human
***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: This pilot study examined the efficacy of two home-based exercise programs on alleviating fatigue and improving functional capacity in breast cancer survivors . Participants were r and omly assigned into one of three groups : aerobic exercise ( AE ) , resistance exercise ( RE ) , or usual care control ( CON ) . After receiving individualized instruction and training , participants assigned to the AE and RE groups were asked to perform the prescribed exercise(s ) 3 times per week for 12 weeks at home . Both groups were instructed to keep their perceived exercise intensity in the " fairly light " to " somewhat hard " range using the Borg Perceived Exertion Scale . All participants completed the revised Piper Fatigue Scale ( PFS ) and the 6-minute walk test ( 6MWT ) at baseline and 12-week post-exercise program . Analysis of pre- and post-training data revealed a significant reduction in fatigue levels on the PFS among participants in the AE group ( Z=2.521 , one-tailed P=0.006 ) , and a significant improvement in the distance of the 6MWT for the RE group ( Z=2.366 , one-tailed P=0.009 ) at the end of 12-week study period . No significant changes in fatigue or functional status were observed in the CON group . Findings provide preliminary support for RE as a viable strategy for improving functional capacity in breast cancer survivors , while AE may be more effective in attenuating cancer-related fatigue . Incorporating RE training for future research may help advance the growing body of knowledge in symptom management for breast cancer survivors 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 PURPOSE To evaluate the efficacy of a psychoeducational intervention in improving cancer-related fatigue .  PATIENTS AND METHODS This r and omized controlled trial involved 109 women commencing adjuvant chemotherapy for stage I or II breast cancer in five chemotherapy treatment centers . Intervention group patients received an individualized fatigue education and support program delivered in the clinic and by phone over three 10- to 20-minute sessions 1 week apart . Instruments included a numeric rating scale assessing confidence with managing fatigue ; 11-point numeric rating scales measuring fatigue at worst , average , and best ; the Functional Assessment of Cancer Therapy-Fatigue and Piper Fatigue Scales ; the Cancer Self-Efficacy Scale ; the European Organisation for Research and Treatment of Cancer Quality of Life Question naire C30 ; and the Hospital Anxiety and Depression Scale . For each outcome , separate analyses of covariance of change scores between baseline ( T1 ) and the three follow-up time points ( T2 , T3 , and T4 ) were conducted , controlling for the variable 's corresponding baseline value . RESULTS Compared with the intervention group , mean difference scores between the baseline ( T1 ) and immediate after the test ( T2 ) assessment s increased significantly more for the control group for worst and average fatigue , Functional Assessment of Cancer Therapy-Fatigue , and Piper fatigue severity and interference measures . These differences were not observed between baseline and T3 and T4 assessment s. No significant differences were identified for any pre- or post-test change scores for confidence with managing fatigue , cancer self-efficacy , anxiety , depression , or quality of life . CONCLUSION Preparatory education and support has the potential to assist women to cope with cancer-related fatigue in the short term . However , further research is needed to identify ways to improve the potency and sustainability of psychoeducational interventions for managing cancer-related fatigue Background Persistent fatigue is recognised as one of the most common , ongoing symptoms reported by patients following cancer treatment and may have profound effects on the quality of life . However , recent cross-sectional studies also highlight the close relationship between cancer related fatigue ( CRF ) and diagnoses of depression or anxiety disorder . There is currently limited information about the relationships between these conditions over time . We sought to examine the longitudinal relationships between fatigue and mood disorder in women treated with adjuvant therapy for early stage breast cancer . Methods Women who had recently completed adjuvant therapy for Stage I or II breast cancer ( n = 212 ) were sent a question naire with established case thresholds for clinical ly-significant fatigue and psychological disorder , as well as a question naire assessing disability . Potentially relevant variables linked to fatigue states , including age , treatment modality , menopausal status , and hematological indices were recorded . The illness outcomes were assessed over 48 months of follow-up . Results The 176 women who responded to the question naire ( 84 % ) had a mean age of 55 ( range 24–83 ) years and had completed adjuvant treatment on average 10 ( range 4.7 – 16.3 ) months previously .  