***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 
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    Input: To investigate whether the impact of postdiagnosis exercise on  breast cancer outcomes  in women diagnosed with early-stage breast cancer differs on the basis of tumor clinicopathologic and molecular features . Using a prospect i ve design , 6,211 patients with early-stage breast cancer from two large population -based cohort studies were studied . Age-adjusted and multivariable Cox regression models were performed to determine the relationship between exercise exposure ( total MET-hours/week ) and recurrence and breast cancer-related death for : ( i ) all patients ( " unselected " cohort ) , and on the basis of ( ii ) classic clinicopathologic features , ( iii ) clinical subtypes , ( iv ) PAM50-based molecular intrinsic subtypes , and ( v ) individual PAM50 target genes . After a median follow-up of 7.2 years , in the unselected cohort ( n = 6,211 ) increasing exercise exposure was not associated with a reduction in the risk of recurrence ( adjusted Ptrend = 0.60 ) or breast cancer-related death ( adjusted Ptrend = 0.39 ) . On the basis of clinicopathologic features , an exercise-associated reduction in breast cancer-related death was apparent for tumors < 2 cm [ HR , 0.50 ; 95 % confidence interval ( CI ) , 0.34 - 0.72 ] , well/moderately differentiated tumors ( HR , 0.63 ; 95 % CI , 0.43 - 0.91 ) , and ER-positive tumors ( HR , 0.72 ; 95 % CI , 0.53 - 0.97 ) . Stratification by clinical subtype indicated that the ER(+)/PR(+)/HER2(-)/low- grade clinical subtype was preferentially responsive to exercise ( recurrence : adjusted HR , 0.63 ; 95 % CI , 0.45 - 0.88 ; breast cancer-related death : adjusted HR , 0.57 ; 95 % CI , 0.37 - 0.86 ) . The impact of exercise on cancer outcomes appears to differ as a function of pathologic and molecular features in early-stage breast cancer . Cancer Res ; 76(18 ) ; 5415 - 22 . © 2016 AACR PURPOSE The purpose of our study was to evaluate the effect of cognitive behavioral therapy ( CBT ) , physical exercise ( PE ) , and of these two interventions combined ( CBT/PE ) on menopausal symptoms ( primary outcome ) , body image , sexual functioning , psychological well-being , and health-related quality of life ( secondary outcomes ) in patients with breast cancer experiencing treatment-induced menopause . PATIENTS AND METHODS Patients with breast cancer reporting treatment-induced menopausal symptoms ( N=422 ) were r and omly assigned to CBT ( n=109 ) , PE ( n=104 ) , CBT/PE ( n=106 ) , or to a waiting list control group ( n=103 ) . Self-report question naires were completed at baseline , 12 weeks , and 6 months . Multilevel procedures were used to compare the intervention groups with the control group over time . RESULTS Compared with the control group , the intervention groups had a significant decrease in levels of endocrine symptoms ( Functional Assessment of Cancer Therapy-Endocrine Symptoms ; P<.001 ; effect size , 0.31 - 0.52 ) and urinary symptoms ( Bristol Female Lower Urinary Tract Symptoms Question naire ; P=.002 ; effect size , 0.29 - 0.33 ) , and they showed an improvement in physical functioning ( 36-Item Short Form Health Survey physical functioning subscale ; P=.002 ; effect size , 0.37 - 0.46 ) . The groups that included CBT also showed a significant decrease in the perceived burden of hot flashes and night sweats ( problem rating scale of the Hot Flush Rating Scale ; P<.001 ; effect size , 0.39 - 0.56 ) and an increase in sexual activity ( Sexual Activity Question naire habit subscale ; P=.027 ; effect size , 0.65 ) . Most of these effects were observed at both the 12-week and 6-month follow-ups . CONCLUSION CBT and PE can have salutary effects on endocrine symptoms and , to a lesser degree , on sexuality and physical functioning of patients with breast cancer experiencing treatment-induced menopause . Future work is needed to improve the design and the planning of these interventions to improve program adherence BACKGROUND During the last decade , survival rates for breast cancer have increased as a result of earlier detection and increased use of adjuvant therapy . Limited data exist on the psychosocial aspects of the transitional period