***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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    ***EXAMPLES*** 
    Input: BACKGROUND This prospect i ve , r and omized , double-blind study assessed whether the addition of dexamethasone to ondansetron leads to improved control of chemotherapy -- induced emesis , both in patients undergoing their first course of highly emetogenic chemotherapy and in chemotherapy-pretreated patients refractory to st and ard anti-emetics . PATIENTS AND METHODS Patients were r and omized to receive either 20 mg dexamethasone as an intravenous infusion or placebo plus ondansetron 8 mg 15 minutes prior to and 4 and 8 hours after the administration of chemotherapy . According to the r and omisation code patients received from day 2 to day 5 either ondansetron 8 mg p.o . + placebo p.o . , three times daily , or ondansetron 8 mg p.o . + dexamethasone 4 mg p.o . , three times daily . Patients undergoing multiple-day treatment received intravenous study treatment on the days of chemotherapy and thereafter oral treatment as outlined above . RESULTS A total of 215 patients were entered into the study . Of these , 207 were evaluable ( 111 previously-untreated and 96 previously-treated patients ) . In the chemotherapy-naive patients the combination of ondansetron plus dexamethasone was significantly superior to ondansetron plus placebo in protecting the patients completely from emesis ( retching and vomiting ) ( 81 % versus 64 % , p = 0.04 ) . The mean number of vomiting episodes was significantly lower in the ondansetron-plus-dexamethasone-treated patients than in those receiving ondansetron plus placebo ( 0.8 versus 2.1 , p = 0.03 ) . In this group of patients there was significantly superior protection from emesis on the second day ( p-value = 0.04 ) , and a trend towards a better protection on the third and fourth days . On each day the active combination offered better protection from nausea with an approximately 20 % difference in favor of ondansetron plus dexamethasone . In the group of established vomiters the combination of ondansetron plus dexamethansone was superior to ondansetron plus placebo in protecting the patients from acute emesis , with 70 % versus 48 % of the patients being completely protected ( p = 0.03 ) . The mean number of vomiting episodes was significantly lower in the ondansetron-plus-dexamethasone-treated- patients than in those receiving ondansetron plus placebo ( 0.9 versus 2.1 , p = 0.02 ) . In the ondansetron-plus-dexamethasone arm 55 % of the patients had complete protection from nausea , retching and vomiting compared to 35 % in the ondansetron-plus-placebo-treated group ( p = 0.05 ) . Overall 22 % of the patients ( 20 % in the ondansetron-plus-placebo and 25 % in the ondansetron-plus-dexamethasone arm ) experienced at least one , usually mild , adverse event . More patients in the ondansetron-plus-dexamethasone arm complained of epigastric pain or burning ( 8/101 versus 4/112 , p-value = 0.16 ) . The difference in patients reporting constipation ( 6/101 versus 0/112 ) was highly significant at a p-value of 0.008 . CONCLUSIONS The combination of dexamethasone plus ondansetron is more effective in protecting chemotherapy-naive patients undergoing their first course of highly emetogenic chemotherapy with cisplatin and chemotherapy-pretreated patients refractory to st and ard antiemetics from chemotherapy-induced nausea and vomiting compared to ondansetron plus placebo Lower pre-chemotherapy night time cortisol excretion predicted more severe cisplatin induced nausea and vomiting in 42 ovarian cancer patients receiving ondansetron as a single antiemetic agent . Dexamethasone administration added to the antiemetic effect of ondansetron principally in patients who had low excretion of cortisol A prospect i ve protocol for treatment of malignant inoperable bowel obstruction was implemented at Grenoble University Hospital Center for 4 years . All 80 episodes of obstruction result ed from peritoneal carcinomatosis and none could expect another treatment cure . The protocol comprised three successive stages . Stage I included treatment for 5 days with a corticosteroid , antiemetic , anticholinergic , and analgesic . Stage II provided a somatostatin analogue if vomiting persisted . After 3 days , Stage III provided a venting gastrostomy .  