***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 The Memorial Symptom Assessment Scale ( MSAS ) is a new patient-rated instrument that was developed to provide multidimensional information about a diverse group of common symptoms . This study evaluated the reliability and validity of the MSAS in the cancer population . R and omly selected in patients and out patients ( n = 246 ) with prostate , colon , breast or ovarian cancer were assessed using the MSAS and a battery of measures that independently evaluate phenomena related to quality of life . Symptom prevalence in the 218 evaluable patients ranged from 73.9 % for lack of energy to 10.6 % for difficulty swallowing . Based on a content analysis , three symptoms were deleted and two were added ; the revised scale evaluates 32 physical and psychological symptoms . A factor analysis of variance yielded two factors that distinguished three major symptom groups and several subgroups . The major groups comprised psychological symptoms ( PSYCH ) , high prevalence physical symptoms ( PHYS H ) , and low prevalence physical symptoms ( PHYS L ) . Internal consistency was high in the PHYS H and PSYCH groups ( Cronback alpha coefficients of 0.88 and 0.83 , respectively ) , and moderate in the PHYS L group ( alpha = 0.58 ) . Although the severity , frequency and distress dimensions were highly intercorrelated , canonical correlations and other analyses demonstrated that multidimensional assessment ( frequency and distress ) augments information about the impact of symptoms . High correlations with clinical status and quality of life measures support the validity of the MSAS and indicate the utility of several subscale scores , including PSYCH , PHYS , and a brief Global Distress Index . The MSAS is a reliable and valid instrument for the assessment of symptom prevalence , characteristics and distress . It provides a method for comprehensive symptom assessment that may be useful when information about symptoms is desirable , such as clinical trials that incorporate quality of life measures or studies of symptom epidemiology Visual  analogue scales ( VAS ) and  verbal rating scales ( VRS ) are widely used to assess pain . This paper presents a secondary analysis of a subsection of data collected as part of an evaluation of an intervention to improve  nighttime pain .  The aims were to describe the relationship between the VAS and VRS ; to compare characteristics of the noncompliant groups in terms of age , gender , type of surgery , and analgesics ; to explore the reasons for noncompletion of the VAS or VRS ; and to determine the noncompliance rates with each assessment scale . Worst and average pain scores were obtained for the second postoperative night for 417 patients . Fifty-nine patients ( 14.2 % ) did not complete the VAS . In contrast , two patients did not complete the VRS ( 0.5 % ) . The scores generated from the  VAS and VRS  correlated well , although the range of VAS scores corresponding to each VRS category was wide . We conclude that the VRS was more suitable for use in this clinical setting 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 The purpose of this study was to develop and test the Verran and Snyder-Halpern ( VSH ) Sleep Scale , an instrument to subjectively measure sleep characteristics . Four major sleep factors and their associated characteristics were proposed for the Sleep Scale . Subjects completed three r and omly ordered sleep question naires on three consecutive weekday mornings within the first two hours after arising . Scales included the  VSH Sleep Scale , a sleep question naire and a sleep log .  The VSH Sleep Scale had a reliability coefficient of .82 ( theta ) . Construct validity was examined by factor analysis and correlations between Sleep Scale items and corresponding items on the two other study instruments . Scale validity also was assessed by the known groups method . Beginning support for the validity of the VSH Sleep Scale is provided 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 BACKGROUND The literature supporting the use of music therapy in palliative care is growing . However , the number of quantitative research studies investigating the use of music therapy in palliative care , and specifically anxiety , is limited . OBJECTIVE The aim of this research project was to examine the effectiveness of a single music therapy session in reducing anxiety for terminally ill patients . DESIGN A r and omized-controlled design was implemented and the following hypotheses tested . There will be a significant difference between the experimental and control groups on anxiety levels as demonstrated by the anxiety measurement of the Edmonton Symptom Assessment System ( ESAS ) , and heart rate . The experimental group received a single music therapy intervention and the control group received a volunteer visit . SETTING /SUBJECTS Twenty-five participants with end-stage terminal disease receiving inpatient hospice services were recruited . RESULTS The first hypothesis was supported . Results demonstrated a significant reduction in anxiety for the experimental group on the anxiety measurement of the ESAS ( p = 0.005 ) . A post hoc analysis found significant reductions in other measurements on the ESAS in the experimental group , specifically pain ( p = 0.019 ) , tiredness ( p = 0.024 ) and drowsiness ( p = 0.018 ) . The second hypothesis was not supported . CONCLUSIONS The study supports the use of music therapy to manage  anxiety  in terminally ill patients . Further studies are required to examine the effect of music therapy over a longer time period , as well as addressing other symptom issues Background About 90 % of patients with intra-thoracic malignancy experience breathlessness .  