***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: Few r and omized controlled trials have examined the effects of combined aerobic and resistance training in breast cancer survivors soon after completing adjuvant therapy . Breast cancer survivors ( N = 58 ) within 2 years of completing adjuvant therapy were r and omly assigned to an immediate exercise group ( IEG ; n = 29 ) or a delayed exercise group ( DEG ; n = 29 ) . The IEG completed 12 weeks of supervised aerobic and resistance exercise , three times per week . The DEG completed the program during the next 12 weeks . Participants completed patient-rated outcomes at baseline , 6 , 12 , 18 and 24 weeks . The primary endpoint was overall quality of life ( QoL ) measured by the Functional Assessment of Cancer Therapy-Breast scale . Secondary endpoints were fatigue , social physique anxiety , and physical fitness . Follow-up data was obtained on 97 % of participants and exercise adherence was 61.3 % . Repeated measures analyses of variance revealed a significant group by time interaction for overall QoL ( P < 0.001 ) . Specifically , QoL increased in the IEG from baseline to 12 weeks by 20.8 points compared to a decrease in the DEG of 5.3 points ( mean group difference = 26.1 ; 95 % CI = 18.3–32.7 ; P < 0.001 ) . From 12 to 24 weeks , QoL increased in the DEG by 29.5 points compared to an increase of 6.5 points in the IEG ( mean group difference = 23.0 ; 95 % CI = 16.3–29.1 ; P < 0.001 ) . Similar results were obtained for the secondary endpoints . Combined aerobic and resistance exercise soon after the completion of breast cancer therapy produces large and rapid improvements in health-related outcomes 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 The question of whether stress poses a risk for cancer progression has been difficult to answer . A r and omized clinical trial tested the hypothesis that cancer patients coping with their recent diagnosis but receiving a psychologic intervention  would have improved survival compared with patients who were only assessed Background Current frequent follow-up after treatment for breast cancer does not meet its intended aims , but does depend on expensive and scarce specialized knowledge for routine history taking and physical examinations . The study described in this paper compared patient satisfaction with a reduced follow-up strategy , i.e. nurse-led telephone follow-up , to satisfaction with traditional hospital follow-up . Methods Patient satisfaction was assessed among patients ( n = 299 ) who were participants of a r and omized controlled trial investigating the cost-effectiveness of several follow-up strategies in the first year after treatment for breast cancer . Data on patient satisfaction were collected at baseline , three , six and 12 months after treatment , using the Dutch version of Ware 's Patient Satisfaction Question naire III ( PSQ III ) . In addition to general satisfaction , the PSQ III reports on satisfaction scores for technical competence , interpersonal aspects , and access of care . Regression analysis was used to predict satisfaction scores from whether or not nurse-led telephone follow-up was received . Results Nurse-led telephone follow-up had no statistically significant influence on general patient satisfaction ( p = 0.379 ) , satisfaction with technical competence ( p = 0.249 ) , and satisfaction with interpersonal aspects ( p = 0.662 ) . Regarding access of care , patient satisfaction scores were significantly higher for patients receiving telephone follow-up ( p = 0.015 ) . However , a mean difference at 12 months of 3.1 points was judged to be not clinical ly relevant . Conclusions No meaningful differences were found in satisfaction scores between nurse-led telephone and hospital follow-up in the first year after breast cancer treatment . With high satisfaction scores and the potential to substantially reduce clinic visits , nurse-led telephone follow-up may be an acceptable alternative to traditional hospital follow-up . Trial registration numberIS RCT N 74071417 Background After curative treatment for breast cancer women frequently attend scheduled follow-up examinations . Usually the follow-up is most frequent in the first 2–3 years ( 2–4 times a year ) ; thereafter the frequency is reduced to once a year in most countries . Its main aim is to detect local disease recurrence , or a second primary breast cancer , but also to provide information and psychosocial support . However , the cost-effectiveness of these frequent visits is under much debate , leading to a search for less intensive and more cost-effective follow-up strategies . In this paper the design of the MaCare trial is described . This trial compares the cost-effectiveness of four follow-up strategies for curatively treated breast cancer patients . We investigate the costs and effects of nurse-led telephone follow-up and a short educational group programme . Methods / design The MaCare trial is a multi centre r and omised clinical trial in which 320 breast cancer patients are r and omised into four follow-up strategies , focussed on the first 18 months after treatment : 1 ) st and ard follow-up ; 2 ) nurse-led telephone follow-up ; 3 ) arm 1 with the educational group programme ; 4 ) arm 2 with the educational group programme . Data is collected at baseline and 3 , 6 , 12 and 18 months after treatment . The primary endpoint of the trial is cancer-specific quality of life as measured by the global health/QoL scale of the EORTC QLQ-C30 . Secondary outcomes are perceived feelings of control , anxiety , patients ' satisfaction with follow-up and costs . A cost-effectiveness analysis will be performed from a societal perspective . Discussion Reduced follow-up strategies for breast cancer have not yet been widely applied in clinical practice . Improvement of psychosocial support and information to patients could lead to a better acceptance of reduced follow-up . The MaCare trial combines a reduced follow-up strategy with additional psychosocial support . Less frequent follow-up can reduce the burden on medical specialists and costs . The educational group programme can improve QoL of patients , but also less frequent follow-up can improve QoL by reducing the anxiety experienced for each follow-up visit . Results of the trial will provide knowledge on both costs and psychosocial aspects regarding follow-up and are expected in 2009 AIMS As a result of the rising prevalence of breast cancer and improved adjuvant treatment strategies , oncologists are faced with an ever-increasing workload of providing long-term follow-up care for early-stage breast cancer patients . In order to cope with these growing dem and s , innovative follow-up strategies are urgently required . MATERIAL S AND METHODS To explore if  patient transfer back to the family physician for follow-up  was a potential option , a prospect i ve programme of planned discharge was established for all patients who had completed adjuvant chemo/radiotherapy or had started adjuvant endocrine therapy .  