***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: 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 The aim of this research is to examine the experience and impact of  chemotherapy-related fatigue in recently diagnosed pediatric oncology patients . A repeated- measures , within-subjects , mixed ( quantitative plus qualitative ) design was used to prospect ively assess fatigue during early chemotherapy cycles and to compare fatigue to depressive symptoms . Parental interviews collected concurrently were analyzed for descriptions of the child 's fatigue and mood states and for strategies to cope with fatigue . Results indicated a significant correlation between fatigue and depression , but qualitative analyses suggested that the 2 phenomena may be unique and distinguishable . Qualitative analyses of parent interviews also identified specific strategies that were frequently used in response to high levels of fatigue . The findings illustrate the significant impact of chemotherapy-related fatigue in children being treated for cancer . The study also provides guidance for the assessment of fatigue and related symptoms and identifies specific strategies for coping with fatigue PURPOSE Fatigue is a distressing symptom occurring in more than 60 % of patients with cancer . The CNS stimulants modafinil and methylpheni date are recommended for the treatment of cancer-related fatigue , despite a limited evidence base . We aim ed to evaluate the efficacy and tolerability of modafinil in the management of fatigue in patients with non-small-cell lung cancer ( NSCLC ) . PATIENTS AND METHODS Adults with advanced NSCLC and performance status of 0 to 2 , who were not treated with chemotherapy or radiotherapy within the last 4 weeks , were r and omly assigned to daily modafinil ( 100 mg on days 1 to 14 ; 200 mg on days 15 to 28 ) or matched placebo . The primary outcome was change in Functional Assessment of Chronic Illness Therapy ( FACIT ) -Fatigue score from baseline to 28 days , adjusted for baseline fatigue and performance status . Secondary outcomes included safety and patient-reported measures of depression , daytime sleepiness , and quality of life . RESULTS A total of 208 patients were r and omly assigned , and 160 patients ( modafinil , n = 75 ; placebo , n = 85 ) completed question naires at both baseline and day 28 and were included in the modified intention-to-treat analysis . FACIT-Fatigue scores improved from baseline to day 28 ( mean score change : modafinil , 5.29 ; 95 % CI , 2.57 to 8.02 ; placebo , 5.09 ; 95 % CI , 2.54 to 7.65 ) , but there was no difference between treatments ( 0.20 ; 95 % CI , -3.56 to 3.97 ) . There was also no difference between treatments for the secondary outcomes ; 47 % of the modafinil group and 23 % of the placebo group stated that the intervention was not helpful . CONCLUSION Modafinil had no effect on cancer-related fatigue and should not be prescribed outside a clinical trial setting . Its use was associated with a clinical ly significant placebo effect PURPOSE Several guidelines on the treatment of cancer-related fatigue recommend optimizing treatment of accompanying symptoms . However , evidence for this recommendation from r and omized clinical trials is lacking . We investigated whether monitoring and protocol ized treatment of physical symptoms alleviates fatigue . PATIENTS AND METHODS In all , 152 fatigued patients with advanced cancer were r and omly assigned to protocol ized patient-tailored treatment ( PPT ) of symptoms or care as usual . The PPT group had four appointments with a nurse who assessed nine symptoms on a 0 to 10 numeric rating scale ( NRS ) . Patients received a nonpharmacologic intervention for symptoms with a score ≥ 1 and a medical intervention for symptoms with a score ≥ 4 . Fatigue dimensions , fatigue NRS score , interference of fatigue with daily life , symptom burden , quality of life , anxiety , and depression were measured at baseline and after 1 , 2 , and 3 months . Differences between the groups over time were assessed by using mixed modeling . RESULTS Seventy-six patients were r and omly assigned to each study arm . Mean age was 58 ± 10 years , 57 % were female , and 65 % were given palliative chemotherapy . We found significant improvements over time in favor of PPT for the primary outcome general fatigue ( P = .01 ) , with significant group differences at month 1 ( effect size , 0.26 ; P = .007 ) and month 2 ( effect size , 0.35 ; P = .005 ) . Improvements in favor of PPT were also found for the following secondary outcomes : fatigue dimensions " reduced activity " and " reduced motivation , " fatigue NRS , symptom burden , interference of fatigue with daily life , and anxiety ( all P ≤ .03 ) . CONCLUSION In fatigued patients with advanced cancer , nurse-led monitoring and protocol ized treatment of physical symptoms is effective in alleviating fatigue CONTEXT Physical activity has been shown to decrease the incidence of breast cancer , but the effect on recurrence or survival after a breast cancer diagnosis is not known . OBJECTIVE To determine whether physical activity among women with breast cancer decreases their risk of death from  breast cancer  compared with more sedentary women . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve observational study based on responses from 2987 female registered nurses in the Nurses ' Health Study who were diagnosed with stage I , II , or III breast cancer between 1984 and 1998 and who were followed up until death or June 2002 , whichever came first . MAIN OUTCOME MEASURE Breast cancer mortality risk according to  physical activity  category ( <3 , 3 - 8.9 , 9 - 14.9 , 15 - 23.9 , or > or = 24 metabolic equivalent task [ MET ] hours per week ) . RESULTS Compared with women who engaged in less than 3 MET-hours per week of physical activity , the adjusted relative risk ( RR ) of death from breast cancer was 0.80 ( 95 % confidence interval [ CI ] , 0.60 - 1.06 ) for 3 to 8.9 MET-hours per week ; 0.50 ( 95 % CI , 0.31 - 0.82 ) for 9 to 14.9 MET-hours per week ; 0.56 ( 95 % CI , 0.38 - 0.84 ) for 15 to 23.9 MET-hours per week ; and 0.60 ( 95 % CI , 0.40 - 0.89 ) for 24 or more MET-hours per week ( P for trend = .004 ) . Three MET-hours is equivalent to walking at average pace of 2 to 2.9 mph for 1 hour . The benefit of physical activity was particularly apparent among women with hormone-responsive tumors . The RR of breast cancer death for women with hormone-responsive tumors who engaged in 9 or more MET-hours per week of activity compared with women with hormone-responsive tumors who engaged in less than 9 MET-hours per week was 0.50 ( 95 % CI , 0.34 - 0.74 ) . Compared with women who engaged in less than 3 MET-hours per week of activity , the absolute unadjusted mortality risk reduction was 6 % at 10 years for women who engaged in 9 or more MET-hours per week . CONCLUSIONS Physical activity after a breast cancer diagnosis may reduce the risk of death from this disease . The greatest benefit occurred in women who performed the equivalent of walking 3 to 5 hours per week at an average pace , with little evidence of a correlation between increased benefit and greater energy expenditure . Women with breast cancer who follow US physical activity recommendations may improve their survival The dem and s of cancer treatment are particularly challenging for newly diagnosed adolescents . If attempts to cope with these dem and s are unsuccessful , adolescents may not comply with or may refuse treatment . As a result , their chances of survival are decreased . The purpose of this study , guided by the Adolescent Self-Sustaining Model , was to determine the effects of a three-part educational intervention design ed to facilitate copying on psychological ( hopefulness , hopelessness , self-esteem , self-efficacy and symptom distress ) and clinical outcomes ( treatment toxicity ) among adolescents newly diagnosed with cancer . This two-site study used a longitudinal experimental two-group design with adolescents r and omly assigned to the intervention or control group . Four measurement points spanning the first 6 months of treatment were included in the design . Of 93 eligible adolescents , 78 ( 46 females and 32 males ) agreed to participate . No statistically significant differences between the intervention and control groups , or between male and female participants , were detected at any measurement point . Differences in scores over time within groups were noted . Explanations for the lack of group differences are offered , as are recommendations for strengthening the intervention and design for future testing Purpose The purpose of the study was to compare the quality of life ( QoL ) , fatigue and mental distress in survivors of malignant extremity bone tumours ( EBT survivors ) with age and gender-matched survivors of Hodgkin ’s disease ( HD survivors ) and testicular cancer ( TC survivors ) as well as normative sample s from the general population . Patients and methods Five years or more after end of treatment , 75 EBT survivors were mailed a question naire containing Short Form-36 ( SF-36 ) , the Hospital Anxiety and Depression Scale , the Fatigue Question naire and questions about demography .  Fifty-eight EBT survivors responded . TC survivors , HD survivors and normative sample s ( NORMs ) had earlier on filled in the same question naire . For EBT survivors , gender and age-matched controls were r and omly selected among TC survivors , HD survivors and NORMs . Results No significant differences in the fatigue or mental distress scores were observed between the survivor groups . The EBT survivors had significantly higher fatigue scores and lower depression scores than NORMs and significantly lower scores on all physical dimensions of QoL than TC survivors , HD survivors and NORMs . In multivariate analysis , a low level of education and lack of employment were significantly associated with caseness of mental distress . Older age at survey , female gender , being an EBT survivor and lack of employment were associated with caseness on the SF-36 Physical Component Summary Scale . Conclusion At long-term follow-up , EBT survivors did not show impaired mental health or fatigue at the group level , although their post-treatment status was characterised by reduced QoL dimensions on physical function compared to TC survivors , HD survivors and NORMs PURPOSE / OBJECTIVES To examine the relationship between physical performance and fatigue in child and adolescent cohorts during the first three cycles of chemotherapy . DESIGN Prospect i ve , observational design . SETTING Two pediatric cancer centers in the upper Midwest region of the United States . SAMPLE 16 children and 14 adolescents newly diagnosed with cancer . METHODS St and ardized instruments were administered during the first and third cycles of chemotherapy . Instruments included  physical performance tests ( Timed Up and Down Stairs [ TUDS ] and the 6-Minute Walk Test [ 6MWT ] ) and a self-report fatigue scale .  MAIN RESEARCH VARIABLES Fatigue and physical performance . FINDINGS In the child cohort , physical performance appeared to improve and fatigue diminished from cycle 1 to 3 of chemotherapy . When time on TUDS decreased , fatigue tended to decrease ; when 6MWT distance increased , fatigue decreased . In the adolescent cohort , fatigue seemed to decrease but physical performance measures evidence d little change . Correlations between changes in the physical performance variables and fatigue were not significant . CONCLUSIONS Fatigue may decrease early in treatment as disease symptoms resolve . 
    Output:
    
Cancer-related fatigue was consistently one of the most prevalent , severe , and distressing symptoms , and it persisted long-term in survivors .
It was associated with a number of factors , including poor sleep , depression , and chemotherapy .
There was little evidence for the effectiveness of any intervention , although exercise appears to be the most promising .
Importantly , fatigue was itself a significant barrier to physical and social activities .
Cancer-related fatigue is a major and disabling problem in young cancer patients .