***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: BACKGROUND Patients with colorectal cancer are usually treated with chemotherapy , which reduces the number of blood cells , especially white blood cells , and consequently increases the risk of infections . Some research studies have reported that aromatherapy massage affects the immune system and improves immune function by , for example , increasing the numbers of natural killer cells and peripheral blood lymphocytes . However , there has been no report of any study which provided good evidence as to whether aromatherapy with Thai massage could improve the immune system in patients with colorectal cancer . The objectives of this study were to determine whether the use of aromatherapy with light Thai massage in patients with colorectal cancer , who have received chemotherapy , can result in improvement of the cellular immunity and reduce the severity of the common symptoms of side effects . MATERIAL S AND METHODS Sixty-six patients with colorectal cancer in Phichit Hospital , Thail and , were enrolled in a single-blind , r and omised-controlled trial . The intervention consisted of three massage sessions with ginger and coconut oil over a 1-week period . The control group received st and ard supportive care only . Assessment s were conducted at pre- assessment and at the end of one week of massage or st and ard care . Changes from pre- assessment to the end of treatment were measured in terms of white blood cells , neutrophils , lymphocytes , CD4 and CD8 cells and the CD4/CD8 ratio and also the severity of self-rated symptom scores . RESULTS The main finding was that after adjusting for pre- assessment values the mean lymphocyte count at the post- assessment was significantly higher ( P=0.04 ) in the treatment group than in the controls . The size of this difference suggested that aromatherapy with Thai massage could boost lymphocyte numbers by 11 % . The secondary outcomes were that at the post assessment the symptom severity scores for fatigue , presenting symptom , pain and stress were significantly lower in the massage group than in the st and ard care controls . CONCLUSIONS Aromatherapy with light Thai massage can be beneficial for the immune systems of cancer patients who are undergoing chemotherapy by increasing the number of lymphocytes and can help to reduce the severity of common symptoms & NA ; St and ard guidelines for cancer pain treatment routinely recommend training patients to reduce barriers to pain relief , use medications appropriately , and communicate their pain‐related needs . Methods are needed to reduce professional time required while achieving sustained intervention effectiveness . In a multisite , r and omized controlled trial , this study tested a pain training method versus a nutrition control . At six oncology clinics , physicians ( N = 22 ) and nurses ( N = 23 ) enrolled patients ( N = 93 ) who were over 18 years of age , with cancer diagnoses , pain , and a life expectancy of at least 6 months .  Pain training and control interventions were matched for material s and method . Patients watched a video followed by about 20 min of manual‐st and ardized training with an oncology nurse focused on review ing the printed material and adapted to individual concerns of patients . A follow‐up phone call after 72 h addressed individualized treatment content and pain communication . Assessment s at baseline , one , three , and 6 months included barriers , the Brief Pain Inventory , opioid use , and physician and nurse ratings of their patients ’ pain . Trained versus control patients reported reduced barriers to pain relief ( P < .001 ) , lower usual pain ( P = .03 ) , and greater opioid use ( P < .001 ) . No pain training patients reported severe pain ( > 6 on a 0–10 scale ) at 1‐month outcomes ( P = .03 ) . Physician and nurse ratings were closer to patients ’ ratings of pain for trained versus nutrition groups ( P = .04 and < .001 , respectively ) . Training efficacy was not modified by patient characteristics . Using video and print material s , with brief individualized training , effectively improved pain management over time for cancer patients of varying diagnostic and demographic groups 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 Some cancer patients use therapeutic massage  to reduce symptoms , improve coping , and enhance quality of life . Although a meta- analysis concludes that massage can confer short-term benefits in terms of psychological wellbeing and reduction of some symptoms , additional vali date d r and omized controlled studies are necessary to determine specific indications for various types of therapeutic massage . In addition , mechanistic studies need to be conducted to discriminate the relative contributions of the therapist and of the reciprocal relationship between body and mind in the subject . Nuclear magnetic resonance techniques can be used to capture dynamic in vivo responses to biomechanical signals induced by massage of myofascial tissue . The relationship of myofascial communication systems ( called “ meridians ” ) to activity in the subcortical central nervous system can be evaluated . Underst and ing this relationship has important implication s for symptom control in cancer patients , because it opens up new research avenues that link self-reported pain with the subjective quality of suffering . The reciprocal body – mind relationship is an important target for manipulation therapies that can reduce suffering OBJECTIVES The aim of the present study was to examine the effect of massage on nausea , anxiety , and depression in patients with breast cancer undergoing chemotherapy . DESIGN This work was a single-center , prospect i ve , r and omized , controlled trial . SETTING S/LOCATION This study was conducted in an oncology clinic , in a hospital in southwestern Sweden . SUBJECTS Thirty-nine ( 39 ) women ( mean age = 51.8 ) with breast cancer undergoing chemotherapy were enrolled . INTERVENTIONS The patients were r and omly assigned to a massage therapy