Radiotherapy had been administered , either alone ( 50 % of women ) or in combination with chemotherapy ( 36 % ) . Responses from 87 women ( 48 % ) indicated a significant fatigue state ( termed here post-cancer fatigue ; PCF ) , and from 59 women ( 33 % ) responses indicated significant psychological distress . Thirty-four women ( 19 % ) were cases of fatigue alone ( i.e. unaccompanied by psychological disorder ) , whereas 52 ( 30 % ) were cases of both disorders . Multivariate analysis did not reveal any association between demographic , clinical or laboratory variables , and caseness for PCF . Self-reported functional disability was significantly associated with fatigue . Follow-up at 24 , 36 and 48 months revealed high rates of ongoing PCF in conjunction with psychological distress , despite falling rates of psychological distress alone and fatigue alone . Conclusion Post-cancer fatigue was prevalent and sustained on follow-up . Concurrent psychological disorder was evident in the majority , but not all , cases of PCF and tended to be sustained over time . Further prospect i ve cohort studies to define the longitudinal co-morbid relationships between fatigue , mood disorder , and ongoing disability after cancer treatment are indicated PURPOSE To determine the effects of breast cancer-specific print material s and step pedometers on  physical activity ( PA ) and quality of life ( QoL ) in breast cancer survivors . PATIENTS AND METHODS Breast cancer survivors ( N = 377 ) were r and omly assigned to receive one of the following : a st and ard public health recommendation for PA , previously developed breast cancer-specific PA print material s , a step pedometer , or a combination of breast cancer-specific print material s and step pedometers . The primary outcome was self-reported moderate/vigorous PA minutes per week . Secondary outcomes were QoL ( Functional Assessment of Cancer Therapy-Breast ) , fatigue , self-reported brisk walking , and objective step counts . Assessment s were conducted at baseline and postintervention ( 12 weeks ) . RESULTS Attrition was 10.3 % ( 39 of 377 ) . On the basis of linear mixed-model analyses , PA increased by 30 minutes/week in the st and ard recommendation group compared with 70 minutes/week in the print material group ( mean difference , 39 minutes/week ; 95 % CI = -10 to 89 ; d = 0.25 ; P = .117 ) , 89 minutes/week in the pedometer group ( mean difference , 59 minutes/week ; 95 % CI , 11 to 108 ; d = 0.38 ; P = .017 ) , and 87 minutes/week in the combined group ( mean difference , 57 minutes/week ; 95 % CI , 8 to 106 ; d = 0.37 ; P = .022 ) . For brisk walking minutes/week , all three intervention groups reported significantly greater increases than the st and ard recommendation group . The combined group also reported significantly improved QoL ( mean difference , 5.8 ; 95 % CI , 2.0 to 9.6 ; d = 0.33 ; P = .003 ) and reduced fatigue ( mean difference , 2.3 ; 95 % CI , 0.0 to 4.7 ; d = 0.25 ; P = .052 ) compared with the st and ard recommendation group . CONCLUSION Breast cancer-specific PA print material s and pedometers may be effective strategies for increasing PA and QoL in breast cancer survivors . A combined approach appears to be optimal . CLINICAL TRIAL REGISTRATION Clinical Trials.gov Identifier PURPOSE Cancer treatment-related fatigue is the most prevalent and distressing symptom of cancer therapy . Interventions to minimize fatigue are needed . The purpose of this study was to examine the relationship between exercise and fatigue over the first three cycles of chemotherapy in women receiving either cyclophosphamide , methotrexate , and fluorouracil ( CMF ) or doxorubicin and cyclophosphamide ( AC ) for breast cancer . METHODS Seventy-two newly diagnosed women with breast cancer were instructed in a home-based moderate-intensity exercise intervention . Measures of functional ability , energy expenditure , and fatigue were obtained at baseline and posttest . Subjects maintained daily records of four types of fatigue , and exercise duration , intensity , and type . RESULTS Exercise significantly reduced all four levels of fatigue ( P < 0.01 ) . As the duration of exercise increased , the intensity of fatigue declined ( P < 0.01 ) . There was a significant carry-over effect of exercise on fatigue , but the effect lasted only 1 d. The level of fatigue at study entry was not associated with number of days of exercise or amount of exercise a woman engaged in . CONCLUSIONS The impact of exercise on fatigue was significant and