***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: PURPOSE We previously evaluated fatigue , menopausal symptoms , and cognitive dysfunction in patients receiving adjuvant therapy for breast cancer and matched healthy women . Here we report assessment of these women 1 and 2 years later . PATIENTS AND METHODS Patients without relapse and controls were evaluated by the Functional Assessment of Cancer Treatment-General Quality of Life question naire , with subscales for fatigue and endocrine symptoms , and by the High Sensitivity Cognitive Screen . RESULTS There were 104 , 91 , and 83 patients and 102 , 81 , and 81 controls assessed at baseline and at 1 and 2 years , respectively . Median Functional Assessment of Cancer Treatment-Fatigue scores ( range , 0 to 52 ) for patients improved from 31 ( on chemotherapy ) to 43 and 45 at 1 and 2 years , respectively , but were stable in controls ( 46 to 48 ) . Median Functional Assessment of Cancer Treatment-Endocrine Symptoms scores ( range , 0 to 72 ) for patients improved from 57 ( on chemotherapy ) to 59 and 61 at 1 and 2 years , respectively , and were stable in controls ( 64 to 65 ) . Differences between patients and controls remained significant for these scales . The incidence of moderate-severe cognitive dysfunction by the High Sensitivity Cognitive Screen  decreased in patients from 16 % ( on chemotherapy ) to 4.4 % and 3.8 % and in controls from 5 % to 3.6 % and 0 % at 1 and 2 years , respectively . There were minimal differences between estrogen receptor-positive patients who started hormonal therapy ( mainly tamoxifen ) after chemotherapy and estrogen receptor-negative patients who did not . Differences in quality of life between patients and controls were significant only at baseline . CONCLUSION Fatigue , menopausal symptoms , and cognitive dysfunction are important adverse effects of chemotherapy that improve in most patients . Hormonal treatment has minimal impact on them 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 & NA ; Few controlled clinical trials of psychological interventions for cancer pain relief exist in spite of frequent support for their importance as adjuncts to medical treatment . This study compared oral mucositis pain levels in 4 groups of cancer patients receiving bone marrow transplants ( BMT ) : ( 1 ) treatment as usual control , ( 2 ) therapist support , ( 3 ) relaxation and imagery training , and ( 4 ) training in a package of cognitive‐behavioral coping skills which included relaxation and imagery . A total of 94 patients completed the study which involved two training sessions prior to treatment and twice a week ‘ booster ’ sessions during the first 5 weeks of treatment . Results confirmed our hypothesis that patients who received either relaxation and imagery alone or patients who received the package of cognitive‐behavioral coping skills would report less pain than patients in the other 2 groups . The hypothesis that the cognitive‐behavioral skills package would have an additive effect beyond relaxation and imagery alone was not confirmed . Average visual analogue scale ( VAS ) report of pain within the therapist support group was not significantly lower than the control group ( P = 0.103 ) nor significantly higher than the training groups . Patient reports of relative helpfulness of the interventions for managing pain and nausea matched the results of VAS reports . From these results , we conclude that relaxation and imagery training reduces cancer treatment‐related pain ; adding cognitive‐behavioral skills to the relaxation with imagery does not , on average , further improve pain relief CONTEXT A prior national survey documented the high prevalence and costs of  alternative medicine use in the United States in 1990 . OBJECTIVE To document trends in alternative medicine use in the United States between 1990 and 1997 . DESIGN Nationally representative r and om household telephone surveys using comparable key questions were conducted in 1991 and 1997 measuring utilization in 1990 and 1997 , respectively . PARTICIPANTS A total of 1539 adults in 1991 and 2055 in 1997 . MAIN OUTCOMES MEASURES Prevalence , estimated costs , and disclosure of alternative therapies to physicians . RESULTS Use of at least 1 of 16 alternative therapies during the previous year increased from 33.8 % in 1990 to 42.1 % in 1997 ( P < or = .001 ) . The therapies increasing the most included herbal medicine , massage , megavitamins , self-help groups , folk remedies , energy healing , and homeopathy . The probability of users visiting an alternative medicine practitioner increased from 36.3 % to 46.3 % ( P = .002 ) . In both surveys alternative therapies were used most frequently for chronic conditions , including back problems , anxiety , depression , and headaches . There was no significant change in disclosure rates between the 2 survey years ; 39.8 % of alternative therapies were disclosed to physicians in 1990 vs 38.5 % in 1997 . The percentage of users paying entirely out-of-pocket for services provided by alternative medicine practitioners did not change significantly between 1990 ( 64.0 % ) and 1997 ( 58.3 % ) ( P=.36 ) . Extrapolations to the US population suggest a 47.3 % increase in total visits to alternative medicine practitioners , from 427 million in 1990 to 629 million in 1997 , thereby exceeding total visits to all US primary care physicians . An estimated 15 million adults in 1997 took prescription medications concurrently with herbal remedies and /or high-dose vitamins ( 18.4 % of all prescription users ) . Estimated expenditures for alternative medicine professional services increased 45.2 % between 1990 and 1997 and were conservatively estimated at $ 21.2 billion in 1997 , with at least $ 12.2 billion paid out-of-pocket . This exceeds the 1997 out-of-pocket expenditures for all US hospitalizations . Total 1997 out-of-pocket expenditures relating to alternative therapies were conservatively estimated at $ 27.0 billion , which is comparable with the projected 1997 out-of-pocket expenditures for all US physician services . CONCLUSIONS  Alternative medicine use and expenditures increased substantially between 1990 and 1997 , attributable primarily to an increase in the proportion of the population seeking alternative therapies , rather than increased visits per patient OBJECTIVE To determine if the quality of  complementary and alternative medicine ( CAM ) placebo controlled r and omized controlled trials ( RCTs ) is related to the effect sizes they produce when the type of interventions and outcome variables are controlled . STUDY DESIGN AND SETTING A sample of 25 CAM meta-analyses was identified from MEDLINE and h and search es containing published effect sizes for at least three efficacy trials employing placebo control groups .  