***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: CONTEXT Multiple complex symptoms from cancer treatment can interfere with functioning . OBJECTIVES To evaluate the efficacy of an " energy and sleep enhancement " ( EASE ) intervention to relieve fatigue and sleep disturbance and improve health-related functional status . METHODS Individuals receiving chemotherapy ( CTX ) were r and omized to the EASE ( n=153 ) or a control intervention ( n=139 ) . The EASE intervention included information and behavioral skills taught by an oncology nurse in three telephone sessions . The primary outcomes of fatigue , sleep disturbance , and functional status were measured before CTX , Day 4 after first treatment ( baseline ) , and 43 - 46 or 57 - 60 days later ( follow-up ) , depending on the CTX cycle length . RESULTS The sample was primarily female ( 82 % ) and non-Hispanic white ( 89 % ) , with mean age of 53.9 years .  Fatigue and patient-reported sleep disturbance were elevated in both groups at baseline and follow-up . Actigraphy revealed that the total sleep time was almost eight hours , and sleep percent was greater than 85 % for both groups at both time points ( normal range ) . Physical functioning was diminished and at the same level as a sample with serious illness . Mental functioning was in normal range . A repeated- measures analysis of variance revealed no statistically significant group-by-time effects for fatigue , sleep disturbance , or functional status .  Unemployed individuals showed greater benefit from the EASE intervention , reporting less pain and symptom interference . CONCLUSION Potential explanations include high variability and /or floor effect for fatigue , incorrect timing of measures , insufficient amount or dose of the intervention , and confounding effects of gender . Future research should consider screening for symptom severity and tailoring interventions This study examined the relationship between objective ly measured nocturnal hot flashes and objective ly measured sleep in breast cancer survivors with insomnia . Twenty-four women who had completed treatment for non-metastatic breast cancer participated . All were enrolled in a study of cognitive-behavioral treatment for chronic insomnia .  Nocturnal hot flashes and sleep  were measured by skin conductance and polysomnography  , respectively . The 10-minute periods around hot flashes were found to have significantly more wake time , and more stage changes to lighter sleep , than other 10-minute periods during the night . Nights with hot flashes had a significantly higher percentage of wake time , a lower percentage of Stage 2 sleep , and a longer REM latency compared to nights without hot flashes . Overall , hot flashes were found to be associated with less efficient , more disrupted sleep . Nocturnal hot flashes , or their underlying mechanisms , should be considered as potential contributors to sleep disruption in women with breast cancer who report poor sleep Research suggests that stress‐reduction programs tailored to the cancer setting help patients cope with the effects of treatment and improve their quality of life .  Yoga , an ancient Eastern science , incorporates stress‐reduction techniques that include regulated breathing , visual imagery , and meditation as well as various postures . The authors examined the effects of the  Tibetan yoga ( TY ) practice s of Tsa lung and Trul khor , which incorporate  controlled breathing and visualization , mindfulness techniques  , and low‐impact postures  in patients with lymphoma STUDY OBJECTIVES To examine how self-reported ratings of sleep disturbance changed from the time of the simulation visit to four months after the completion of radiation therapy ( RT ) and to investigate whether specific patient , disease , and symptom characteristics predicted the initial levels of sleep disturbance and /or characteristics of the trajectories of sleep disturbance . DESIGN Prospect i ve longitudinal study . SETTING Two radiation therapy centers . PATIENTS Patients ( n = 82 ) who underwent primary or adjuvant RT for prostate cancer . MEASUREMENTS AND RESULTS Changes in self-reported sleep disturbance were measured using the General Sleep Disturbance Scale ( GSDS ) . Depressive symptoms were assessed using the Center for Epidemiologic Studies -Depression Scale . Trait and state anxiety were measured using the Spielberger State-Trait Anxiety Inventory . Hierarchical linear modeling was used to answer the study aims . Self-reported sleep disturbance increased during the course of RT and then decreased following the completion of RT . Predictors of higher levels of sleep disturbance included younger age , higher levels of trait anxiety , higher levels of depressive symptoms , and higher levels of sleep disturbance at the initiation of RT . CONCLUSIONS Sleep disturbance is a significant problem in patients with prostate cancer who undergo RT . Younger men with co-occurring depression and anxiety may be at greatest risk for sleep disturbance during RT Sleep disturbance is common in patients with advanced cancer , and