Patient and family physician information packages were also provided . RESULTS Between April and August 2005 , of the 193 patients assessed for transfer back to the family physician for follow-up care , transfer was possible in 43 % . Fifty-seven per cent ( or 110 patients ) were unsuitable for transfer back to the family physician . The reasons cited among those deemed unsuitable for transfer were as follows : clinical trial enrollment ( 50.9 % ) , ongoing endocrine treatment ( 31.8 % ) , new symptoms ( 6.3 % ) , and patient refusal ( 0.9 % ) . In both discharged and non-discharged groups , patients were also frequently being followed by other oncologists ( surgical and /or radiation ) . CONCLUSION Transfer of care back to family physicians for follow-up may offer a strategy to control workload volumes , and thus enable oncologists to focus their efforts on newly diagnosed and advanced-stage patients with more complex patient care needs BACKGROUND Routine follow-up of breast cancer patients in specialist clinics is st and ard practice in most countries . Follow-up involves regularly scheduled breast cancer check-ups during the disease-free period . The aims of follow-up are to detect breast cancer recurrence and to provide psychosocial support to the patient ; however , little is known about patients ' views on breast cancer follow-up . AIM To assess the effect on patient satisfaction of transferring primary responsibility for follow-up of women with breast cancer in remission from hospital outpatient clinics to general practice . METHOD R and omized controlled trial with 18 months ' follow-up in which women received routine follow-up either in hospital outpatient clinics or from their own general practitioner . Two hundred and ninety-six women with breast cancer in remission receiving regular follow-up care at two district general hospitals in Engl and were included in the study . Patient satisfaction was measured by means of a self-administered question naire supplied three times during the 18-month study period . RESULTS The general practice group selected responses indicating greater satisfaction than did the hospital group on virtually every question . Furthermore , in the general practice group there was a significant increase in satisfaction over baseline ; a similar significant increase in satisfaction over baseline was not found in the hospital group . CONCLUSION Patients with breast cancer were more satisfied with follow-up in general practice than in hospital outpatient departments . When discussing follow-up with breast cancer patients , they should be provided with complete and accurate information about the goals , expectations , and limitations of the follow-up programme so that they can make an informed choice PURPOSE To up date the 1999 American Society of Clinical Oncology ( ASCO ) guideline on breast cancer follow-up and management in the adjuvant setting . METHODS An ASCO Expert Panel review ed pertinent information from the literature through March 2006 . More weight was given to studies that tested a hypothesis directly relating testing to one of the primary outcomes in a r and omized design . RESULTS The evidence supports regular history , physical examination , and mammography as the cornerstone of appropriate breast cancer follow-up . All patients should have a careful history and physical examination performed by a physician experienced in the surveillance of cancer patients and in breast examination . Examinations should be performed every 3 to 6 months for the first 3 years , every 6 to 12 months for years 4 and 5 , and annually thereafter . For those who have undergone breast-conserving surgery , a post-treatment mammogram should be obtained 1 year after the initial mammogram and at least 6 months after completion of radiation therapy . Thereafter , unless otherwise indicated , a yearly mammographic evaluation should be performed . Patients at high risk for familial breast cancer syndromes should be referred for genetic counseling . The use of CBCs , chemistry panels , bone scans , chest radiographs , liver ultrasounds , computed tomography scans , [18F]fluorodeoxyglucose-positron emission tomography scanning , magnetic resonance imaging , or tumor markers ( carcinoembryonic antigen , CA 15 - 3 , and CA 27.29 ) is not recommended for routine breast cancer follow-up in an otherwise asymptomatic patient with no specific findings on clinical examination . CONCLUSION Careful history taking , physical examination , and regular mammography are recommended for appropriate detection of breast cancer recurrence PURPOSE Women with breast cancer were provided with an audiotape of their primary adjuvant treatment consultation , and the following patient outcomes were measured at 12 weeks postconsultation : perceived degree of information provision , audiotape satisfaction and use , communication satisfaction with oncologist , mood state , and cancer-specific quality of life . PATIENTS AND METHODS Participants included 628 women newly diagnosed with breast cancer and 40 oncologists from six cancer centers in Canada . The patients were block r and omized to one of four consultation groups : st and ard care control , not audiotaped ; audiotaped , no audiotape given ; audiotaped , patient given audiotape ; and audiotaped , patient offered choice of receiving audiotape or not . RESULTS Patients receiving the consultation audiotape had significantly better recall of having discussed side effects of treatment than patients who did not receive the audiotape . Audiotape benefit was not significantly related to patient satisfaction with communication , mood state , or quality of life at 12 weeks 
    Output:
    
Mammographically detected local recurrences or those detected by women themselves gave better survival than those detected by clinical examination .
Follow up in alternative setting s to the specialist clinic is acceptable to women but trials are underpowered for survival .