***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: Clinical and experimental studies have shown that a moderately increased physical activity level may have beneficial effects in terms of exercise conditioning , resistance to infection and decreased relative risk of cancer . Modulation of the innate and adaptive components of the immune system with a shift of cytokines and their antagonists to a more pro- and less anti-inflammatory response was found to be a prominent feature in non-tumor patients and healthy volunteers . As quantitative data concerning the cytokine/antagonist response following exercise are not available for tumor patients , we compared the effects of a post-operative rehabilitation program with moderate exercise ( ME ) intensity ( 0.55 - 0.65 x maximal aerobic power ) with a program with low exercise ( LE ) intensity ( 0.30 - 0.40 x maximal aerobic power ) in patients with curatively treated colorectal carcinoma ( UICC II and III ) measuring pro- ( IL-1beta , IL-6 , tumour necrosis factor ( TNF ) ) and anti-inflammatory cytokines ( IL-1 receptor antagonist , sTNF receptors I and II ) . Twenty-three patients participated in this prospect i ve trial , N = 13 in the ME group , N = 10 in the LE group . Exercise was performed daily 30 - 40 min for 2 weeks . Basal ( circulating ) and LPS-stimulated ( phasic ) cytokine and antagonist response was determined before exercise and after 1 and 2 weeks using appropriate ELISA tests . The LPS-stimulated interleukin-1 receptor antagonist ( IL-1ra ) response in the ME group gradually decreased from 31,532.6 ( 160.0 - 70,028.0 ) to 18,033.0 pg/ml ( 5040.0 - 52,570.0 ) after one and to 22,892.0 pg/ml ( 6376.0 - 34,726.0 ) after 2 weeks ( P < 0.05 ) with a concomitant decrease of the corresponding IL-1ra/IL-6 and IL-1ra/IL-1beta ratio : 2.51 - 1.41 and 4.1 - 3.1 , respectively . In contrast , in the LE group LPS-stimulated cytokines and antagonists did not significantly change during exercise . Circulating cytokines and antagonists remained unchanged in both groups . In providing quantitative data in patients with curatively-treated colorectal cancer , we demonstrated that a short-term rehabilitation program with moderate exercise leads to a decreased LPS-induced antagonist response with a shift to a more pro-inflammatory state ( decreased antagonist/cytokine ratio ) . Whether this change of the phasic immune response to moderate exercise may be clinical ly beneficial ( decreased rates of infection , relapses and /or second tumours ) is possible , but has to be investigated in long-term studies PURPOSE The impact of psychotherapeutic support on survival for patients with gastrointestinal cancer undergoing surgery was studied . PATIENTS AND METHODS A r and omized controlled trial was conducted in cooperation with the Departments of General Surgery and Medical Psychology , University Hospital of Hamburg , Germany , from January 1991 to January 1993 . Consenting patients ( N = 271 ) with a preliminary diagnosis of cancer of the esophagus , stomach , liver/gallbladder , pancreas , or colon/rectum were stratified by sex and r and omly assigned to a control group that received st and ard care as provided on the surgical wards , or to an experimental group that received formal psychotherapeutic support in addition to routine care during the hospital stay . From June 2003 to December 2003 , the 10-year follow-up was conducted . Survival status for all patients was determined from our own records and from three external sources : the Hamburg cancer registry , family doctors , and the general citizen registration offices . RESULTS Kaplan-Meier survival curves demonstrated better survival for the experimental group than the control group . The unadjusted significance level for group differences was P = .0006 for survival to 10 years . Cox regression models that took TNM staging or the residual tumor classification and tumor site into account also found significant differences at 10 years . Secondary analyses found that differences in favor of the experimental group occurred in patients with stomach , pancreatic , primary liver , or colorectal cancer . CONCLUSION The results of this study indicate that patients with gastrointestinal cancer , who undergo surgery for stomach , pancreatic , primary liver , or colorectal cancer , benefit from a formal program of psychotherapeutic support during the inpatient hospital stay in terms of long-term survival Goals of workProstate cancer patients receiving and rogen deprivation therapy ( ADT )  are vulnerable to a number of potentially debilitating side effects , which can significantly impact quality of life . The role of alternate therapies , such as physical activity ( PA ) , in attenuating these side effects is largely understudied for such a large population . Thus , the purpose of this study was to investigate the effects of PA intervention for men receiving ADT on PA behavior , quality of life , and fitness measures . Patients and methods One hundred participants were r and omized into an intervention ( n = 53 ) or a wait-list control group ( n = 47 ) , with 11 dropping out of the intervention group and 23 dropping out of the wait-list control group prior to post-testing . The intervention consisted of both an individually tailored home-based aerobic and light resistant training program and weekly group sessions .  PA , quality of life , fitness , and physiological outcomes were assessed pre and post the 16-week intervention . Results Significant increases in PA , supported by changes in girth measures and blood pressure , support the beneficial impact of the intervention . Positive trends were also evident for depression and fatigue . However , due to the high dropout rate , these results must be interpreted with caution . Conclusions PA effectively attenuates many of the side effects of ADT and should be recommended to prostate survivors as an alternate therapy . Determining the maintenance of this behavior change will be important for underst and ing how the long-term benefits of increased activity levels may alleviate the late effects of ADT The authors prospect ively investigated the relation between stressful life events and risk of breast cancer among 10,808 women from the Finnish Twin Cohort . Life events and breast cancer risk factors were assessed by self-administered question naire in 1981 . A national modification of a st and ardized life event inventory was used , examining accumulation of life events and individual life events and placing emphasis on the 5 years preceding completion of the question naire . Through record linkage with the Finnish Cancer Registry , 180 incident cases of breast cancer were identified in the cohort between 1982 and 1996 . The multivariable adjusted hazard ratio for breast cancer per one-event increase in the total number of life events was 1.07 ( 95 % confidence interval ( CI ) : 1.00 , 1.15 ) . This risk estimate rose to 1.35 ( 95 % CI : 1.09 , 1.67 ) when only major life events were taken into account . Independently of total life events , divorce/separation ( hazard ratio ( HR ) = 2.26 , 95 % CI : 1.25 , 4.07 ) , death of a husb and ( HR = 2.00 , 95 % CI : 1.03 , 3.88 ) , and death of a close relative or friend ( HR = 1.36 , 95 % CI : 1.00 , 1.86 ) were all associated with increased risk of breast cancer . The findings suggest a role for life events in breast cancer etiology through hormonal or other mechanisms OBJECTIVE To evaluate the effect of early exercise therapy on the natural killer cell cytotoxic activity ( NKCA ) of patients who had undergone curative resection of stomach cancer . DESIGN Prospect i ve study . PATIENTS Thirty-five stomach cancer patients who had undergone curative surgery were r and omly divided into an exercise group ( n = 17 ) and a control group ( n = 18 ) . INTERVENTION From postoperative day 2 , moderated exercise using arm and bicycle ergometers performed twice a day , 5 times a week , for 14 days . The intensity of exercise was 60 % of maximal heart rate . Venous blood sample s were obtained on postoperative days 1 , 7 , and 14 . MAIN OUTCOME MEASURE Mean sequential change of NKCA . RESULTS The mean sequential change of NKCA decreased until postoperative day 7 and then increased . Mean NKCA of day 7 decreased in both groups , compared with that at postoperative day 1 . At day 14 , the mean NKCA of the exercise group demonstrated a significant increase compared with that of the control group ( p < .05 ) . CONCLUSION This study suggests that early moderate exercise has a beneficial effect on the function of in vitro NK cells in stomach cancer patients after curative surgery 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 PURPOSE Men with prostate cancer are often advised to make changes in diet and lifestyle , although the impact of these changes has not been well documented . Therefore , we evaluated the effects of comprehensive lifestyle changes on prostate specific antigen ( PSA ) , treatment trends and serum stimulated LNCaP cell growth in men with early , biopsy proven prostate cancer after 1 year . MATERIAL S AND METHODS Patient recruitment was limited to men who had chosen not to undergo any conventional