suggests the effectiveness of a low- to moderate-intensity regular exercise program in maintaining functional ability and reducing fatigue in women with breast cancer receiving chemotherapy PURPOSE To determine 1-year outcomes of a four-component behavioral therapy ( BT ) sleep intervention ( Individualized Sleep Promotion Plan [ ISPP ] ) versus a healthy eating control ( HEC ) on cancer-related fatigue in women receiving breast cancer adjuvant chemotherapy treatment ( CTX ) . PATIENTS AND METHODS A total of 219 participants from 12 oncology clinics were r and omly assigned in a clinical trial . Before CTX , research nurses coached intervention participants to develop a BT plan including stimulus control , modified sleep restriction , relaxation therapy , and sleep hygiene . BT plans were revised before each CTX and 30 , 60 , and 90 days after the last CTX and reinforced 7 to 9 days later . HEC participants received nutritional information and equal attention . Pittsburgh Sleep Quality Index ( PSQI ) , Daily Diary , Wrist Actigraph , and Piper Fatigue Scale measures and Repeated Linear Mixed Model analysis following the Intent to Treat paradigm were used . RESULTS Sleep quality differed over 1 years time ( F [ 4,162 ] = 7.7 , P < .001 ; by group , F [ 1,173 ] = 4.8 , P = .029 ; and over time by group , F [ 4,162 ] = 3.3 , P = .013 ) . Pairwise comparisons revealed significant differences between groups at 90 days ( P = .002 ) but not at 1 year ( P = .052 ) . Seven days of diary and actigraphy data did not corroborate with monthly reflections ( PSQI ) . The night awakenings ( Actigraph ) pattern was significantly different by group over time ( P = .046 ) , with no differences between groups at 90 days or at 1 year . Fatigue was lower at 1 year than before CTX ; no group effects were found . CONCLUSION The BT group , on average , experienced significant improvement on global sleep quality compared with the HEC group , but not on objective sleep or fatigue outcomes Purpose Postoperative radiotherapy for breast cancer has a number of associated complications . This study examined whether supervised moderate-intensity exercise could mitigate the complications that occur during radiotherapy . Patients and Methods Forty women were r and omized before radiotherapy after various operations for breast cancer . Seventeen patients who were assigned to the 
    Output:
    
agent
***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: This pilot study examined the efficacy of two home-based exercise programs on alleviating fatigue and improving functional capacity in breast cancer survivors . Participants were r and omly assigned into one of three groups : aerobic exercise ( AE ) , resistance exercise ( RE ) , or usual care control ( CON ) . After receiving individualized instruction and training , participants assigned to the AE and RE groups were asked to perform the prescribed exercise(s ) 3 times per week for 12 weeks at home . Both groups were instructed to keep their perceived exercise intensity in the " fairly light " to " somewhat hard " range using the Borg Perceived Exertion Scale . All participants completed the revised Piper Fatigue Scale ( PFS ) and the 6-minute walk test ( 6MWT ) at baseline and 12-week post-exercise program . Analysis of pre- and post-training data revealed a significant reduction in fatigue levels on the PFS among participants in the AE group ( Z=2.521 , one-tailed P=0.006 ) , and a significant improvement in the distance of the 6MWT for the RE group ( Z=2.366 , one-tailed P=0.009 ) at the end of 12-week study period . No significant changes in fatigue or functional status were observed in the CON group . Findings provide preliminary support for RE as a viable strategy for improving functional capacity in breast cancer survivors , while AE may be more effective in attenuating cancer-related fatigue . Incorporating RE training for future research may help advance the growing body of knowledge in symptom management for breast cancer survivors 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 PURPOSE To evaluate the efficacy of a psychoeducational intervention in improving cancer-related fatigue .  