***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: A r and omised controlled pilot study was carried out to examine the effects of adjunctive aromatherapy massage on mood , quality of life and physical symptoms in patients with cancer attending a specialist unit . Participants were r and omised  to conventional day care alone or day care plus weekly aromatherapy massage using a st and ardised blend of oils for four weeks . At baseline and at weekly intervals , patients rated their mood , quality of life and the intensity and bother of two symptoms most important to them . Forty-six patients were recruited to the study . Due to a large number of withdrawals , only 11 of 23 ( 48 % ) patients in the aromatherapy group and 18 of 23 ( 78 % ) in the control group completed all four weeks . Mood , physical symptoms and quality of life improved in both groups . There was no statistically significant difference between groups in any of the outcome measures . Despite a lack of measurable benefit , all patients were satisfied with the aromatherapy and wished to continue . Whilst this pilot study has shown that a r and omised controlled trial of complementary therapy is feasible , it has also identified several areas that would require further consideration when design ing future studies , e.g. , the recruitment and retention of appropriate numbers of patients and the outcome measures used AIM The objective of this study was to determine whether reflexology has an impact on the quality of life of patients in the palliative stage of cancer . METHOD Twelve patients in the palliative stage of cancer with various tumour types were r and omised into two groups . They were r and omly assigned to receive either reflexology or placebo reflexology . All participants completed a linear analogue self- assessment scale relating to quality of life . All participants then received three sessions of either reflexology or placebo reflexology . The same person , a qualified reflexologist , provided the interventions for both groups . The participants were not aware of which intervention they were receiving . All participants then completed a second linear analogue self- assessment scale relating to quality of life . RESULTS All participants felt that their quality of life had improved , even those who had received the placebo treatment . The reflexology group , however , reported more benefit than the placebo group . There was a significant difference ( p = 0.004 ) between the reflexology group and the placebo group . CONCLUSION This study showed that reflexology does have an impact on the quality of life of patients in the palliative stage of cancer Background Anxiety is the most common mental disorder in end-stage renal disease patients . The use of aromatherapy as a treatment for anxiety has increased substantially in most countries . Objectives This study aim ed to investigate the effect of inhaling rose water aromatherapy on anxiety in hemodialysis patients . Methods This r and omized controlled clinical trial was carried out in the hemodialysis ward of Birj and Vali-Asr hospital on 46 patients who were r and omly divided into control and experimental groups . The st and ard state-trait anxiety inventory of Spielberger was used to investigate the anxiety level of the sample s. The experimental group inhaled rose water for 4 weeks , but the control group did not undergo any intervention . At the end of week 2 and week 4 , the participants ’ anxiety was measured , and the results were statistically analyzed . Results Mean scores of state and trait anxiety in the experimental group before intervention were 47/47 ± 7/6 and 49/56 ± 13/8 , respectively ; those after week 4 following the intervention were reduced to 37/1 ± 6/5 and 42/9 ± 10/1 ; inhalation of rose water fragrance in the experimental group caused a significant decrease ( P < 0.001 ) in the state and trait anxiety levels compared with controls ( P = 0.43 ) . Conclusions According to the present study , rose water noticeably reduces the anxiety of hemodialysis patients . Therefore , inhalation of rose water can improve the patient ’s emotional and spiritual condition during hemodialysis treatment Many specialist palliative care services are under pressure to provide therapies such as aromatherapy , acupuncture or reflexology either by paid staff or volunteers . The evidence to justify the provision of such treatment , however , remains largely anecdotal as controlled clinical trials are difficult to design . Reflexology involves the application of pressure to ` reflex ’ areas of the h and s or feet with the intention of producing specific effects elsewhere in the body . The reflexologist palpates tender or painful areas that , it is suggested , indicate functional imbalance . As well as treatment of specific conditions , it is suggested that reflexology can relax the patient , which may aid selfhealing and prevention of disease . We have therefore conducted a pilot study with a r and omized controlled design to compare reflexology with simple foot massage In the GRADE approach , r and