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: Background Collaborative care interventions to treat depression have begun to be tested in setting s outside of primary care . However , few studies have exp and ed the collaborative care model to other setting s and targeted comorbid physical symptoms of depression . Purpose The aims of this report were to : ( 1 ) describe the design and methods of a trial testing the efficacy of a stepped collaborative care intervention design ed to manage cancer-related symptoms and improve overall quality of life in patients diagnosed with hepatobiliary carcinoma ; and ( 2 ) share the lessons learned during the design , implementation , and evaluation of the trial . Methods The trial was a phase III r and omized controlled trial testing the efficacy of a stepped collaborative care intervention to reduce depression , pain , and fatigue in patients diagnosed with advanced cancer . The intervention was compared to an enhanced usual care arm . The primary outcomes included the Center for Epidemiological Studies -Depression scale , Brief Pain Inventory , and Functional Assessment of Cancer Therapy (FACT)-Fatigue , and the FACT-Hepatobiliary . Sociodemographic and disease-specific characteristics were recorded from the medical record ; Natural Killer cells and cytokines that are associated with these symptoms and with disease progression were assayed from serum . Results and Discussion The issues addressed include : ( 1 ) development of collaborative care in the context of oncology ( e.g. , timing of the intervention , tailoring of the intervention , ethical issues regarding r and omization of patients , and changes in medical treatment over the course of the study ) ; ( 2 ) use of a website by chronically ill population s ( e.g. , design and access to the website , development of the website and intervention , ethical issues associated with website development , website usage , and unanticipated costs associated with website development ) ; ( 3 ) evaluation of the efficacy of intervention ( e.g. , patient preferences , proxy raters , changes in medical treatment , and inclusion of biomarkers as endpoints ) ; and ( 4 ) analyses and interpretation of the intervention ( e.g. , confounding factors , dose and active ingredients , and risks and benefits of collaborative care interventions in chronically ill patients ) . Limitations The limitations to the study , although not fully realized at this time as the trial is ongoing , include : ( 1 ) heterogeneity of the diagnoses and treatments of participants ; and ( 2 ) inclusion of caregivers as proxy raters but not as participants in the intervention . Conclusions Collaborative care interventions to manage multiple symptoms in a tertiary cancer center are feasible . However , research ers design ing and implementing interventions that are web-based , target multiple symptoms , and for oncology patients may benefit from previous experiences Background Hematopoietic stem cell transplantation is an intensive therapy used to improve survivorship and cure various oncologic diseases . However , this therapy is associated with high mortality rates and numerous negative side-effects . The recovery of the immune system is a special concern and plays a key role in the success of this treatment . In healthy population s it is known that exercise plays an important role in immune system regulation , but little is known about the role of exercise in the hematological and immunological recovery of children undergoing hematopoietic stem cell transplant . The primary objective of this r and omized-controlled trial ( RCT ) is to study the effect of an exercise program ( in- and outpatient ) on immune cell recovery in patients undergoing an autologous stem cell transplantation . The secondary objective is to determine if an exercise intervention diminishes the usual deterioration in quality of life , physical fitness , and the acquisition of a sedentary lifestyle . Methods This RCT has received approval from The Conjoint Health Research Ethics Board ( CHREB ) of the University of Calgary ( Ethics ID # E-24476 ) . Twenty-four participants treated for a malignancy with autologous stem cell transplant ( 5 to 18 years ) in the Alberta Children ’s Hospital will be r and omly assigned to an exercise or control group . The exercise group will participate in a two-phase exercise intervention ( in- and outpatient ) from hospitalization until 10 weeks after discharge . The exercise program includes strength , flexibility and aerobic exercise . During the inpatient phase this program will be performed 5 times/week and will be supervised . The outpatient phase will combine a supervised session with two home-based exercise sessions with the use of the Wii device . The control group will follow the st and ard protocol without any specific exercise program . A range of outcomes , including quantitative and functional recovery of immune system , cytokine levels in serum , natural killer ( NK ) cells and their subset recovery and function , and gene expression of activating and inhibitory NK cell receptors , body composition , nutrition , quality of life , fatigue , health-related fitness assessment and physical activity levels will be examined , providing the most comprehensive assessment to date . Discussion We expect to find improvements in immunological