From these 25 review s , 26 pairs of trials were selected : the one reporting the largest effect size and the matching trial reporting the smallest effect size . Quality and publication characteristics were then abstract ed from each trial . RESULTS Unlike the preponderance of past evidence examining the relationship between quality and effect size , the present study found that trials possessing the largest effect sizes within a meta- analysis were also associated with higher quality ratings than their counterparts possessing the lowest effect sizes ( P=.019 ) . CONCLUSIONS Possible theoretical reasons for this unexpected positive relationship include ( a ) sampling error , ( b ) reduced within group variation , ( c ) fraudulent reporting , and ( d ) the restriction of the analyses to placebo controlled trial Evaluating the effectiveness of nursing interventions in decreasing pain is a top priority for clinical research . Unfortunately , most of the research on cancer pain relief has been limited to treatment studies involving the administration of analgesics . Research is needed to determine which nonanalgesic methods of pain control are effective and under what conditions . Consequently , an experimental study was design ed to test the effectiveness of massage as an intervention for cancer pain . Twenty-eight patients were r and omly assigned to a  massage or control group .  The patients in the massage group were given a 10 minute massage to the back ; the patients in the control group were visited for 10 minutes . For males , there was a significant decrease in pain level immediately after the massage . For females , there was not a significant decrease in pain level immediately after the massage . There were no significant differences between pain 1 hour and 2 hours after the massage in comparison with the initial pain for males or females . Massage was shown to be an effective short-term nursing intervention for pain in males in this sample Complementary therapies are increasingly used to reduce side effects of cancer treatment , without evidence for their effectiveness . In a r and omized , prospect i ve , 2-period , crossover intervention study , the authors tested the effects of therapeutic massage ( MT ) and healing touch ( HT ) , in comparison to presence alone or st and ard care , in inducing relaxation and reducing symptoms in 230 subjects . MT and HT lowered blood pressure , respiratory rate ( RR ) , and heart rate ( HR ) . MT lowered anxiety and HT lowered fatigue , and both lowered totalmooddisturbance . Pain ratings were lower after MT and HT , with 4-week nonsteroidal antiinflammatory drug use less during MT . There were no effects on nausea . Presence reduced RR and HR but did not differ from st and ard care on any measure of pain , nausea , mood states , anxiety , or fatigue . MT and HT are more effective than presence alone or st and ard care in reducing pain , mood disturbance , and fatigue in patients receiving cancer chemotherapy Purpose / Objective : Patients with cancer or symptoms referable to cancer therapy were offered acupuncture as potential palliation of their symptoms . This paper describes the physical integration of the discipline into the Oncology Clinic , and patient perspectives on its availability and efficacy . Patients and methods : Between August 1999 and May 2000 , 123 patients with varying symptoms received acupuncture in our Center 's Radiation and Medical Oncology Clinics and Breast Health Center . These patients had 823 visits during this time period . A practice outcome analysis was performed on patients receiving therapy between 1 January 2000 and 30 April 2000 . The 89 patients treated during this interval had 444 total visits . In June and July 2000 , a question naire was administered by phone to 79 of these patients ( 89 % ) . St and ard allopathic care continued while patients were receiving acupuncture . Results : Major reasons for referral included pain ( 53 % ) , xerostomia ( 32 % ) , hot flashes ( 6 % ) and nausea/loss of appetite ( 6 % ) . Patients had a mean of five acupuncture visits ( range 1– 9 ) . Most patients ( 60 % ) showed at least 30 % improvement in their symptoms . About one-third of patients had no change in severity of symptoms . There were no untoward effects reported related to the acupuncture . When analysed by diagnosis , these values persist . Irrespective of response to therapy , 86 % of respondents considered it ‘ very important ' that we continue to provide acupuncture services . Conclusion : Acupuncture may contribute to control of symptoms for cancer patients . Expansion of providers , continued patient follow-up , optimization of techniques and prospect i ve objective measurement of response continue in our clinic BACKGROUND Despite recent findings that patients who use complementary and alternative medicine ( CAM )  typically choose not to mention this to their physicians , little is known about the reasons for this lack of communication . Underst and ing the reasons for nondisclosure of CAM use is critical to improving physician-patient communication and patient care . METHODS We are conducting a 5-year prospect i ve cohort study consisting of 4 interview cycles . The multiethnic , population -based sample consists of 86 San Francisco residents with recently diagnosed breast cancer ( response rate = 87 % ) . Findings are determined using qualitative analysis of transcribed interviews . RESULTS At initial contact , 72 % of the participants were using at least 1 CAM therapy for breast cancer . Six months later , 65 % of participants were using  CAM .  Of the women being treated by an alternative practitioner , 54 % disclosed their  CAM use  to their physicians . Conversely , 94 % discussed details of their biomedical treatments with their alternative pract 
    Output:
    
There is paucity of multi-institutional RCTs evaluating CAM interventions for cancer pain with adequate power , duration , and sham control .
Hypnosis , imagery , support groups , acupuncture , and healing touch seem promising , particularly in the short term , but none can be recommended because of a paucity of rigorous trials .