***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 
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    Input: We have evaluated the perioperative effects of melatonin with those of midazolam in 75 women in a prospect i ve , r and omized , double-blind , placebo-controlled study . Patients were given sublingual midazolam 15 mg , melatonin 5 mg or placebo , approximately 100 min before a st and ard anaesthetic . Sedation , anxiety and orientation were quantified before , and 10 , 30 , 60 and 90 min after premedication , and 15 , 30 , 60 and 90 min after admission to the recovery room . Psychomotor performance was evaluated at these times also , using the digit-symbol substitution test ( DSST ) and the Trieger dot test ( TDT ) . Patients who received premedication with either midazolam or melatonin had a significant decrease in anxiety levels and increase in levels of sedation before operation compared with controls . Midazolam produced the highest scores for sedation at 30 and 60 min after administration and significant psychomotor impairment in the preoperative period compared with melatonin or placebo . After operation , patients who received midazolam or melatonin premedication had increased levels of sedation at 30 min and impairment in performance on the DSST at 15 , 30 and 90 min compared with controls . There were no significant differences between the three groups for anxiety levels or TDT performance after operation . Amnesia was notable only in the midazolam group for one preoperative event ( entry into the operating room ) . Patient satisfaction was noted in the midazolam and melatonin groups only . We have demonstrated that melatonin can be used effectively for premedication of adult patients Background Studies have shown that there is a high prevalence of depression in cancer patients . Women with breast cancer may have an even higher risk of depression particularly in a postmenopausal or estrogen deficiency state . A small number of r and omized controlled trials have examined the efficacy of antidepressants compared to that of a placebo in cancer patients , but some results have been difficult to interpret due to a heterogeneous patient group . In the current investigation , we screened newly diagnosed early stage breast cancer patients for depressive symptoms prior to the initiation of adjuvant therapy and investigated whether the oral antidepressant fluoxetine affected depressive symptoms , completion of adjuvant treatment , and quality of life . Methods Patients with newly diagnosed early stage breast cancer were screened for depressive symptoms prior to the initiation of adjuvant therapy . Patients with depressive symptoms were r and omized to a daily oral fluoxetine or a placebo . Patients were then followed for 6 months and evaluated for quality of life , completion of adjuvant treatment , and depressive symptoms . Results A high percentage of patients with newly diagnosed early stage breast cancer were found to have depressive symptoms prior to the initiation of adjuvant therapy . The use of fluoxetine for 6 months result ed in an improvement in quality of life , a higher completion of adjuvant treatment ( chemotherapy , hormonal therapy , chemotherapy plus hormonal therapy ) , and a reduction in depressive symptoms compared to patients who received placebo . Conclusions An antidepressant should be considered for early stage breast cancer patients with depressive symptoms who are receiving adjuvant treatment Introduction Breast cancer represents about one-third of all cancer diagnoses and accounts for about 15 % of cancer deaths in women . Many of these patients experience depression , anxiety , sleep disturbances and cognitive dysfunction . This may adversely affect quality of life and also contribute to morbidity and mortality . Melatonin is a regulatory circadian hormone having , among others , a hypnotic and an antidepressive effect . It has very low toxicity and very few adverse effects compared with the more commonly used antidepressants and hypnotics . Methods and analysis The objective of this double-blind , r and omised , placebo-controlled trial is to investigate whether treatment with oral melatonin has a prophylactic or ameliorating effect on depressive symptoms , anxiety , sleep disturbances and cognitive dysfunction in women with breast cancer . Furthermore , the authors will examine whether a specific clock-gene , PER3 , is correlated with an increased risk of depressive symptoms , sleep disturbances or cognitive dysfunction . The MELODY trial is a prospect i ve double-blinded , r and omised , placebo-controlled trial in which the authors intend to include 260 patients . The primary outcome is depressive symptoms measured by the Major Depression Inventory . The secondary