their family carers also may suffer from sleep problems . The aims of this study were to determine the prevalence of sleep-wake disturbances in patients with advanced cancer and their carers , to monitor the amount of daytime spent in activity and rest , and to examine the relationship between sleep , physical , and psychological symptoms . This was a prospect i ve , descriptive observational study in patients with advanced incurable cancer and their carers attending a regional cancer center , using subjective ( Short Form-36 ,  Epworth Sleepiness Score , Hospital Anxiety and Depression Scale , Memorial Symptom Assessment Scale  , and  sleep history and diary ) and objective ( Actiwatch ) assessment s over a seven-day period . Sixty patients with advanced cancer and their family carers completed the study .  Poor sleep was a frequent complaint : 47 % of the patients and 42 % of the carers reported that they did not sleep well , yet patients reported sleeping an average of 8.2 hours and carers 7.8 hours per night . The objective assessment s revealed that although sleep efficiency ( SE ) was greater than 90 % for most patients and carers , sleep fragmentation was high in both groups . Patients and carers who complained of poor sleep were significantly more anxious ( P<0.001 and < 0.05 ) compared with patients and carers who reported sleeping well . Patients who complained of poor sleep had significantly more pain ( P<0.05 ) . These results show that a substantial proportion of advanced cancer patients and their carers complained of poor sleep despite reporting " normal " duration of sleep . Objective measurements using Actiwatch revealed good SE but high levels of sleep fragmentation and movement , suggesting that sleep quality may be disturbed . Further work is required to investigate sleep quality and the consequences of poor sleep . In the meantime , health care professionals need to routinely inquire about sleep and consider possible reversible underlying factors , such as pain and anxiety , for those who report sleep disturbance Purpose The purpose of this study was to examine patterns of circadian activity rhythms and their relationship with fatigue , anxiety/depression , and demographic/medical variables in women receiving breast cancer adjuvant therapy treatments ( Tx ) at three times within a r and omized clinical trial ( RCT ) design ed to improve sleep and modify fatigue . Methods A RCT enrolled 219 women with stage I – IIIA breast cancer who were r and omized 2 days prior to starting chemotherapy to a behavioral therapy sleep intervention or healthy eating control group . All cases with available data ( n = 190 ) were included in a descriptive , correlational , repeated measures analysis . Activity data were collected continuously by wrist actigraphy for 7 days at three times : the start ( Tx 1 ) , continuation ( Tx 3 ) , and recovery ( 30 days after last Tx ) of chemotherapy .  Circadian activity rhythm parameters were generated using Action4 software ( Ambulatory Monitoring , Inc. ) . Measures collected simultaneously included Piper Fatigue Scale , Hospital Anxiety and Depression Scale , and demographic/medical variables . Results Circadian activity rhythm parameters at three times in both groups were disrupted compared to healthy adults , but similar to values of cancer patients . Significant changes in mesor , amplitude , peak activity , and 24 h autocorrelation values were found over time in both groups . The intervention group ’s amplitude and circadian quotient values were significantly more robust . More robust activity rhythms were associated with lower fatigue , depressive symptoms , body mass index , and higher performance status in both groups . Conclusions Disrupted patterns of circadian activity rhythms were prevalent and associated with distressing fatigue and depressive symptoms during chemotherapy and at recovery . The intervention result ed in more robust rhythms Abstract Eight women who were in treatment for breast cancer ( n = 4 ) or breast cancer survivors ( n = 4 ) , presenting with 1 or more of 4 symptoms ( chronic pain , fatigue , hot flashes , and sleep difficulties ) , were given 4 to 5 sessions of self-hypnosis training for symptom management . Analyses revealed ( a ) significant pre- to posttreatment decreases in pain intensity , fatigue , and sleep problems and ( b ) that pain intensity continued to decrease from posttreatment to 6-month follow-up . Although there was a slight increase in fatigue severity and sleep problems from posttreatment to 6-month follow-up , the follow-up scores did not return to pretreatment levels . The findings provide initial support for using hypnosis to manage symptoms in women who are breast cancer survivors . Clinical trials evaluating hypnosis efficacy over and above other treatments are warranted PURPOSE To determine 1-year outcomes of a four-component behavioral therapy ( BT ) sleep intervention ( Individualized Sleep Promotion Plan [ ISPP ] ) versus a healthy eating control ( HEC ) on cancer-related fatigue in women receiving breast cancer adjuvant chemotherapy