group ( 20 minutes of massage on five occasions ) or a control group ( five 20-minute visits ) . OUTCOME MEASURES All patients recorded nausea and anxiety on the Visual Analogue Scale before and after each intervention . They also completed the Hospital Anxiety and Depression Scale . RESULTS Massage treatment significantly reduced nausea compared with control treatment ( p = 0.025 ) when improvement was measured as a percentage of the five treatment periods . Differences in anxiety and depression between the two treatment regimes could not be statistically demonstrated . CONCLUSIONS This study complements previous studies on the effect of massage and supports the conclusion that massage reduces nausea in these patients Purpose Medical professionals ’ practice s and knowledge regarding cancer pain management have often been cited as inadequate . This study aim ed to evaluate knowledge , practice s and perceived barriers regarding  cancer pain management among physicians and nurses in Korea . Methods A nationwide question naire survey was administered to physicians and nurses involved in the care of cancer patients . Question naire items covered pain assessment and documentation practice s , knowledge regarding cancer pain management , the perceived barriers to cancer pain control , and processes perceived as the major causes of delay in opioid administration . Results A total of 333 question naires ( 149 physicians and 284 nurses ) were analyzed . Nurses performed  pain assessment  and  documentation  more regularly than physicians did . Although physicians had better knowledge of pain management than did nurses , both groups lacked knowledge regarding the side effects and pharmacology of opioids . Physicians working in the palliative care ward and nurses who had received pain management education obtained higher scores on knowledge . Physicians perceived patients ’ reluctance to take opioids as a barrier to pain control , more so than did nurses , while nurses perceived patients ’ tendency to under-report of pain as a barrier , more so than did physicians . Physicians and nurses held different perceptions regarding major cause of delay during opioid administration . Conclusions There were differences between physicians and nurses in knowledge and practice s for cancer pain management . An effective educational strategy for cancer pain management is needed in order to improve medical professionals ’ knowledge and clinical practice 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 A r and omized controlled trial was conducted to evaluate outcomes of a multimedia instructional program for family caregivers in simple touch-based techniques to provide comfort to cancer patients at home . Methods A multilingual 78-min DVD and 66-page manual were produced for homebased instruction . Content addresses attitudes and communication about touch in cancer , psychological preparation for giving and receiving touch , safety pre caution s , massage techniques for comfort and relaxation , acupressure for specific cancer-related symptoms , and practice in the home setting . Material s were produced in English , Spanish , and Chinese versions . A community-based multiethnic sample of 97 adult patient/caregiver dyads was r and omized to experimental ( massage ) or attention control ( reading ) groups for 4 weeks .  Massage dyads received the program and instructions to practice at least three times per week , while control caregivers read to their patients for the same frequency . Self-report instruments assessed change in symptom severity , quality of life , perceived stress , and caregiver attitudes . Results Significant reductions in all symptoms occurred for patients after both activities : 12–28 % reductions after reading vs. 29–44 % after massage . Massage caregivers showed significant gains in confidence , comfort , and self-efficacy using touch and massage as forms of caregiving . Conclusions Multimedia instruction in touch and massage methods may offer family members a viable means of enhancing self-efficacy and satisfaction in caregiving while decreasing patient pain , depression , and other symptoms . Family members may be able to learn and apply safe and simple methods that increase patient comfort and reduce distress & NA ; The purpose of this study was to determine the levels of change on st and ard pain scales that represent clinical ly important differences to patients . Data from analgesic studies are often difficult to interpret because the clinical importance of the results is not obvious . Differences between groups , as summarized by a change in mean values over time , can be difficult to apply to clinical care . Baseline scores vary widely and group mean differences could reflect large changes in a few patients , small changes in many patients , or any combination of these outcomes . Determination of the proportion of patients who have a clinical ly important improvement in their pain would provide a more interpretable result with direct clinical implication s. However , determining a clinical ly important outcome requires information about the degree of change over time that is clinical ly important . Data from the titration phase of a multiple cross‐over r and omized clinical trial of oral transmucosal fentanyl citrate ( OTFC )  for the treatment of cancer‐related breakthrough pain were re‐analyzed to examine the differences in pain scores between treatment episodes that did and did not yield adequate pain relief . The scales evaluated were absolute pain intensity difference ( PID , 0–10 scale ) , percentage pain intensity difference ( PID% , 0–100 % scale ) , pain relief ( PR , 0 ( none ) , 1 ( slight ) , 2 ( moderate ) , 3 ( lots ) , 4 ( complete ) ) , sum 
    Output:
    
Based on the evidence , weak recommendations are suggested for massage therapy , compared to an active comparator , for the treatment of pain , fatigue , and anxiety .
No recommendations were suggested for massage therapy compared to no treatment or sham control based on the available literature to date .