recovery and quality of life , and decreased acquisition of sedentary behavior and fitness deconditioning . The comprehensive outcomes generated in this RCT will provide preliminary data to conduct a multisite study that will generate stronger outcomes .Trial registration Gov identification # BACKGROUND This r and omized controlled trial on Physical Activity in Pediatric Cancer ( PAPEC ) was design ed to assess the impact of an exercise program on pediatric cancer patients undergoing chemotherapy for solid tumors . METHODS AND DESIGN 60 pediatric patients of both sexes , aged 4 to 18 years and undergoing treatment for extracranial primary solid tumors will be recruited for this trial . Each participant will be r and omly assigned ( with blocking on sex ) to either an intervention or control ( normal care ) group . The intervention group will participate in combined inpatient physical training ( aerobic + strength ) for the duration of neoadjuvant chemotherapy . The intervention will include 3 weekly 60 - 70 min exercise sessions in the child 's room or in a pediatric gym at the hospital , depending on the child 's health state . In both groups , determination of several primary ( cardio-respiratory fitness , muscle strength , functional capacity , physical activity levels , body weight and quality of life ) and secondary outcomes [ immune function and inflammatory profile ( blood levels of 47 cytokines ) ] will be made at the following time points : ( i ) before the exercise intervention ( immediately after diagnosis and before treatment onset ) ; ( ii ) after the exercise intervention ( upon termination of neoadjuvant chemotherapy ) ; and ( iii ) after a detraining period ( 2 months after the intervention ) . DISCUSSION The PAPEC trial will provide relevant new information on biological mechanisms and inform on the potential clinical use of exercise during pediatric cancer treatment as a simple way to prevent future long-term treatment effects and improve the general health state of pediatric cancer patients Background While research on exercise interventions during anticancer treatment is well-established in adults , only very few studies exist in children . However , pediatric patients experience great limitations to being physically active , and appropriate interventions are desired . ProcedureThe present study aim ed at investigating the effects of individualized exercise interventions during inpatient stays on pediatric patients with a malignant bone tumor . The parameter of interest was  physical activity ( PA ) . Patients ’ PA during home stays was assessed 6 weeks as well as 3 , 6 , 12 , and 18 months post-surgery . Patients were distinguished into an intervention  group and a  control group . All patients received endoprosthetic replacement of the affected bone in the same institution . Results A constant increase in all PA parameters was observed during follow-up . Exercise interventions were possible and appeared worthwhile . The intervention group showed better PA results at all measurements ; however , no significant differences between groups were found . Furthermore , differences decreased especially after the cessation of the intervention . General problems in reaching appropriate power and compliance were observed . Conclusions Individualized exercise interventions in pediatric bone tumor patients are possible and appear to be beneficial . Such interventions should be implemented in adjuvant care ; however , future research is needed to underst and more about the effects of different interventions Purpose : To describe the effect of therapeutic yoga on child and parental reports of quality of life in children hospitalized with oncological diagnoses . Methods : Six children participated in 5 yoga sessions  over 2 months . The PedsQL 4.0 was administered to each child and participating parent/caregivers at baseline and after completion of the yoga intervention . The Wilcoxon nonparametric rank test measured individual differences over time . Results : Statistically significant differences ( P < .05 ) were found in child perception of gross motor function . Conclusion : These feasibility study data suggest that therapeutic yoga positively affected child perception of gross motor function measured on the PedsQL 4.0 . Further studies are needed , including a r and omized control trial and with a larger number of participants , to clarify and confirm the effect of therapeutic yoga Background Low levels of physical activity , musculoskeletal morbidity and weight gain are commonly reported problems in children with cancer . Intensive medical treatment and a decline in physical activity may also result in reduced motor performance . Therefore , simple and inexpensive ways to promote physical activity and exercise are becoming an increasingly important part of children ’s cancer treatment . Methods The aim of this study is to evaluate the effect of active video games in promotion of physical activity in children with cancer . The research is conducted as a parallel r and omized clinical trial with follow-up . Patients between 3 and 16 years old , diagnosed with cancer and treated with vincristine in two specialized medical centers are asked to participate . Based on statistical estimates , the target enrollment is 40 patients . The intervention includes playing elective active video games and , in