***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: In the context of chronic physical illness , such as breast cancer , depression is associated with increased morbidity , longer periods of hospitalization , and greater overall disability . Prompt diagnosis and effective treatment is , therefore , essential . Several small studies have established the efficacy of tricyclic antidepressants ( TCAs ) in this setting , and the selective serotonin reuptake inhibitors ( SSRIs ) would appear to be an alternative therapeutic option because of their established efficacy and better tolerability profile . This was a multicenter , double-blind , parallel-group study in which 179 women with breast cancer were r and omized to treatment with either the SSRI paroxetine ( 20–40mg/day ) , or the TCA , amitriptyline ( 75–150mg/day ) . After 8-weeks treatment , depressive symptomatology had improved markedly and to a similar extent in both groups on the Montgomery Asberg Depression Rating Scale . Clinical global impression ( CGI ) Global improvement and Patient global evaluation scales indicated that patients were minimally to much improved at study endpoint ; a change from moderately/mildly ill to borderline ill on the CGI severity of Illness scale . A steady improvement in quality of life was also observed in both groups . There were no clinical ly significant differences between the groups . In total , 47 ( 53.4 % ) patients in the paroxetine group and 53 ( 59.6 % ) patients in the amitriptyline group had adverse experiences , the most common of which were the well-recognized side-effects of the antidepressant medications or chemotherapy . Anticholinergic effects were almost twice as frequent in the amitriptyline group ( 19.1 % ) compared with paroxetine ( 11.4 % ) . This study has demonstrated that paroxetine is a suitable alternative to amitriptyline for the treatment of depression in patients with breast cancer In a study lasting 12 weeks , relaxation training was evaluated as a coping re source for cancer patients . 80 patients of both sexes were r and omised to relaxation training and to a control ( no training ) group ( 40 in each ) . Scores for anxiety , depression and psychiatric morbidity were obtained at 0 , 6 and 12 weeks with well-known question naires and a new anxiety and depression scale , the effects of serious illness ( ESI ) scale . 71 patients ( 32 men and 39 women ) successfully completed the study . Results showed that relaxation training and control group scores were similar at 0 weeks . Higher anxiety , depression and psychiatric morbidity scores were reported by all patients at 6 and , to a lesser extent , at 12 weeks with greater differences in women . Female controls invariably reported significantly higher scores at 6 and 12 weeks on all indices . Male controls reported significantly higher anxiety scores only at 6 and 12 weeks Background Studies have shown that there is a high prevalence of depression in cancer patients . Women with breast cancer may have an even higher risk of depression particularly in a postmenopausal or estrogen deficiency state . A small number of r and omized controlled trials have examined the efficacy of antidepressants compared to that of a placebo in cancer patients , but some results have been difficult to interpret due to a heterogeneous patient group . In the current investigation , we screened newly diagnosed early stage breast cancer patients for depressive symptoms prior to the initiation of adjuvant therapy and investigated whether the oral antidepressant fluoxetine affected depressive symptoms , completion of adjuvant treatment , and quality of life . Methods Patients with newly diagnosed early stage breast cancer were screened for depressive symptoms prior to the initiation of adjuvant therapy . Patients with depressive symptoms were r and omized to a daily oral fluoxetine or a placebo . Patients were then followed for 6 months and evaluated for quality of life , completion of adjuvant treatment , and depressive symptoms . Results A high percentage of patients with newly diagnosed early stage breast cancer were found to have depressive symptoms prior to the initiation of adjuvant therapy . The use of fluoxetine for 6 months result ed in an improvement in quality of life , a higher completion of adjuvant treatment ( chemotherapy , hormonal therapy , chemotherapy plus hormonal therapy ) , and a reduction in depressive symptoms compared to patients who received placebo . Conclusions An antidepressant should be considered for early stage breast cancer patients with depressive symptoms who are receiving adjuvant treatment Goals of workCancer is often burdened by psychological comorbidity , mainly represented by depression , anxiety and adjustment disorders . Efficacy and tolerability of sertraline in the treatment of depressive disorders is well known ; however , its efficacy and safety in patients with cancer has been poorly studied . This study was aim ed to provide evidence s of effectiveness , safety , tolerability and rapidity of action of sertraline in a population of oncological out patients affected by mood disorders and its effects on quality of life .  