***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 suggested that unfractionated heparin ( UFH ) effects malignancy progression . We review ed all published clinical reports concerning the effects of UFH , as compared to no treatment on survival of cancer patients .  Studies were classified on method ological strength and subdivided as to whether therapeutic or prophylactic dosages of UFH were used . Mortality rates after 3 years were extracted or calculated . One r and omized study that evaluated the use of UFH in therapeutic dosages in patients with small cell lung carcinoma reported on an improved survival ( odds ratio ( OR ) 0.64 ; 95 % confidence interval ( CI ) : 0.25 to 1.62 ) . A detrimental effect was observed in 2 r and omized studies which investigated the effects of intraportal UFH treatment in a prophylactic dose after surgery for gastrointestinal cancer ( OR 1.66 ; 95 % CI : 1.02 to 2.71 ) . In contrast , level 2 studies in which either therapeutic or prophylactic dosages of UFH on mortality of patients with gastrointestinal cancer  were evaluated , showed OR of 0.58 ( 95 % CI ; 0.11 - 3.13 ) and 0.65 ( 95 % CI 0.51 to 0.84 ) , respectively . We conclude that there is no convincing evidence of either positively or negatively effects of UFH on survival of patients with malignancy A small proportion of patients with deep vein thrombosis develop recurrent venous thromboembolic complications or bleeding during anticoagulant treatment . These complications may occur more frequently if these patients have concomitant cancer . This prospect i ve follow-up study sought to determine whether in thrombosis patients those with cancer have a higher risk for recurrent venous thromboembolism or bleeding during anticoagulant treatment than those without cancer . Of the 842 included patients , 181 had known cancer at entry . The 12-month cumulative incidence of recurrent thromboembolism in cancer patients was 20.7 % ( 95 % CI , 15.6%-25.8 % ) versus 6.8 % ( 95 % CI , 3.9%- 9.7 % ) in patients without cancer , for a hazard ratio of 3.2 ( 95 % CI , 1.9 - 5.4 ) The 12-month cumulative incidence of major bleeding was 12.4 % ( 95 % CI , 6.5%-18.2 % ) in patients with cancer and 4.9 % ( 95 % CI , 2.5%-7.4 % ) in patients without cancer , for a hazard ratio of 2.2 ( 95 % CI , 1.2 - 4.1 ) . Recurrence and bleeding were both related to cancer severity and occurred predominantly during the first month of anticoagulant therapy but could not be explained by sub- or overanticoagulation . Cancer patients with venous thrombosis are more likely to develop recurrent thromboembolic complications and major bleeding during anticoagulant treatment than those without malignancy . These risks correlate with the extent of cancer . Possibilities for improvement using the current paradigms of anticoagulation seem limited and new treatment strategies should be developed OBJECTIVE To prospect ively assess whether low-molecular-weight heparin ( LMWH ) provides a survival benefit in patients with advanced cancer . PATIENTS AND METHODS Between December 1998 and June 2001 , we performed a r and omized controlled study of patients with advanced cancer . Initially , the study was double blinded and placebo controlled , with the patients receiving daily injections of 5000 U of LMWH or saline . However , because of low accrual midway through the study , the placebo injection arm was eliminated , and the study became open labeled , with patients receiving either LMWH injections plus st and ard clinical care or st and ard clinical care alone . The primary study end point was overall survival . RESULTS Of 141 patients r and omized to this clinical trial , 3 dropped out , leaving 138 patients . The median survival time was 10.5 months ( 95 % confidence interval , 7.6 - 12.2 months ) for the combined st and ard care and placebo groups . The median survival time for the combined LMWH arms was 7.3 months ( 95 % confidence interval , 4.8 - 12.2 months ) . These median survival times were not significantly different ( log-rank P = .46 ) . The median survival times for the blinded and unblinded LMWH groups were 6.2 months and 9.0 months , respectively . The median survival times were 10.3 months for the blinded placebo arm and 10.5 months for the st and ard care arm . The rate of severe or life-threatening venous thromboembolism was 6 % in the LMWH arms and 7 % in the control arms . The rate of severe or life-threatening bleeding was 3 % in the LMWH arms and 7 % in the control arms Background . A positive influence of anticoagulant treatment in small cell lung cancer ( SCLC ) has been sug gested by experimental and clinical data BACKGROUND Small cell lung cancer ( SCLC ) is a chemotherapy-responsive tumor type but most patients ultimately experience disease progression . SCLC is associated with alterations in the coagulation system . The present r and omized clinical trial ( RCT ) was design ed to determine whether addition of low-molecular-weight heparin ( LMWH ) to combination chemotherapy ( CT ) would improve SCLC outcome compared with CT alone . METHODS Combination CT consisted of cyclophosphamide , epirubicine and vincristine ( CEV ) given at 3-weekly intervals for six cycles . Eighty-four patients were r and omized to receive either CT alone ( n = 42 ) or CT plus LMWH ( n = 42 ) . LMWH consisted of dalteparin given at a dose of 5000 U once daily during the 18 weeks of CT . Results Overall tumor response rates were 42.5 % with CT alone and 69.2 % with CT plus LMWH ( P = 0.07 ) . Median progression-free survival was 6.0 months with CT alone