addition , education and consultations for the family . The control group will receive a general recommendation for physical activity for 30 minutes per day . The main outcomes are the amount of physical activity and sedentary behavior . Other outcomes include motor performance , fatigue and metabolic risk factors . The outcomes are examined with question naires , diaries , physical examinations and blood tests at baseline and at 2 , 6 , 12 and 30 months after the baseline . Additionally , the children ’s perceptions of the most enjoyable activation methods are explored through an interview at 2 months . Discussion This trial will help to answer the question of whether playing active video games is beneficial for children with cancer . It will also provide further reasoning for physical activity promotion and training of motor skills during treatment . Trial registration Clinical Trials.gov identifier : NCT01748058 ( October 15 , 2012 ) The purpose of this review is to summarize literature that describes the impact of exercise on health and physical function among children during and after treatment for cancer . Relevant studies were identified by entering the following search terms into Pubmed : aerobic training ; resistance training ; stretching ; pediatric ; children ; AND cancer . Reference lists in retrieved manuscripts were also review ed to identify additional trials . We include fifteen intervention trials published between 1993 and 2011 that included children younger than age 21 years with cancer diagnoses . Nine included children with an acute lymphoblastic leukemia ( ALL ) diagnosis , and six children with mixed cancer diagnoses . Generally , interventions tested were either in-hospital supervised exercise training or home based programs design ed to promote physical activity . Early evidence from small studies indicates that the effects of exercise include increased cardiopulmonary fitness , improved muscle strength and flexibility , reduced fatigue and improved physical function . Generalizations to the entire childhood cancer and childhood cancer survivor population s are difficult as most of the work has been done in children during treatment for and among survivors of ALL . Additional r and omized studies are needed to confirm these benefits in larger population s of children with ALL , and in population s with cancer diagnoses other than ALL Context Long-term survivors of childhood cancer may be affected by treatment-associated impairments that limit physical performance and restrict participation in activities of daily living . Prevalence of these impairments and their association with particular types of cancer or treatment methods are not known . Contribution Patients surviving childhood cancer for at least 5 years were compared with their siblings who did not have cancer . All survivors were at an increased relative risk for persistent impairment , but survivors of brain and bone cancer were particularly likely to report performance limitations and restrictions in routine activities . Implication s Despite substantial improvements in treatment of childhood cancer , profound alterations in quality of life often persist into adulthood . The Editors Profound advances in treatment efficacy and a concomitant increase in the number of long-term survivors have generated a need for investigations into the adverse effects of childhood cancer and its treatment ( 1 - 5 ) . Surgery , chemotherapy , and radiotherapy are essential to providing a long-term cure in many children with malignant and nonmalignant neoplasms . Surgical procedures can result in structural and functional changes , which can have long-term implication s in young children who are growing and developing . Chemotherapy and radiotherapy are cytotoxic and thus can have deleterious effects on developing organ systems ( 6 - 18 ) . Long-term survivors of childhood cancer are at risk for many late effects , including early death , second cancer , and organ system dysfunction ( 19 - 22 ) . Endocrine , musculoskeletal , neurologic , sensory , cardiac , and pulmonary impairments also have been documented ( 1 , 19 , 20 , 22 - 29 ) . A malignant disease or its treatment may cause long-term impairments in intellectual , emotional , and physical domains that diminish functioning ( performance limitations ) . Performance limitations can restrict the survivor 's ability to participate fully in daily activities necessary for self-care , home management , or work ( participation restrictions ) . Delayed consequences of therapy are of special interest in children with cancer because of their young age and because of the potential remaining years of life that may be affected ( 30 ) . Performance limitations and participation restrictions have been reported in as many as 69 % of survivors of childhood cancer ( 31 - 33 ) . The aims of this analysis were to estimate the prevalence of performance limitations and participation restrictions among a cohort of long-term survivors of childhood cancer . We compared these results with similar findings in a comparative group of siblings of survivors . In addition , we evaluated whether performance limitations and participation restrictions were affected by cancer type ; treatment methods ; or delayed effects of the cancer , its treatment , or both . Methods Study Participants The Childhood Cancer 