Material s and methods Thirty-five adult cancer out patients with mood depression , during chemotherapy  , were enrolled to a 12-week trial with a flexible dose regime of sertraline . The treatment response was assessed at baseline , week 4 and week 12 , with hospital anxiety and depression scale ( HADS ) and Montgomery Asberg depression rating scale ( MADRS ) , to rate depression and anxiety ; mini mental adjustment to cancer scale ( Mini-MAC ) , to assess the psychological response to the diagnosis of cancer ; clinical global impression ( CGI ) to evaluate severity of illness ; dosage record and treatment emergent symptom scale ( DOTES ) , to assess the adverse effects of the clinical treatments and their possible relation with the drug used ; and QL index to rate quality of life . Main results Both mean depression scores , analysed by HADS and MADRS scales , and HADS anxiety scores significantly decreased during the 12 weeks of study . Mean MINI-MAC scores show that hopelessness and anxious preoccupation decreased significantly at T2 compared with T0 . No severe adverse effects were observed . Conclusion In this preliminary study , sertraline was found to be effective and well tolerated in the treatment of depressed out patients with cancer Little has been done to study the effectiveness of antidepressants in controlling anxiety/depression in a population of cancer patients . A double‐blind placebo‐controlled study was therefore design ed to assess the effectiveness of 20 mg fluoxetine . Of 115 cancer patients who fulfilled entry criteria for levels of distress , 45 patients were r and omized to a  fluoxetine treatment group ( FA ) and 46 patients to a placebo group ( PA ) after a 1‐week placebo period design ed to exclude placebo responders . The Montgomery and Asberg Depression Scale ( MADRS ) , the Hamilton Anxiety Scale ( HAS ) , the Hospital Anxiety and Depression Scale ( HADS ) , the Revised Symptom Checklist ( SCL90‐R ) and the Spitzer Quality of Life Index ( SQOLI ) were used to assess the efficacy of fluoxetine . The response rate , defined by a HADS score lower than 8 after 5 weeks of treatment , was not significantly higher in the FA group ( 11 % ) compared to the PA group ( 7 % ) . Compared to the PA group , patients in the FA group showed a significantly greater decrease in SCL90‐R mean total score after 5 weeks , but not a greater decrease in HADS mean score . No difference between the two groups was found in observer‐reported assessment s ( MADRS , HAS and SQOLI ) . Significantly more drop‐outs were observed in the FA group ( n=15 ) than in the PA group ( n=7 ) , although the frequencies of side‐effects were not significantly different The purpose of this study was to test a brief orientation program for reducing anxiety , depressive symptoms , and overall distress in cancer patients at their initial clinic visit . One hundred and fifty consecutively referred patients seen in an oncology outpatient clinic were r and omly assigned to an intervention or usual care control group . The intervention group received a clinic tour , general information about clinic operations , and a question and answer session with an oncology counselor . Outcome measures included the State-Trait Anxiety Inventory ( STAI ) , the Brief Profile of Mood States ( POMS ) , the Center for Epidemiologic Studies -Depression ( CES-D ) Scale , and an oncology clinic question naire which were administered at the initial clinic visit and follow-up . There were no statistically significant clinical or demographic differences between groups at initial assessment . At follow-up , the intervention group had lower state anxiety , lower overall distress , and fewer patients reporting depressive symptoms . Patients in the intervention group demonstrated significantly more knowledge about clinic operations and greater satisfaction with care . These data provide evidence that anxiety , distress and depressive symptoms can be reduced with an orientation program . This finding has particular relevance in the early stages of diagnosis where patients may suffer symptoms of anxiety and depression BACKGROUND Depression is a common disorder in cancer patients , and it is associated with reduced quality of life , abnormal illness behavior , pain , and suicide risk . A few studies have investigated the effects of tricyclic antidepressants and serotonin reuptake inhibitors in cancer patients . No data are available regarding the use of reboxetine , a norepinephrine reuptake inhibitor that has been shown to be safe ( e.g. , absence of clinical ly significant drug-drug interactions and cytochrome P450 metabolism ) and effective in the treatment of depressed patients , including those with medical illness ( e.g. , Parkinson 's disease , human immunodeficiency virus infection ) . METHOD The effects of reboxetine were investigated in 20 breast cancer patients with a DSM-IV diagnosis of major depressive disorder in an open , prospect i ve 8-week trial . Severity of depression was assessed with the 17-item Hamilton Rating Scale for Depression ( HAM-D ) . Psychiatric symptoms ( Brief Symptom Inventory [ BSI ] ) , styles of coping with cancer ( Mini-Mental Adjustment to Cancer [ Mini-MAC ] ) , quality of life ( European Organization for Research and Treatment of Cancer Quality -of-Life Question naire C30 [ EORTC-QLQ-C30 ] ) , and Clinical Global Impressions scale scores were also monitored . RESULTS At 8 weeks , a significant ( p < .01 ) reduction was observed in HAM-D scores , several BSI dimension scores , and Mini-MAC hopelessness and anxious preoccupation scores . A significant ( p < .05 ) improvement from baseline to endpoint was found on the EORTC-QLQ-C30 subfactors emotional , cognitive , dyspnea , sleep , and global . Discontinuation was necessary in 1 subject because of hypomanic switch and in another because of side effects ( tachycardia , tension ) . Seven patients experienced transient side effects ( e.g. , mild anxiety , insomnia , sweating ) . CONCLUSION In this open trial , reboxetine appeared to be well tolerated and promising in reducing depressive symptoms and maladjusted coping styles and in improving scores on quality -of-life parameters Abstract A behavioural programme to treat psychological distress following mastectomy for breast cancer is described . The first 10 patients to be treated were r and omly allocated to two treatment groups : Behavioural Programme Only or Behavioural Programme + Drugs ( antidepressant medication ) . Both groups showed improvement over treatment , but the Behavioural Programme + Drugs group appeared to maintain their improvement better Summary Background . Fatigue can significantly interfere with a cancer patient ’s ability to fulfill daily responsibilities and enjoy life . It commonly co-exists with depression in patients undergoing chemotherapy , suggesting that administration of an antidepressant that alleviates symptoms of depression could also reduce fatigue . Methods . We report on a double-blind clinical trial of 94 female breast cancer patients receiving at least four cycles of chemotherapy r and omly assigned to receive either  20 mg of the selective serotonin re-uptake inhibitor ( SSRI ) paroxetine ( Paxil ® , SmithKline Beecham Pharmaceuticals ) or an identical-appearing placebo . Patients began their study medication seven days following their first on- study treatment and continued until seven days following their fourth on- study treatment . Seven days after each treatment , participants completed question naires measuring fatigue ( Multidimensional Assessment of Fatigue , Profile of Mood States-Fatigue/Inertia subscale and Fatigue Symptom Checklist ) and depression ( Profile of Mood States-Depression subscale [ POMS-DD ] and Center for Epidemiologic Studies -Depression [ CES-D ] ) . Results . Repeated- measures ANOVAs , after controlling for baseline measures , showed that paroxetine was more effective than placebo in reducing depression during chemotherapy as measured by the CES-D ( p=0.006 ) and the POMS-DD ( p=0.07 ) but not in reducing fatigue ( all measures , ps > 0.27 ) . Conclusions . Although depression was significantly reduced in the 44 patients receiving paroxetine  compared to the 50 patients receiving placebo , indicating that a biologically active dose was used , no significant differences between groups on any of the measures of fatigued were observed . Results suggest that modulation of serotonin may not be a primary mechanism of fatigue related to cancer treatment Cognitive impairment seems to be highly prevalent in patients with advanced cancer .  Modafinil , a novel vigilance and wake-promoting agent , may be an alternative treatment . We wanted to investigate this treatment on attentional and psychomotor dysfunction in cancer patients . 28 cancer patients with a tiredness score of 50 mm or more on a scale of 0 to 10 ( 0=no tiredness , 10=worst possible tiredness ) and Karnofsky Performance Status 40—70 were included . All medications were kept stable during the trial despite short acting opioids for breakthrough pain . On day 1 the patients were r and omly assigned to receive 200 mg Modafinil orally or placebo and on day 4 they crossed 
    Output:
    
RESULTS Recent evidence from r and omized controlled trials has demonstrated the efficacy of psychosocial and pharmacologic treatments to alleviate depression in patients with cancer .