Breathing training is helpful , but it is unknown whether repeated sessions are needed . The present study aims to test whether three sessions are better than one for breathlessness in this population . Methods This is a multi-centre r and omised controlled non-blinded parallel arm trial . Participants were allocated to three sessions or single ( 1:2 ratio ) using central computer-generated block r and omisation by an independent Trials Unit and stratified for centre . The setting was respiratory , oncology or palliative care clinics at eight UK centres . Inclusion criteria were people with intrathoracic cancer and refractory breathlessness , expected prognosis ≥3 months , and no prior experience of breathing training . The trial intervention was a complex breathlessness intervention ( breathing training , anxiety management , relaxation , pacing , and prioritisation ) delivered over three hour-long sessions at weekly intervals , or during a single hour-long session . The main primary outcome was worst breathlessness over the previous 24 hours ( ‘ worst ’ ) , by numerical rating scale ( 0 = none ; 10 = worst imaginable ) . Our primary analysis was area under the curve ( AUC ) ‘ worst ’ from baseline to 4 weeks . All analyses were by intention to treat . Results Between April 2011 and October 2013 , 156 consenting participants were r and omised ( 52 three ; 104 single ) . Overall , the ‘ worst ’ score reduced from 6.81 ( SD , 1.89 ) to 5.84 ( 2.39 ) . Primary analysis [ n = 124 ( 79 % ) ] , showed no between-arm difference in the AUC : three sessions 22.86 ( 7.12 ) vs single session 22.58 ( 7.10 ) ; P value = 0.83 ) ; mean difference 0.2 , 95 % CIs ( –2.31 to 2.97 ) . Complete case analysis showed a non-significant reduction in QALYs with three sessions ( mean difference –0.006 , 95 % CIs –0.018 to 0.006 ) . Sensitivity analyses found similar results . The probability of the single session being cost-effective ( threshold value of £ 20,000 per QALY ) was over 80 % . Conclusions There was no evidence that three sessions conferred additional benefits , including cost-effectiveness , over one . A single session of breathing training seems appropriate and minimises patient burden . Trial registration Registry : IS RCT N ; Trial registration number : IS RCT N49387307 ; http://www.is rct n.com/IS RCT N49387307 ; registration date : Purpose A pilot study to document changes in symptoms after acupuncture or nurse-led supportive care in patients with incurable cancer . Methods Patients receiving palliative care with estimated survival of at least 3 months were screened with the Edmonton Symptom Assessment System ( ESAS ) . Patients ( n=20 ) with significant symptoms were r and omised to receive weekly acupuncture or nurse-led supportive care for 4 weeks . ESAS scores were obtained before and after each treatment , and weekly for 6 weeks after treatment by telephone . Results 42 of 170 patients screened were eligible . 20 gave consent for recruitment . The compliance rate was 90 % for acupuncture and 80 % for nurse-led supportive care .  Total symptom scores were reduced by an average of 22 % after each acupuncture visit and by 14 % after each supportive care visit . Compared with baseline , ESAS scores at the end of the follow-up period were reduced by 19 % for the acupuncture arm and 26 % for nurse-led supportive care . Conclusion Patients appear to benefit from incorporating acupuncture in the treatment of advanced incurable cancer . Acupuncture was well tolerated with no significant or unexpected side effects . Acupuncture had an immediate effect on all symptoms , whereas nurse-led supportive care had a larger impact 6 weeks after the final session . Both interventions appear helpful to this population and warrant further study Effective evaluation and treatment of cancer pain require valid and independent measurement of pain intensity , pain relief , and psychological distress . The Memorial Pain Assessment Card ( MPAC ) is a simple instrument design ed to provide rapid evaluation of these subjective experiences . On the 8.5 by 11 inch card are printed the eight pain intensity descriptors , and three visual analog scales 
    Output:
    
CAM may provide a limited short-term benefit in patients with symptom burden .