between the end of primary treatment and survivorship . We investigated the baseline psychosocial status of women enrolled in a r and omized trial testing two psychosocial interventions for women at the end of primary treatment . METHODS Participants , identified within 1 month after surgery ( registration ) , provided demographic information and limited measures of quality of life . They were followed until they finished primary treatment ( enrollment ) , at which time they completed a mailed baseline survey that included st and ardized measures of quality of life ( including st and ardized scales of physical and emotional functioning ) , mood , symptoms , and sexual functioning .  A total of 558 patients ( mean age = 56.9 years ) were enrolled in the study between July 1 , 1999 , and June 30 , 2002 . Health outcomes were examined according to treatment received : mastectomy with and without chemotherapy , and lumpectomy with and without chemotherapy . All statistical tests were two-sided . RESULTS Among all treatment groups , patients who had a mastectomy had the poorest physical functioning at registration ( P<.001 ) and at enrollment ( P=.05 ) . At enrollment , mood and emotional functioning were similar among all patients , with no differences by type of treatment received . At enrollment , symptoms , including muscle stiffness , breast sensitivity , aches and pains , tendency to take naps , and difficulty concentrating , were common among patients in all groups and were statistically significantly associated with poor physical functioning and emotional well-being . Sexual functioning was worse for women who received chemotherapy than for those who did not , regardless of type of surgery ( P<.001 ) . CONCLUSIONS At the end of primary treatment for breast cancer , women in all treatment groups report good emotional functioning but report decreased physical functioning , particularly among women who have a mastectomy or receive chemotherapy . Clinical interventions to address common symptoms associated with treatment should be considered to improve physical and emotional functioning at the end of primary treatment for breast cancer Abstract Objectives To determine the effectiveness of tai chi interventions compared with aerobic exercise , a current core st and ard treatment in patients with fibromyalgia , and to test whether the effectiveness of tai chi depends on its dosage or duration . Design Prospect i ve , r and omized , 52 week , single blind comparative effectiveness trial . Setting Urban tertiary care academic hospital in the United States between March 2012 and September 2016 . Participants 226 adults with fibromyalgia ( as defined by the American College of Rheumatology 1990 and 2010 criteria ) were included in the intention to treat analyses : 151 were assigned to one of four tai chi groups and 75 to an aerobic exercise group . Interventions Participants were r and omly assigned to either supervised aerobic exercise ( 24 weeks , twice weekly ) or one of four classic Yang style supervised tai chi interventions ( 12 or 24 weeks , once or twice weekly ) . Participants were followed for 52 weeks . Adherence was rigorously encouraged in person and by telephone . Main outcome measures The primary outcome was change in the revised fibromyalgia impact question naire ( FIQR ) scores at 24 weeks compared with baseline . Secondary outcomes included changes of scores in patient ’s global assessment , anxiety , depression , self efficacy , coping strategies , physical functional performance , functional limitation , sleep , and health related quality of life . Results FIQR scores improved in all five treatment groups , but the combined tai chi groups improved statistically significantly more than the aerobic exercise group in FIQR scores at 24 weeks ( difference between groups=5.5 points , 95 % confidence interval 0.6 to 10.4 , P=0.03 ) and several secondary outcomes ( patient ’s global assessment = 0.9 points , 0.3 to 1.4 , P=0.005 ; anxiety=1.2 points , 0.3 to 2.1 , P=0.006 ; self efficacy=1.0 points , 0.5 to 1.6 , P=0.0004 ; and coping strategies , 2.6 points , 0.8 to 4.3 , P=0.005 ) . Tai chi treatment compared with aerobic exercise administered with the same intensity and duration ( 24 weeks , twice weekly ) had greater benefit ( between group difference in FIQR scores=16.2 points , 8.7 to 23.6 , P<0.001 ) . The groups who received tai chi for 24 weeks showed greater improvements than those who received it for 12 weeks ( difference in FIQR scores=9.6 points , 2.6 to 16.6 , P=0.007 ) . There was no significant increase in benefit for groups who received tai chi twice weekly compared with once weekly . Participants attended the tai chi training sessions more often than participants attended aerobic exercise . The effects of tai chi were consistent across all instructors . No serious adverse events related to the interventions were reported . Conclusion Tai chi mind-body treatment results in similar or greater improvement in symptoms than aerobic exercise , the current most commonly prescribed non-drug treatment , for a variety of outcomes for patients with fibromyalgia . Longer duration of tai chi showed greater improvement . This mind-body approach may be considered a therapeutic option in the multidisciplinary management of fibromyalgia . Trial registration Clinical Trials.gov NCT01420640 BACKGROUND The tAnGo trial was design ed to investigate the potential role of gemcitabine when added to anthracycline and taxane-containing adjuvant chemotherapy for early breast cancer . When this study was developed , gemcitabine had shown significant activity in metastatic breast cancer , and there was evidence of a favourable interaction with paclitaxel . METHODS tAnGo was an international , open-label , r and omised , phase 3 superiority trial that enrolled women aged 18 years or older with newly diagnosed , early-stage breast cancer who had a definite indication for chemotherapy , any nodal status , any hormone receptor status , Eastern Cooperative Oncology Group performance status of 0 - 1 , and adequate bone marrow , hepatic , and renal function . Women were recruited from 127 clinical centres and hospitals in the UK and Irel and , and r and omly assigned ( 1:1 ) to one of two treatment regimens : epirubicin , cyclophosphamide , and paclitaxel ( four cycles of 90 mg/m2 intravenously administered epirubicin and 600 mg/m2 intravenously administered cyclophosphamide on day 1 every 3 weeks , followed by four cycles of 175 mg/m2 paclitaxel as a 3 h infusion on day 1 every 3 weeks ) or epirubicin , cyclophosphamide , and paclitaxel plus gemcitabine ( the same chemotherapy regimen as the other group , with the addition of 1250 mg/m2 gemcitabine to the paclitaxel cycles , administered intravenously as a 0·5 h infusion on days 1 and 8 every 3 weeks ) . Patients were r and omly assigned by a central computerised deterministic minimisation procedure , with stratification by country , age , radiotherapy intent , nodal status , and oestrogen receptor and HER-2 status . The primary endpoint was disease-free survival and the trial aim ed to detect 5 % differences in 5-year disease-free survival between the treatment groups . Recruitment completed in 2004 and this is the final , intention-to-treat analysis . This trial is registered with EudraCT ( 2004 - 002927 - 41 ) , IS RCT N ( 51146252 ) , and Clinical Trials.gov ( NCT00039546 ) . FINDINGS Between Aug 22 , 2001 , and Nov 26 , 2004 , 3152 patients were enrolled and r and omly assigned to epirubicin , cyclophosphamide , paclitaxel , and gemcitabine ( gemcitabine group ; n=1576 ) or to epirubicin , cyclophosphamide , and paclitaxel ( control group ; n=1576 ) . 11 patients ( six in the gemcitabine group and five in the control group ) were ineligible because of pre-existing metastases and were therefore excluded from the analysis . At this protocol -specified final analysis ( median follow-up 10 years [ IQR 10 - 10 ] ) , 1087 disease-free survival events and 914 deaths had occurred . Disease-free survival did not differ significantly between the treatment groups at 10 years ( 65 % [ 63 - 68 ] in the gemcitabine group vs 65 % [ 62 - 67 ] in the control group ) , and median disease-free survival was not reached ( adjusted hazard ratio 0·97 [ 95 % CI 0·86 - 1·10 ] , p=0·64 ) . Toxicity , dose intensity , and a detailed 
    Output:
    
Conclusions : TCC appears to be effective on some physical and psychological symptoms and improves the quality of life in patients with breast cancer .