PATIENTS AND METHODS This r and omized controlled trial involved 109 women commencing adjuvant chemotherapy for stage I or II breast cancer in five chemotherapy treatment centers . Intervention group patients received an individualized fatigue education and support program delivered in the clinic and by phone over three 10- to 20-minute sessions 1 week apart . Instruments included a numeric rating scale assessing confidence with managing fatigue ; 11-point numeric rating scales measuring fatigue at worst , average , and best ; the Functional Assessment of Cancer Therapy-Fatigue and Piper Fatigue Scales ; the Cancer Self-Efficacy Scale ; the European Organisation for Research and Treatment of Cancer Quality of Life Question naire C30 ; and the Hospital Anxiety and Depression Scale . For each outcome , separate analyses of covariance of change scores between baseline ( T1 ) and the three follow-up time points ( T2 , T3 , and T4 ) were conducted , controlling for the variable 's corresponding baseline value . RESULTS Compared with the intervention group , mean difference scores between the baseline ( T1 ) and immediate after the test ( T2 ) assessment s increased significantly more for the control group for worst and average fatigue , Functional Assessment of Cancer Therapy-Fatigue , and Piper fatigue severity and interference measures . These differences were not observed between baseline and T3 and T4 assessment s. No significant differences were identified for any pre- or post-test change scores for confidence with managing fatigue , cancer self-efficacy , anxiety , depression , or quality of life . CONCLUSION Preparatory education and support has the potential to assist women to cope with cancer-related fatigue in the short term . However , further research is needed to identify ways to improve the potency and sustainability of psychoeducational interventions for managing cancer-related fatigue Background Persistent fatigue is recognised as one of the most common , ongoing symptoms reported by patients following cancer treatment and may have profound effects on the quality of life . However , recent cross-sectional studies also highlight the close relationship between cancer related fatigue ( CRF ) and diagnoses of depression or anxiety disorder . There is currently limited information about the relationships between these conditions over time . We sought to examine the longitudinal relationships between fatigue and mood disorder in women treated with adjuvant therapy for early stage breast cancer . Methods Women who had recently completed adjuvant therapy for Stage I or II breast cancer ( n = 212 ) were sent a question naire with established case thresholds for clinical ly-significant fatigue and psychological disorder , as well as a question naire assessing disability . Potentially relevant variables linked to fatigue states , including age , treatment modality , menopausal status , and hematological indices were recorded . The illness outcomes were assessed over 48 months of follow-up . Results The 176 women who responded to the question naire ( 84 % ) had a mean age of 55 ( range 24–83 ) years and had completed adjuvant treatment on average 10 ( range 4.7 – 16.3 ) months previously .  Radiotherapy had been administered , either alone ( 50 % of women ) or in combination with chemotherapy ( 36 % ) . Responses from 87 women ( 48 % ) indicated a significant fatigue state ( termed here post-cancer fatigue ; PCF ) , and from 59 women ( 33 % ) responses indicated significant psychological distress . Thirty-four women ( 19 % ) were cases of fatigue alone ( i.e. unaccompanied by psychological disorder ) , whereas 52 ( 30 % ) were cases of both disorders . Multivariate analysis did not reveal any association between demographic , clinical or laboratory variables , and caseness for PCF . Self-reported functional disability was significantly associated with fatigue . Follow-up at 24 , 36 and 48 months revealed high rates of ongoing PCF in conjunction with psychological distress , despite falling rates of psychological distress alone and fatigue alone . Conclusion Post-cancer fatigue was prevalent and sustained on follow-up . Concurrent psychological disorder was evident in the majority , but not all , cases of PCF and tended to be sustained over time . Further prospect i ve cohort studies to define the longitudinal co-morbid relationships between fatigue , mood disorder , and ongoing disability after cancer treatment are indicated PURPOSE To determine the effects of breast cancer-specific print material s and step pedometers on  physical activity ( PA ) and quality of life ( QoL ) in breast cancer survivors . PATIENTS AND METHODS Breast cancer survivors ( N = 377 ) were r and omly assigned to receive one of the following : a st and ard public health recommendation for PA , previously developed breast cancer-specific PA print material s , a step pedometer , or a combination of breast cancer-specific print material s and step pedometers . The primary outcome was self-reported moderate/vigorous PA minutes per week . Secondary outcomes were QoL ( Functional Assessment of Cancer Therapy-Breast ) , fatigue , self-reported brisk walking , and objective step counts . Assessment s were conducted at baseline and postintervention ( 12 weeks ) . RESULTS Attrition was 10.3 % ( 39 of 377 ) . On the basis of linear mixed-model