Obstruction relief with symptom control was obtained by medical treatment in 29 cases and symptom control occurred alone in an additional 32 cases . Ten patients were relieved by venting gastrostomy . Symptom control without permanent nasogastric tube ( NGT ) placement occurred in 72 episodes ( 90 % ) . Eight patients with refractory vomiting were obliged to continue the NGT until death . Fifty-eight obstruction episodes ( 73 % ) were controlled in 10 days or less . Median time before gastrostomy was 17 days . Median survival was 31 days . This series suggests that a staged protocol for the treatment of inoperable malignant bowel obstruction  is highly effective in relieving symptoms . A subgroup experiences relief of obstruction using this approach CONTEXT Does octreotide reduce vomiting in cancer-associated bowel obstruction ? OBJECTIVES To evaluate the net effect of adding octreotide or placebo to st and ardized therapies on the number of days free of vomiting for population s presenting with vomiting and inoperable bowel obstruction secondary to cancer or its treatment . METHODS Twelve services enrolled people with advanced cancer presenting with vomiting secondary to bowel obstruction where surgery or anti-cancer therapies were not indicated immediately . In a double-blind study , participants were r and omized to placebo or octreotide ( 600 μg/24 hours by infusion ) . Both arms received st and ardized supportive therapy ( infusion of ranitidine [ 200 mg/24 hours ] , dexamethasone [ 8 mg/24 hours ] , and parenteral hydration [ 10 - 20 mL/kg/24 hours ] ) . The primary outcome was patient-reported days free of vomiting at 72 hours . RESULTS In a study that recruited to the numbers identified in its power calculation , 87 participants provided data at 72 hours ( 45 , octreotide arm ) . Seventeen people ( octreotide ) and 14 ( placebo ) were free of vomiting for 72 hours ( P = 0.67 ) . Mean days free of vomiting were 1.87 ( SD 1.10 ; octreotide ) and 1.69 ( SD 1.15 ; placebo ; P = 0.47 ) . An adjusted multivariate regression of the incidence of vomiting over the study showed a reduced number of episodes of vomiting in the octreotide group ( incidence rate ratio = 0.40 ; 95 % CI : 0.19 - 0.86 ; P = 0.019 ) ; however , people in the octreotide arm were 2.02 times more likely to be administered hyoscine butylbromide ( P = 0.004 ) , potentially reflecting increased colicky pain . CONCLUSION Although there was no reduction in the number of days free of vomiting , the multivariate analysis suggests that further study of somatostatin analogues in this setting is warranted Despite the importance of symptom control in the cancer population , few studies have systematic ally assessed the prevalence and characteristics of symptoms or the interactions between various symptom characteristics and other factors related to quality of life ( QOL ) . As part of a validation study of a new symptom assessment instrument , in patients and out- patients with prostate , colon , breast or ovarian cancer were evaluated using the  Memorial Symptom Assessment Scale and other measures of psychological condition , performance status , symptom distress and overall quality of life .  The mean age of the 243 avaluable patients was 55.5 years ( range 23–86 years ) ; over 60 % were women and almost two-thirds had metastatic disease . The Karnofsky Performance Status ( KPS ) score was≤80 in 49.8 % and 123 were in patients at the time of assessment . Across tumour types , 40–80 % experienced lack of energy , pain , feeling drowsy , dry mouth , insomnia , or symptoms indicative of psychological distress . Although symptom characteristics were variable , the proportion of patients who described a symptom as relatively intense or frequent always exceeded the proportion who reported it as highly distressing . The mean ( ±SD , range ) number of symptoms per patient was 11.5±6.0 ( 0–25 ) ; in patients had more symptoms than out patients ( 13.5±5.4 vs. 9.7±6.0 , p<0.002 ) and those with KPS≤80 had more symptoms than those with KPS>80 ( 14.8±5.5 vs. 9.2±4.9 , p<0.0001 ) . The number of symptoms was highly associated with heightened psychological distress and poorer quality of life ( for example , r=0.67 for the relationship with the Functional Living Index-Cancer , a QOL measure ) . These data clarify the prevalence and characteristics of cancer-related symptoms and suggest that the number of symptoms per patient may be a useful quality of life indicator Early and intensive pharmacological treatment not only may reduce gastrointestinal symptoms but also reverse malignant bowel obstruction .  