and 10.0 months with CT plus LMWH ( P = 0.01 ) . Median overall survival was 8.0 months with CT alone and 13.0 months with CT plus LMWH ( P = 0.01 ) . Similar improvement in survival with LMWH treatment occurred in patients with both limited and extensive disease stages . The risk of death in the CT + LMWH group relative to that in the CT group was 0.56 ( 95 % confidence interval 0.30 , 0.86 ) ( P = 0.012 by log rank test ) . Toxicity from the experimental treatment was minimal and there were no treatment-related deaths . CONCLUSIONS These results support the concept that anticoagulants , and particularly LMWH , may improve clinical outcomes in SCLC . Further clinical trials of this relatively non-toxic treatment approach are indicated PURPOSE Studies in cancer patients with venous thromboembolism suggested that low molecular weight heparin may prolong survival . In a double-blind study , we evaluated the effect of low molecular weight heparin on survival in patients with advanced malignancy without venous thromboembolism . METHODS Patients with metastasized or locally advanced solid tumors were r and omly assigned to receive a 6-week course of subcutaneous nadroparin or placebo . The primary efficacy analysis was based on time from r and om assignment to death . The primary safety outcome was major bleeding . RESULTS In total , 148 patients were allocated to nadroparin and 154 patients were allocated to placebo .  Mean follow-up was 1 year . In the intention-to-treat analysis the overall hazard ratio of mortality was 0.75 ( 95 % CI , 0.59 to 0.96 ) with a median survival of 8.0 months in the nadroparin recipients versus 6.6 months in the placebo group . After adjustment for potential confounders , the treatment effect remained statistically significant . Major bleeding occurred in five ( 3 % ) of nadroparin-treated patients and in one ( 1 % ) of the placebo recipients ( P = .12 ) . In the a priori specified subgroup of patients with a life expectancy of 6 months or more at enrollment , the hazard ratio was 0.64 ( 95 % CI , 0.45 to 0.90 ) with a median survival of 15.4 and 9.4 months , respectively . For patients with a shorter life expectancy , the hazard ratio was 0.88 ( 95 % CI , 0.62 to 1.25 ) . CONCLUSION A brief course of subcutaneous low molecular weight heparin favorably influences the survival in patients with advanced malignancy and deserves additional clinical evaluation PURPOSE In experimental systems , interference with coagulation can affect tumor biology . Furthermore , it has been suggested that low molecular weight heparin therapy may prolong survival in patients with cancer . The primary aim of this study was to assess survival at 1 year of patients with advanced cancer . PATIENTS AND METHODS Patients with advanced malignancy ( N = 385 ) were r and omly assigned to receive either a once-daily subcutaneous injection of dalteparin ( 5,000 IU ) , a low molecular weight heparin , or placebo for 1 year . RESULTS The Kaplan-Meier survival estimates at 1 , 2 , and 3 years after r and omization for patients receiving dalteparin were 46 % , 27 % , and 21 % , respectively , compared with 41 % , 18 % , and 12 % , respectively , for patients receiving placebo ( P = .19 ) . In an analysis not specified a priori , survival was examined in a subgroup of patients  ( dalteparin , n = 55 ; and placebo , n = 47 ) who had a better prognosis and who were alive 17 months after r and omization . In these patients , Kaplan-Meier survival estimates at 2 and 3 years from r and omization were significantly improved for patients receiving dalteparin versus placebo ( 78 % v 55 % and 60 % v 36 % , respectively , P = .03 ) . The rates of symptomatic venous thromboembolism were 2.4 % and 3.3 % for dalteparin and placebo , respectively , with bleeding rates of 4.7 % and 2.7 % , respectively . CONCLUSION Dalteparin administration did not significantly improve 1-year survival rates in patients with advanced malignancy . However , the observed improved survival in a subgroup of patients with a better prognosis suggests a potential modifying effect of dalteparin on tumor biology Gynecologic malignancies are often associated with deep vein thrombosis and pulmonary embolism , even before treatment is begun . But such complications also happen during treatment , also if thromboembolism prophylaxis is performed . The incidence of pulmonary embolism before treatment was investigated using scintigraphy . In a retrospective and in a prospect i ve r and omized trial , various methods of thromboembolism prophylaxis were evaluated during primary or postoperative radiation therapy .  Pulmonary embolism was present in 11.9 % of the patients admitted with uterine malignancy . Retrospectively , there were deep vein thromboses in 6.8 % , pulmonary embolisms in 3.8 % and bleeding complications in 5.3 % of the patients receiving thromboembolism prophylaxis with acenocoumarol during radiation therapy of cervical and endometrial cancer . In the prospect i ve study , deep vein thromboses occurred in 1.5 % , pulmonary embolisms in 5.9 % and bleedings in 2.2 % , with both the LMW heparin and the acenocoumarol groups presenting similar results . Thromboembolism is a frequent paraneoplasia of uterine malignancies . The prevention of thromboembolic complications during radiation therapy of uterine malignancies is efficacious and safe using either LMW heparin or acenocoumarol 
    Output:
    
Conclusion This review suggests a survival benefit of heparin in cancer patients in general , and in patients with limited small cell lung cancer in particular