omized trials start as high- quality evidence and observational studies as low- quality evidence , but both can be rated down if most of the relevant evidence comes from studies that suffer from a high risk of bias . Well-established limitations of r and omized trials include failure to conceal allocation , failure to blind , loss to follow-up , and failure to appropriately consider the intention-to-treat principle . More recently recognized limitations include stopping early for apparent benefit and selective reporting of outcomes according to the results . Key limitations of observational studies include use of inappropriate controls and failure to adequately adjust for prognostic imbalance . Risk of bias may vary across outcomes ( e.g. , loss to follow-up may be far less for all-cause mortality than for quality of life ) , a consideration that many systematic review s ignore . In deciding whether to rate down for risk of bias -- whether for r and omized trials or observational studies -- authors should not take an approach that averages across studies . Rather , for any individual outcome , when there are some studies with a high risk , and some with a low risk of bias , they should consider including only the studies with a lower risk of bias Research suggests that patients with cancer , particularly in the palliative care setting , are increasingly using aromatherapy and massage . There is good evidence that these therapies may be helpful for anxiety reduction for short periods , but few studies have looked at the longer term effects . This study was design ed to compare the effects of four-week courses of aromatherapy massage and massage alone on physical and psychological symptoms in patients with advanced cancer . Forty-two patients were r and omly allocated to receive weekly massages with lavender essential oil and an inert carrier oil ( aromatherapy group ) , an inert carrier oil only ( massage group ) or no intervention . Outcome measures included a Visual Analogue Scale ( VAS ) of pain intensity , the Verran and Snyder-Halpern ( VSH ) sleep scale , the Hospital Anxiety and Depression ( HAD ) scale and the Rotterdam Symptom Checklist ( RSCL ) . We were unable to demonstrate any significant long-term benefits of aromatherapy or massage in terms of improving pain control , anxiety or quality of life . However , sleep scores improved significantly in both the massage and the combined massage ( aromatherapy and massage ) groups . There were also statistically significant reductions in depression scores in the massage group . In this study of patients with advanced cancer , the addition of lavender essential oil did not appear to increase the beneficial effects of massage . Our results do suggest , however , that patients with high levels of psychological distress  respond best to these therapies Results of the pilot study of the four counties r and omised controlled trial to evaluate the effectiveness of aromatherapy massage with 1 % Santalum album ( S and alwood ) ( group A ) when compared with massage with Sweet Almond Carrier oil , ( group B ) or S and alwood oil via an aromastone ( group C ) , in reducing levels of anxiety in palliative care . The aims of the pilot study were to evaluate the effectiveness of aromatherapy  in reducing anxiety in patients receiving palliative care in four counties . The primary end points of the research were to report a statistically significant difference in anxiety scores between experimental group ( B ) and comparison groups ( A and C ) and to influence the integration of aromatherapy into all aspects of palliative care . The limited data of the pilot study ( N=34 ) tested the logistics of the research , particularly the 25 % attrition rate and the robustness of the data collection tools . The results were not substantial enough to generate coherent statistics . Therefore no assumptions could be drawn from these results due to the inconsistencies that were bound to occur in such a small sample . However , the results do seem to support the notion that S and alwood oil is effective in reducing anxiety UNLABELLED Distress associated with cancer often presents with symptoms of depression and /or anxiety .  Cognitive Behaviour Therapy ( CBT ) is one of the most effective psychological treatments . Complementary therapies , especially aromatherapy massage ( AM ) , are also popular and alleviate anxiety . No studies have directly compared these two treatments . AIMS The aim of this study is to ( 1 ) test the feasibility of recruitment into a r and omised controlled trial of AM versus CBT in patients with cancer ; ( 2 ) test and modify the intervention ; ( 3 ) determine whether changes in outcomes were consistent with published data . METHODS Patients at all stages of cancer , recruited from oncology outpatient clinics and screening eight or more for anxiety and /or depression on the HADS , were r and omised to Treatment as Usual ( TAU ) plus up to eight sessions weekly of either AM or CBT , offered within 3 months . The POMS was collected at baseline and 3 and 6 months post baseline . RESULTS Of those suitable , over 60 % ( 39/63 ) participated ( AM , n = 20 ; CBT , n = 19 ) and over 90 % ( 36/39 ) were followed up . Both packages were well received . The preference was for AM , with more sessions were taken up ; ( Mean number sessions AM = 7.2 ( SD 2.0 ) and CBT = 5.4 ( SD 3.1 ) ; P<0.05 ) . Significant improvements in POMS ( Total Mood , depression and anxiety scores ) occurred with both interventions . Between-group comparison showed a non-significant trend towards greater improvement in depression with CBT . CONCLUSIONS Recruitment was feasible ; the interventions acceptable and engagement with treatment was high . Improvements with both interventions were observed . The beneficial effects on depression with CBT appeared to be sustained Objective The aim of this pilot study is to analyze the reactions of healthy test persons and conscious as well as unconscious palliative patients to aroma stimuli . Patients and methods In a r and omized controlled study , healthy prob and s , conscious and unconscious palliative patients were exposed to two essential oils ( lemon , lavender ) . Water was used as the control stimulus .  Physiological parameters ( breathing rate and heart rate , oxygen saturation , systolic , diastolic and mean arterial pressure ) were measured . Results 10 test persons ( control group ) , 15 conscious patients and 5 unconscious palliative patients were exposed to the stimuli . Healthy test persons reacted to lemon oil with a significant increase in respiration rate , heart rate and diastolic blood pressure , whereas to lavender oil with a significant decrease in respiration rate was measured . There were no significant reactions concerning the other parameters . Conscious and unconscious patients reacted with a significant increase in all measured parameters to lemon oil and with a significant decrease in all parameters except for oxygen saturation to lavender oil . No significant differences in the reactions were measured between the conscious and unconscious patients and no significant reactions to control stimuli were detected . All physiological reactions were very short and only detectable during stimulus presentation . ConclusionS ignificant physiological reactions were measured after simulation with aroma oils in all three groups in this study . Healthy prob and s showed different reactions than palliative patients irrespective to their conscious state OBJECTIVE Common factors predict outcome in psychotherapy , but there is a dearth of research defining and st and ardising control conditions . A description and evaluation of a talking control ( TC ) used in a r and omized controlled trial ( RCT ) of cognitive-behavioral therapy ( CBT ) for older people with depression in primary care is presented . METHODS Two hundred and four older people participated in a RCT of CBT for people with a Geriatric Mental State diagnosis of Depression ( Serfaty et al. , 2009 ) . One in 10 session of CBT or TC were evaluated using the  Cognitive Therapy Scale ( CTS ) to examine common and specific factors in therapy . RESULTS 1005 therapy sessions were delivered ; 508 for TC and 497 CBT . There were higher total CTS scores ( P<0.001 ) for CBT ( median 55.0 ; QR 52.0 - 55.0 ) than TC ( median 23.0 ; QR 21.0 - 24.0 ) . CBT scored better than TC for specific techniques ( median 23.7 ; IQR 21.0 - 24.0 versus median 0.70.0 ; IQR 0.0 - 0.0 , P<0.001 ) . Both interventions scored highly for interpersonal effectiveness , but no difference was observed . The TC was easily delivered , deemed acceptable by patients and was not associated with harm . CONCLUSIONS Development , st and ardization and measurement of a TC intervention is possible and provides a useful comparator in evaluations of effectiveness of CBT Context Some patients nearing death seek pain relief with massage , but little is known about the effectiveness of massage in managing pain in palliative care setting s. Contribution In this r and omized trial in 380 patients with advanced cancer , improvement in  pain and mood immediately after treatment was greater with massage than with simple touch . Unfortunately , there were no sustained differences in pain , quality of life , or analgesic use during 3 weeks . Adverse effects were infrequent and similar in both groups . Implication Massage may offer some immediate relief for patients with advanced cancer , but the absence of sustained effects demonstrates the need for more effective strategies to manage pain at the end of life . The Editors Symptom relief is central to end-of-life care ; however , many terminally ill individuals experience serious pain and other physical and emotional symptoms ( 14 ) . Studies examining the efficacy of therapies that may mediate these sympt 
    Output:
    
In comparison with usual care , another therapy or an active control , evidence on the effectiveness of  massage and aromatherapy  in reducing anxiety , pain and improving quality -of-life was inconclusive .
There was some evidence ( low quality ) that compared to an active control , reflexology reduced pain .