analyses , PA increased by 30 minutes/week in the st and ard recommendation group compared with 70 minutes/week in the print material group ( mean difference , 39 minutes/week ; 95 % CI = -10 to 89 ; d = 0.25 ; P = .117 ) , 89 minutes/week in the pedometer group ( mean difference , 59 minutes/week ; 95 % CI , 11 to 108 ; d = 0.38 ; P = .017 ) , and 87 minutes/week in the combined group ( mean difference , 57 minutes/week ; 95 % CI , 8 to 106 ; d = 0.37 ; P = .022 ) . For brisk walking minutes/week , all three intervention groups reported significantly greater increases than the st and ard recommendation group . The combined group also reported significantly improved QoL ( mean difference , 5.8 ; 95 % CI , 2.0 to 9.6 ; d = 0.33 ; P = .003 ) and reduced fatigue ( mean difference , 2.3 ; 95 % CI , 0.0 to 4.7 ; d = 0.25 ; P = .052 ) compared with the st and ard recommendation group . CONCLUSION Breast cancer-specific PA print material s and pedometers may be effective strategies for increasing PA and QoL in breast cancer survivors . A combined approach appears to be optimal . CLINICAL TRIAL REGISTRATION Clinical Trials.gov Identifier PURPOSE Cancer treatment-related fatigue is the most prevalent and distressing symptom of cancer therapy . Interventions to minimize fatigue are needed . The purpose of this study was to examine the relationship between exercise and fatigue over the first three cycles of chemotherapy in women receiving either cyclophosphamide , methotrexate , and fluorouracil ( CMF ) or doxorubicin and cyclophosphamide ( AC ) for breast cancer . METHODS Seventy-two newly diagnosed women with breast cancer were instructed in a home-based moderate-intensity exercise intervention . Measures of functional ability , energy expenditure , and fatigue were obtained at baseline and posttest . Subjects maintained daily records of four types of fatigue , and exercise duration , intensity , and type . RESULTS Exercise significantly reduced all four levels of fatigue ( P < 0.01 ) . As the duration of exercise increased , the intensity of fatigue declined ( P < 0.01 ) . There was a significant carry-over effect of exercise on fatigue , but the effect lasted only 1 d. The level of fatigue at study entry was not associated with number of days of exercise or amount of exercise a woman engaged in . CONCLUSIONS The impact of exercise on fatigue was significant and suggests the effectiveness of a low- to moderate-intensity regular exercise program in maintaining functional ability and reducing fatigue in women with breast cancer receiving chemotherapy PURPOSE To determine 1-year outcomes of a four-component behavioral therapy ( BT ) sleep intervention ( Individualized Sleep Promotion Plan [ ISPP ] ) versus a healthy eating control ( HEC ) on cancer-related fatigue in women receiving breast cancer adjuvant chemotherapy treatment ( CTX ) . PATIENTS AND METHODS A total of 219 participants from 12 oncology clinics were r and omly assigned in a clinical trial . Before CTX , research nurses coached intervention participants to develop a BT plan including stimulus control , modified sleep restriction , relaxation therapy , and sleep hygiene . BT plans were revised before each CTX and 30 , 60 , and 90 days after the last CTX and reinforced 7 to 9 days later . HEC participants received nutritional information and equal attention . Pittsburgh Sleep Quality Index ( PSQI ) , Daily Diary , Wrist Actigraph , and Piper Fatigue Scale measures and Repeated Linear Mixed Model analysis following the Intent to Treat paradigm were used . RESULTS Sleep quality differed over 1 years time ( F [ 4,162 ] = 7.7 , P < .001 ; by group , F [ 1,173 ] = 4.8 , P = .029 ; and over time by group , F [ 4,162 ] = 3.3 , P = .013 ) . Pairwise comparisons revealed significant differences between groups at 90 days ( P = .002 ) but not at 1 year ( P = .052 ) . Seven days of diary and actigraphy data did not corroborate with monthly reflections ( PSQI ) . The night awakenings ( Actigraph ) pattern was significantly different by group over time ( P = .046 ) , with no differences between groups at 90 days or at 1 year . Fatigue was lower at 1 year than before CTX ; no group effects were found . CONCLUSION The BT group , on average , experienced significant improvement on global sleep quality compared with the HEC group , but not on objective sleep or fatigue outcomes Purpose Postoperative radiotherapy for breast cancer has a number of associated complications . This study examined whether supervised moderate-intensity exercise could mitigate the complications that occur during radiotherapy . Patients and Methods Forty women were r and omized before radiotherapy after various operations for breast cancer . Seventeen patients who were assigned to the 
    Output:
    