    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: Background Collaborative care interventions to treat depression have begun to be tested in setting s outside of primary care . However , few studies have exp and ed the collaborative care model to other setting s and targeted comorbid physical symptoms of depression . Purpose The aims of this report were to : ( 1 ) describe the design and methods of a trial testing the efficacy of a stepped collaborative care intervention design ed to manage cancer-related symptoms and improve overall quality of life in patients diagnosed with hepatobiliary carcinoma ; and ( 2 ) share the lessons learned during the design , implementation , and evaluation of the trial . Methods The trial was a phase III r and omized controlled trial testing the efficacy of a stepped collaborative care intervention to reduce depression , pain , and fatigue in patients diagnosed with advanced cancer . The intervention was compared to an enhanced usual care arm . The primary outcomes included the Center for Epidemiological Studies -Depression scale , Brief Pain Inventory , and Functional Assessment of Cancer Therapy (FACT)-Fatigue , and the FACT-Hepatobiliary . Sociodemographic and disease-specific characteristics were recorded from the medical record ; Natural Killer cells and cytokines that are associated with these symptoms and with disease progression were assayed from serum . Results and Discussion The issues addressed include : ( 1 ) development of collaborative care in the context of oncology ( e.g. , timing of the intervention , tailoring of the intervention , ethical issues regarding r and omization of patients , and changes in medical treatment over the course of the study ) ; ( 2 ) use of a website by chronically ill population s ( e.g. , design and access to the website , development of the website and intervention , ethical issues associated with website development , website usage , and unanticipated costs associated with website development ) ; ( 3 ) evaluation of the efficacy of intervention ( e.g. , patient preferences , proxy raters , changes in medical treatment , and inclusion of biomarkers as endpoints ) ; and ( 4 ) analyses and interpretation of the intervention ( e.g. , confounding factors , dose and active ingredients , and risks and benefits of collaborative care interventions in chronically ill patients ) . Limitations The limitations to the study , although not fully realized at this time as the trial is ongoing , include : ( 1 ) heterogeneity of the diagnoses and treatments of participants ; and ( 2 ) inclusion of caregivers as proxy raters but not as participants in the intervention . Conclusions Collaborative care interventions to manage multiple symptoms in a tertiary cancer center are feasible . However , research ers design ing and implementing interventions that are web-based , target multiple symptoms , and for oncology patients may benefit from previous experiences Background Hematopoietic stem cell transplantation is an intensive therapy used to improve survivorship and cure various oncologic diseases . However , this therapy is associated with high mortality rates and numerous negative side-effects . The recovery of the immune system is a special concern and plays a key role in the success of this treatment . In healthy population s it is known that exercise plays an important role in immune system regulation , but little is known about the role of exercise in the hematological and immunological recovery of children undergoing hematopoietic stem cell transplant . The primary objective of this r and omized-controlled trial ( RCT ) is to study the effect of an exercise program ( in- and outpatient ) on immune cell recovery in patients undergoing an autologous stem cell transplantation . The secondary objective is to determine if an exercise intervention diminishes the usual deterioration in quality of life , physical fitness , and the acquisition of a sedentary lifestyle . Methods This RCT has received approval from The Conjoint Health Research Ethics Board ( CHREB ) of the University of Calgary ( Ethics ID # E-24476 ) . Twenty-four participants treated for a malignancy with autologous stem cell transplant ( 5 to 18 years ) in the Alberta Children ’s Hospital will be r and omly assigned to an exercise or control group . The exercise group will participate in a two-phase exercise intervention ( in- and outpatient ) from hospitalization until 10 weeks after discharge . The exercise program includes strength , flexibility and aerobic exercise . During the inpatient phase this program will be performed 5 times/week and will be supervised . The outpatient phase will combine a supervised session with two home-based exercise sessions with the use of the Wii device . The control group will follow the st and ard protocol without any specific exercise program . A range of outcomes , including quantitative and functional recovery of immune system , cytokine levels in serum , natural killer ( NK ) cells and their subset recovery and function , and gene expression of activating and inhibitory NK cell receptors , body composition , nutrition , quality of life , fatigue , health-related fitness assessment and physical activity levels will be examined , providing the most comprehensive assessment to date . Discussion We expect to find improvements in immunological recovery