treatment ( CTX ) . PATIENTS AND METHODS A total of 219 participants from 12 oncology clinics were r and omly assigned in a clinical trial . Before CTX , research nurses coached intervention participants to develop a BT plan including stimulus control , modified sleep restriction , relaxation therapy , and sleep hygiene . BT plans were revised before each CTX and 30 , 60 , and 90 days after the last CTX and reinforced 7 to 9 days later . HEC participants received nutritional information and equal attention . Pittsburgh Sleep Quality Index ( PSQI ) , Daily Diary , Wrist Actigraph , and Piper Fatigue Scale measures and Repeated Linear Mixed Model analysis following the Intent to Treat paradigm were used . RESULTS Sleep quality differed over 1 years time ( F [ 4,162 ] = 7.7 , P < .001 ; by group , F [ 1,173 ] = 4.8 , P = .029 ; and over time by group , F [ 4,162 ] = 3.3 , P = .013 ) . Pairwise comparisons revealed significant differences between groups at 90 days ( P = .002 ) but not at 1 year ( P = .052 ) . Seven days of diary and actigraphy data did not corroborate with monthly reflections ( PSQI ) . The night awakenings ( Actigraph ) pattern was significantly different by group over time ( P = .046 ) , with no differences between groups at 90 days or at 1 year . Fatigue was lower at 1 year than before CTX ; no group effects were found . CONCLUSION The BT group , on average , experienced significant improvement on global sleep quality compared with the HEC group , but not on objective sleep or fatigue outcomes Goals of workThe goal of this study is to characterize sleep quality and quantity prior to and in the first three nights after initial chemotherapy for breast cancer . Material s and methods This study makes use of secondary analysis of data from two separate r and omized clinical trials ( RCT ) of behavioral interventions to improve fatigue and sleep .  Patients came from two comprehensive cancer centers , three clinical cancer centers , and 10 community clinics in five states . Participants were women with stage I – IIIA breast cancer treated with anthracycline and /or cyclophosphamide-based regimens .  Main results Baseline data from each RCT were used in the analysis . Sixty-five percent of women self-reported poor sleep in the month preceding chemotherapy using the Pittsburgh Sleep Quality Index ( PSQI ) score > 5 . Three nights of actigraphy data indicated a wide range of sleep experience with an average of 10 awakenings and time ( minutes ) awake after sleep onset ( WASO-M ) averaging 61 min per night . The first night ’s sleep was the worst . There was no statistically significant relationship between self-reported poor sleep and sleep measures obtained by actigraphy .  Women with poor sleep at baseline ( global PSQI > 5 ) had significantly lower ( p < 0.001 ) physical ( PCS ) and mental ( MCS ) health status . However , neither the PCS nor MCS was associated with any of the average actigraphy sleep parameters or night 1 parameters in the aggregated sample . Increasing age was also associated with poorer sleep . Conclusions A high percent of women with breast cancer begin chemotherapy with disturbed sleep and the initial nights after chemotherapy are characterized by sleep fragmentation that disrupts sleep maintenance . Interventions should focus on strategies to decrease the number and duration of night awakenings . Further research is needed to identify predictors of poor sleep during this time OBJECTIVE The diagnosis of breast cancer , the most common type of cancer among American women , elicits greater distress than any other diagnosis regardless of prognosis . Therefore , the present study examined the efficacy of a stress reduction intervention for women with breast cancer . METHODS As part of a larger , r and omized , controlled study of the effects on measures of stress of a mindfulness-based stress reduction ( MBSR ) intervention for women with breast cancer , the current analyses examined the effects on sleep complaints . RESULTS Analyses of the data indicated that both MBSR and a free choice ( FC ) control condition produced significant improvement on daily diary sleep quality measures though neither showed significant improvement on sleep-efficiency . Participants in the MBSR who reported greater mindfulness practice improved significantly more on the sleep quality measure most strongly associated with distress . CONCLUSION MBSR appears to be a promising intervention to improve the quality of sleep in woman with breast cancer whose sleep complaints are due to stress Background This study ’s purpose was twofold : ( 1 ) to establish adherence rates to a behavioral 
    Output:
    
Studies of sleep and cancer focus on specific types of symptoms of poor sleep , and there are no published prevalence studies that focus on underlying sleep disorders .
Challenging the current paradigm of the way sleep is studied in cancer could produce better clinical screening tools for use in oncology clinics leading to better triaging of patients with sleep complaints to sleep specialists , and overall improvement in sleep quality