outcomes are anxiety measured by a Visual Analogue Scale , total sleep time , sleep efficiency , sleep latency and periods awake measured by actigraphy and changes in cognitive function measured by a neuropsychological test battery . Tertiary outcomes are fatigue , pain , well-being and sleep quality /quantity measured by Visual Analogue Scale and sleep diary and sleepiness measured by the Karolinska Sleepiness Scale . The PER3 genotype is also to be determined in blood sample Summary Background . Fatigue can significantly interfere with a cancer patient ’s ability to fulfill daily responsibilities and enjoy life . It commonly co-exists with depression in patients undergoing chemotherapy , suggesting that administration of an antidepressant that alleviates symptoms of depression could also reduce fatigue . Methods . We report on a double-blind clinical trial of 94 female breast cancer patients receiving at least four cycles of chemotherapy r and omly assigned to receive either  20 mg of the selective serotonin re-uptake inhibitor ( SSRI ) paroxetine ( Paxil ® , SmithKline Beecham Pharmaceuticals ) or an identical-appearing placebo . Patients began their study medication seven days following their first on- study treatment and continued until seven days following their fourth on- study treatment . Seven days after each treatment , participants completed question naires measuring fatigue ( Multidimensional Assessment of Fatigue , Profile of Mood States-Fatigue/Inertia subscale and Fatigue Symptom Checklist ) and depression ( Profile of Mood States-Depression subscale [ POMS-DD ] and Center for Epidemiologic Studies -Depression [ CES-D ] ) . Results . Repeated- measures ANOVAs , after controlling for baseline measures , showed that paroxetine was more effective than placebo in reducing depression during chemotherapy as measured by the CES-D ( p=0.006 ) and the POMS-DD ( p=0.07 ) but not in reducing fatigue ( all measures , ps > 0.27 ) . Conclusions . Although depression was significantly reduced in the 44 patients receiving paroxetine  compared to the 50 patients receiving placebo , indicating that a biologically active dose was used , no significant differences between groups on any of the measures of fatigued were observed . Results suggest that modulation of serotonin may not be a primary mechanism of fatigue related to cancer treatment BACKGROUND Low urinary melatonin levels have been associated with an increased risk of breast cancer in premenopausal women . However , the association between  melatonin  levels and breast cancer risk in postmenopausal women remains unclear . METHODS We investigated the association between  melatonin levels and  breast cancer risk in postmenopausal women in a prospect i ve case-control study nested in the Hormones and Diet in the Etiology of Breast Cancer Risk cohort , which included 3966 eligible postmenopausal women . The concentration of melatonin 's major metabolite , 6-sulfatoxymelatonin , was measured in a baseline 12-hour overnight urine sample from 178 women who later developed incident breast cancer and from 710 matched control subjects . We used multivariable-adjusted conditional logistic regression models to investigate associations . Relative risks are reported as odds ratios ( ORs ) . All statistical tests were two-sided . RESULTS Increased melatonin levels were associated with a statistically significantly lower risk of invasive breast cancer in postmenopausal women ( for women in the highest quartile of total overnight 6-sulfatoxymelatonin output vs the lowest quartile , multivariable OR also adjusted for testosterone = 0.56 , 95 % confidence interval [ CI ] = 0.33 to 0.97 ; P(trend ) = .02 ) . This association was strongest among never and past smokers ( OR = 0.38 , 95 % CI = 0.20 to 0.74 ; P(trend ) = .001 ) and after excluding women who were diagnosed with invasive breast cancer within 4 years after urine collection ( OR = 0.34 , 95 % CI = 0.15 to 0.75 ; P(trend ) = .002 ) . We did not observe substantial variation in relative risks by hormone receptor status of breast tumors . Among the 3966 women in the cohort , 40 of the 992 women in the highest quartile of 6-sulfatoxymelatonin developed breast cancer during follow-up , compared with 56 of the 992 women in the lowest quartile of 6-sulfatoxymelatonin . CONCLUSION Results from this prospect i ve study provide evidence for a statistically significant inverse association between melatonin levels , as measured in overnight morning urine , and invasive breast cancer risk in postmenopausal women BACKGROUND Exposure to light at night may increase the risk of breast cancer by suppressing the normal nocturnal production of melatonin by the pineal gl and , which , in turn , could increase the release of estrogen by the ovaries . This study investigated whether such exposure is associated with an increased  risk of breast cancer in women . METHODS Case patients ( n = 813 ) , aged 20 - 74 years , were diagnosed from November 1992 through March 1995 ; control subjects ( n = 793 ) were identified by r and om-digit dialing and were frequency matched according to 5-year age groups . An in-person interview was used to gather information on sleep habits and bedroom lighting environment in the 10 years before diagnosis and lifetime occupational history . Odds ratios ( ORs ) and 95 % confidence intervals ( CIs ) were estimated by use of conditional logistic regression , with adjustment for other potential risk factors . RESULTS Breast cancer risk was increased among subjects who frequently did not sleep during the period of the night when melatonin levels are typically at their highest ( OR = 1.14 for each night per week ; 95 % CI = 1.01 to 1.28 ) . Risk did not increase with interrupted sleep accompanied by turning on a light . There was an indication of increased risk among subjects with the brightest bedrooms . Graveyard shiftwork was associated with increased breast cancer risk ( OR = 1.6 ; 95 % CI = 1.0 to 2.5 ) , with a trend of increased risk with increasing years and with more hours per week of graveyard shiftwork ( P = .02 , Wald chi-squared test ) . CONCLUSION The results of this study provide evidence that indicators of exposure to light at night may be associated with the risk of developing breast cancer BACKGROUND AND PURPOSE To estimate the prevalence of  insomnia symptoms and syndrome in the general population , describe the types of self-help treatments and consultations initiated for insomnia , and examine help-seeking determinants . PATIENTS AND METHODS A r and omly selected sample of 2001 French-speaking adults from the province of Quebec ( Canada ) responded to a telephone survey about sleep , insomnia , and its treatments .  RESULTS Of the total sample , 25.3 % were dissatisfied with their sleep , 29.9 % reported insomnia symptoms , and 9.5 % met criteria for an insomnia syndrome . Thirteen percent of the respondents had consulted a healthcare provider specifically for insomnia in their lifetime , with general practitioners being the most frequently consulted . Daytime fatigue ( 48 % ) , psychological distress ( 40 % ) , and physical discomfort ( 22 % ) were the main determinants prompting individuals with insomnia to seek treatment . Of the total sample , 15 % had used at least once herbal/dietary products to facilitate sleep and 11 % had used prescribed sleep medications in the year preceding the survey . Other self-help strategies employed to facilitate sleep included reading , listening to music , and relaxation . CONCLUSIONS These findings confirm the high prevalence of insomnia in the general population . While few insomnia sufferers seek professional consultations , many individuals initiate self-help treatments , particularly when daytime impairments such as fatigue become more noticeable . Improved knowledge of the determinants of help-seeking behaviors could guide the development of effective public health prevention and intervention programs to promote healthy sleep Mounting evidence suggests habitual sleep duration is associated with various health outcomes ; both short and long sleep duration have been implicated in increased risk of cardiovascular disease , diabetes , and all-cause mortality . However , data on the relation between sleep duration and cancer risk are sparse and inconclusive . A link between low levels of melatonin , a hormone closely related to sleep , and increased risk of breast cancer has recently been suggested but it is unclear whether duration of sleep may affect breast cancer risk . We explored the association between  habitual sleep duration reported in 1986 and subsequent risk of breast cancer in the Nurses ' Health Study using Cox proportional hazards models . During 16 years of follow-up , 4,223 incident cases of breast cancer occurred among 77,418 women in this cohort . Compared with women sleeping 7 hours , covariate-adjusted hazard ratios and 95 % confidence intervals for those sleeping < or = 5 , 6 , 8 , and > or = 9 hours were 0.93 ( 0.79 - 1.09 ) , 0.98 ( 0.91 - 1.06 ) , 1.05 ( 0.97 - 1.13 ) , and 0.95 ( 0.82 - 1.11 ) , respectively . A moderate trend in risk increase towards longer sleep duration was observed when analyses were restricted to participants who reported same sleep duration in 1 
    Output:
    
The data presented in this review encourage the performance of new clinical trials to investigate the possible use of melatonin in cancer patients suffering from sleep-wake and mood disturbances  , also considering that melatonin registered a low toxicity in cancer patients