Fifteen consecutive advanced cancer patients with inoperable bowel obstruction received a combination of drugs including metoclopramide , octreotide , dexamethasone and an initial bolus of amidotrizoato .  Recovery of intestinal transit was reported within 1 - 5 days in fourteen patients , who continued this treatment without presenting symptoms of bowel obstruction until death . This case series establishes that the combination of propulsive and antisecretive agents can act synergistically to allow a fast recovery of bowel transit without inducing unpleasant colic . It suggests that the most important mechanism in these circumstances is functional and can be reversible , if an aggressive treatment is initiated early before fecal impaction and edema render bowel obstruction irreversible A single institution , prospect i ve , r and omized trial was performed in terminal cancer patients to compare tropisetron ( TRO ) , metoclopramide ( MET ) , and chlorpromazine ( CHL ) in the management of nausea and emesis .  Patients had far advanced cancer , were far removed from chemotherapy or radiotherapy  , and their nausea and emesis was not due to bowel obstruction , drug intake , or cranial , electrolytic , or metabolic causes . The effects of antiemetic treatments were evaluated from Days 1‐15 Goal of workThe objectives of this prospect i ve observational study were to estimate the frequency of patients who reported an impact of chemotherapy-induced nausea and vomiting ( CINV ) on their daily life and to evaluate the determinants of such an impact . Material s and methods Adult cancer patients at seven Italian oncology centers who were receiving cisplatin-containing regimens reported incidence and intensity of CINV for eight consecutive days in a diary and completed a Functional Living Index for Emesis ( FLIE ) question naire . Main results Overall , 34 % of patients reported vomiting and 62 % reported nausea after chemotherapy . On days 1 to 5 after receiving chemotherapy , 67 % of patients who had at least one emetic episode and 77 % of those who suffered from at least mild nausea experienced an impact on their daily activities as measured on the FLIE question naire . More than 90 % of all patients with both acute and delayed nausea or vomiting reported an impact on their daily life . Both acute and delayed vomiting contributed in similar measure to impact daily life ; however , the importance of delayed nausea was greater than that of acute nausea . Conclusions Despite antiemetic prophylaxis , CINV is still prevalent and often impacts the daily life of patients in Italy , especially in the delayed phase . The duration more than the severity seems to be responsible for the impact of CINV on the patients ’ daily lives Purpose Despite significant antiemetic advances , almost 50 % of treated cancer patients still experience nausea and vomiting ( N&V ) . The goal of antiemetic therapy — complete prevention of treatment-induced nausea and /or vomiting (TIN+/−V)—remains elusive for several reasons . Potentially , N&V may be part of a symptom cluster where co-occurring symptoms negatively affect antiemetic management . Consequently , we examined TIN+/−V incidence and the impact of nausea , vomiting and symptom cluster(s ) containing them , respectively , on patients ’ quality of life ( QoL ) and psychological adjustment across treatment . Methods A longitudinal secondary analysis was performed on data from a prospect i ve , observational QoL study involving 200 newly diagnosed cancer patients who underwent combined modality treatment .  QoL , psychological adjustment and patient/ clinical characteristics were examined at pretreatment , on-treatment ( 8 weeks ) and post-treatment . Results Overall , 62 % of patients experienced TIN+/−V , with TIN ( 60 % ) doubling TIV incidence ( 27 % ) . Exploratory factor analyses of QoL scores at each treatment time point identified a recurrent gastrointestinal symptom cluster comprising nausea , vomiting and appetite loss . Approximately two thirds of patients reported co-occurrence of all three symptoms , which exerted synergistic effects of multiplicative proportions on overall QoL. Patients who reported co- 
    Output:
    
There are few studies assessing the effects of corticosteroids on nausea and vomiting not related to chemotherapy , radiotherapy , or surgery in adult cancer patients .
This review found very low- quality evidence which neither supported nor refuted corticosteroid use in this setting .