and quality of life , and decreased acquisition of sedentary behavior and fitness deconditioning . The comprehensive outcomes generated in this RCT will provide preliminary data to conduct a multisite study that will generate stronger outcomes .Trial registration Gov identification # BACKGROUND This r and omized controlled trial on Physical Activity in Pediatric Cancer ( PAPEC ) was design ed to assess the impact of an exercise program on pediatric cancer patients undergoing chemotherapy for solid tumors . METHODS AND DESIGN 60 pediatric patients of both sexes , aged 4 to 18 years and undergoing treatment for extracranial primary solid tumors will be recruited for this trial . Each participant will be r and omly assigned ( with blocking on sex ) to either an intervention or control ( normal care ) group . The intervention group will participate in combined inpatient physical training ( aerobic + strength ) for the duration of neoadjuvant chemotherapy . The intervention will include 3 weekly 60 - 70 min exercise sessions in the child 's room or in a pediatric gym at the hospital , depending on the child 's health state . In both groups , determination of several primary ( cardio-respiratory fitness , muscle strength , functional capacity , physical activity levels , body weight and quality of life ) and secondary outcomes [ immune function and inflammatory profile ( blood levels of 47 cytokines ) ] will be made at the following time points : ( i ) before the exercise intervention ( immediately after diagnosis and before treatment onset ) ; ( ii ) after the exercise intervention ( upon termination of neoadjuvant chemotherapy ) ; and ( iii ) after a detraining period ( 2 months after the intervention ) . DISCUSSION The PAPEC trial will provide relevant new information on biological mechanisms and inform on the potential clinical use of exercise during pediatric cancer treatment as a simple way to prevent future long-term treatment effects and improve the general health state of pediatric cancer patients Background While research on exercise interventions during anticancer treatment is well-established in adults , only very few studies exist in children . However , pediatric patients experience great limitations to being physically active , and appropriate interventions are desired . ProcedureThe present study aim ed at investigating the effects of individualized exercise interventions during inpatient stays on pediatric patients with a malignant bone tumor . The parameter of interest was  physical activity ( PA ) . Patients ’ PA during home stays was assessed 6 weeks as well as 3 , 6 , 12 , and 18 months post-surgery . Patients were distinguished into an intervention  group and a  control group . All patients received endoprosthetic replacement of the affected bone in the same institution . Results A constant increase in all PA parameters was observed during follow-up . Exercise interventions were possible and appeared worthwhile . The intervention group showed better PA results at all measurements ; however , no significant differences between groups were found . Furthermore , differences decreased especially after the cessation of the intervention . General problems in reaching appropriate power and compliance were observed . Conclusions Individualized exercise interventions in pediatric bone tumor patients are possible and appear to be beneficial . Such interventions should be implemented in adjuvant care ; however , future research is needed to underst and more about the effects of different interventions Purpose : To describe the effect of therapeutic yoga on child and parental reports of quality of life in children hospitalized with oncological diagnoses . Methods : Six children participated in 5 yoga sessions  over 2 months . The PedsQL 4.0 was administered to each child and participating parent/caregivers at baseline and after completion of the yoga intervention . The Wilcoxon nonparametric rank test measured individual differences over time . Results : Statistically significant differences ( P < .05 ) were found in child perception of gross motor function . Conclusion : These feasibility study data suggest that therapeutic yoga positively affected child perception of gross motor function measured on the PedsQL 4.0 . Further studies are needed , including a r and omized control trial and with a larger number of participants , to clarify and confirm the effect of therapeutic yoga Background Low levels of physical activity , musculoskeletal morbidity and weight gain are commonly reported problems in children with cancer . Intensive medical treatment and a decline in physical activity may also result in reduced motor performance . Therefore , simple and inexpensive ways to promote physical activity and exercise are becoming an increasingly important part of children ’s cancer treatment . Methods The aim of this study is to evaluate the effect of active video games in promotion of physical activity in children with cancer . The research is conducted as a parallel r and omized clinical trial with follow-up . Patients between 3 and 16 years old , diagnosed with cancer and treated with vincristine in two specialized medical centers are asked to participate . Based on statistical estimates , the target enrollment is 40 patients . The intervention includes playing elective active video games and , in addition , education and consultations for the family . The control group will receive a general recommendation for physical activity for 30 minutes per day . The main outcomes are the amount of physical activity and sedentary behavior . Other outcomes include motor performance , fatigue and metabolic risk factors . The outcomes are examined with question naires , diaries , physical examinations and blood tests at baseline and at 2 , 6 , 12 and 30 months after the baseline . Additionally , the children ’s perceptions of the most enjoyable activation methods are explored through an interview at 2 months . Discussion This trial will help to answer the question of whether playing active video games is beneficial for children with cancer . It will also provide further reasoning for physical activity promotion and training of motor skills during treatment . Trial registration Clinical Trials.gov identifier : NCT01748058 ( October 15 , 2012 ) The purpose of this review is to summarize literature that describes the impact of exercise on health and physical function among children during and after treatment for cancer . Relevant studies were identified by entering the following search terms into Pubmed : aerobic training ; resistance training ; stretching ; pediatric ; children ; AND cancer . Reference lists in retrieved manuscripts were also review ed to identify additional trials . We include fifteen intervention trials published between 1993 and 2011 that included children younger than age 21 years with cancer diagnoses . Nine included children with an acute lymphoblastic leukemia ( ALL ) diagnosis , and six children with mixed cancer diagnoses . Generally , interventions tested were either in-hospital supervised exercise training or home based programs design ed to promote physical activity . Early evidence from small studies indicates that the effects of exercise include increased cardiopulmonary fitness , improved muscle strength and flexibility , reduced fatigue and improved physical function . Generalizations to the entire childhood cancer and childhood cancer survivor population s are difficult as most of the work has been done in children during treatment for and among survivors of ALL . Additional r and omized studies are needed to confirm these benefits in larger population s of children with ALL , and in population s with cancer diagnoses other than ALL Context Long-term survivors of childhood cancer may be affected by treatment-associated impairments that limit physical performance and restrict participation in activities of daily living . Prevalence of these impairments and their association with particular types of cancer or treatment methods are not known . Contribution Patients surviving childhood cancer for at least 5 years were compared with their siblings who did not have cancer . All survivors were at an increased relative risk for persistent impairment , but survivors of brain and bone cancer were particularly likely to report performance limitations and restrictions in routine activities . Implication s Despite substantial improvements in treatment of childhood cancer , profound alterations in quality of life often persist into adulthood . The Editors Profound advances in treatment efficacy and a concomitant increase in the number of long-term survivors have generated a need for investigations into the adverse effects of childhood cancer and its treatment ( 1 - 5 ) . Surgery , chemotherapy , and radiotherapy are essential to providing a long-term cure in many children with malignant and nonmalignant neoplasms . Surgical procedures can result in structural and functional changes , which can have long-term implication s in young children who are growing and developing . Chemotherapy and radiotherapy are cytotoxic and thus can have deleterious effects on developing organ systems ( 6 - 18 ) . Long-term survivors of childhood cancer are at risk for many late effects , including early death , second cancer , and organ system dysfunction ( 19 - 22 ) . Endocrine , musculoskeletal , neurologic , sensory , cardiac , and pulmonary impairments also have been documented ( 1 , 19 , 20 , 22 - 29 ) . A malignant disease or its treatment may cause long-term impairments in intellectual , emotional , and physical domains that diminish functioning ( performance limitations ) . Performance limitations can restrict the survivor 's ability to participate fully in daily activities necessary for self-care , home management , or work ( participation restrictions ) . Delayed consequences of therapy are of special interest in children with cancer because of their young age and because of the potential remaining years of life that may be affected ( 30 ) . Performance limitations and participation restrictions have been reported in as many as 69 % of survivors of childhood cancer ( 31 - 33 ) . The aims of this analysis were to estimate the prevalence of performance limitations and participation restrictions among a cohort of long-term survivors of childhood cancer . We compared these results with similar findings in a comparative group of siblings of survivors . In addition , we evaluated whether performance limitations and participation restrictions were affected by cancer type ; treatment methods ; or delayed effects of the cancer , its treatment , or both . Methods Study Participants The Childhood Cancer 
    Output:
    