treatment , which provided an unusual opportunity to have a nonintervention r and omized control group to avoid the confounding effects of interventions such as radiation , surgery or and rogen deprivation therapy . A total of 93 volunteers with serum PSA 4 to 10 ng/ml and cancer Gleason scores less than 7 were r and omly assigned to an experimental group that was asked to make comprehensive lifestyle changes or to a usual care control group . RESULTS None of the experimental group patients but 6 control patients underwent conventional treatment due to an increase in PSA and /or progression of disease on magnetic resonance imaging . PSA decreased 4 % in the experimental group but increased 6 % in the control group ( p = 0.016 ) . The growth of LNCaP prostate cancer cells ( American Type Culture Collection , Manassas , Virginia ) was inhibited almost 8 times more by serum from the experimental than from the control group ( 70 % vs 9 % , p < 0.001 ) . Changes in serum PSA and also in LNCaP cell growth were significantly associated with the degree of change in diet and lifestyle . CONCLUSIONS Intensive lifestyle changes may affect the progression of early , low grade prostate cancer in men . Further studies and longer term followup are warranted Objectives : To test experimentally whether a psychological intervention reduces depression-related symptoms and markers of inflammation among cancer patients and to test one mechanism for the intervention effects . Depression and inflammation are common among cancer patients . Data suggest that inflammation can contribute to depressive symptoms , although the converse remains untested . Methods : As part of a r and omized clinical trial , newly diagnosed breast cancer patients ( n = 45 ) with clinical ly significant depressive symptoms were evaluated and r and omized to psychological intervention with assessment or assessment only study arms . The intervention spanned 12 months , with assessment s at baseline , 4 , 8 , and 12 months . Mixed-effects modeling tested the hypothesis that the intervention reduced self-reported depressive symptoms ( Center for Epidemiological Studies Depression scale , Profile of Mood States Depression and Fatigue subscales , and Medical Outcomes Study -Short Form 36 Bodily Pain subscale ) and immune cell numbers that are elevated in the presence of inflammation ( white blood cell count , neutrophil count , and helper/suppressor ratio ) . Mediation analyses tested whether change in depressive symptoms , pain , or fatigue predicted change in white blood cell count , neutrophil count , or the helper/suppressor ratio . Results : The intervention reduced significantly depressive symptoms , pain , fatigue , and inflammation markers . Moreover , the intervention effect on inflammation was mediated by its effect on depressive symptoms . Conclusions : This is the first experiment to test whether psychological treatment effective in reducing depressive symptoms would also reduce indicators of inflammation . Data show that the intervention reduced directly depressive symptoms and reduced indirectly inflammation . Psychological treatment may treat effectively depressive symptoms , pain , and fatigue among cancer patients . CES-D = Center for Epidemiological Studies -Depression scale , Iowa short form ; SF-36 = Medical Outcomes Study -Short Form 36 ; KPS = Karnofsky Performance Status Background Obesity is characterized by chronic mild inflammation and may influence the risk and progression of cancer . Purpose The current study is an exploratory analysis of the effect of a weight loss intervention that emphasized increased physical activity on inflammatory cytokines ( tumor necrosis factor-α [ TNF-α ] , interleukin-6 [ IL-6 ] , interleukin-8 [ IL-8 ] , and vascular endothelial growth factor [ VEGF ] ) at the end of the 16-week intervention period in overweight breast cancer survivors . Methods Study participants averaged 56 years of age ( N = 68 ) . Intervention participants ( n = 44 vs. 24 controls ) participated in a cognitive behavioral therapy-based weight management program as part of an exploratory r and omized trial . The intervention incorporated strategies to promote increased physical activity and diet modification . Baseline and 16-week data included height , weight , body composition , physical activity level , and biomarkers IL 
    Output:
    
Conclusions Although there are considerable evidence s of PBI effects on some immune indicators , the effect sizes are modest and it is still premature to conclude whether PBIs have effects on immune functions among cancer patients .