at the longer term effects . This study was design ed to compare the effects of four-week courses of aromatherapy massage and massage alone on physical and psychological symptoms in patients with advanced cancer . Forty-two patients were r and omly allocated to receive weekly massages with lavender essential oil and an inert carrier oil ( aromatherapy group ) , an inert carrier oil only ( massage group ) or no intervention . Outcome measures included a Visual Analogue Scale ( VAS ) of pain intensity , the Verran and Snyder-Halpern ( VSH ) sleep scale , the Hospital Anxiety and Depression ( HAD ) scale and the Rotterdam Symptom Checklist ( RSCL ) . We were unable to demonstrate any significant long-term benefits of aromatherapy or massage in terms of improving pain control , anxiety or quality of life . However , sleep scores improved significantly in both the massage and the combined massage ( aromatherapy and massage ) groups . There were also statistically significant reductions in depression scores in the massage group . In this study of patients with advanced cancer , the addition of lavender essential oil did not appear to increase the beneficial effects of massage . Our results do suggest , however , that patients with high levels of psychological distress  respond best to these therapies Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background : Annually , about 6000 new cases are diagnosed with breast cancer in Iran . In Iran , more women are affected with breast cancer than a decade earlier in comparison with other countries , and 70 % of them are diagnosed at an advanced phase . Insomnia is the most common disorder following breast cancer , and interference in sleep quality and rest causes changes in physiological functions and reduces the body 's daily performance . The objective of this study was to determine the effect of massage therapy on the quality of sleep in patients with breast cancer . Material s and Methods : This clinical trial was conducted for about 1 month in a referral chemotherapy clinic of a teaching hospital in Isfahan , Iran . The participants consisted of 57 women with breast cancer who were selected by simple r and om sampling . They were r and omly assigned to two groups of control and experimental . The control group was treated only by usual medical therapy , whereas the case group was treated by combined medical – massage therapy . Data collection tools were the vali date d Pittsburgh Sleep Quality Index and a demographic question naire . Data were analyzed by SPSS using descriptive statistics , Chi-square test , paired t-test , and Student 's t-test . Results : The results showed significant differences in the mean scores of quality of sleep before and after the intervention in the case group , while no significant differences were observed in the mean scores of quality of sleep before and after the intervention in the control group . In addition , no significant differences were observed in the mean scores of quality of sleep before the intervention between 
    Output:
    
These results seem to indicate that manipulative CAM may be effective on symptom management in cancer .