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: Developing an evidence base for making public health decisions will require using data from evaluation studies with r and omized and nonr and omized design s. Assessing individual studies and using studies in quantitative research syntheses require transparent reporting of the study , with sufficient detail and clarity to readily see differences and similarities among studies in the same area . The Consoli date d St and ards of Reporting Trials ( CONSORT ) statement provides guidelines for transparent reporting of r and omized clinical trials . We present the initial version of the Transparent Reporting of Evaluations with Nonr and omized Design s ( TREND ) statement . These guidelines emphasize the reporting of theories used and descriptions of intervention and comparison conditions , research design , and methods of adjusting for possible biases in evaluation studies that use nonr and omized design In recent years quality of life instruments have been featured as primary outcomes in many r and omized trials . One of the challenges facing the investigator using such measures is determining the significance of any differences observed , and communicating that significance to clinicians who will be applying the trial results . We have developed an approach to elucidating the significance of changes in score in quality of life instruments by comparing them to global ratings of change . Using this approach we have established a plausible range within which the minimal clinical ly important difference ( MCID ) falls . In three studies in which instruments measuring  dyspnea , fatigue , and emotional function in patients with chronic heart and lung disease were applied the MCID was represented by mean change in score of approximately 0.5 per item , when responses were presented on a seven point Likert scale . Furthermore , we have established ranges for changes in question naire scores that correspond to moderate and large changes in the domains of interest . This information will be useful in interpreting question naire scores , both in individuals and in groups of patients participating in controlled trials , and in the planning of new trials Cancer and treatment can negatively affect the body 's performance and appearance .  Exercise has been tested in a few studies for altered body image among middle-aged women with breast cancer . The aim of the study was to explore how young pre-cancer athletes of both genders experience disease- and treatment-related physical fitness and appearance changes while undergoing chemotherapy and participating in a 6-week group exercise intervention . A prospect i ve , explorative study using semi-structured interviews was conducted before and at termination of the intervention . The study included 22 cancer patients ( median age 28 years ) . The young athletes experienced a change from a high level of physical activity , body satisfaction and a positive self-identity to a low level of physical activity , body denial and a negative self-identity . In the program , the patients experienced increased physical strength and recapture of certain aspects of their former positive body perception . Deterioation of muscle functions caused by chemotherapy was particularly painful to these patients , independent of gender and age . Young physically active patients are heavily dependent on their physical capacity , body satisfaction and self-identity . This should be taken into account when design ing programs to rehabilitate and encourage these patients through the often-strenuous antineoplastic treatments PURPOSE This study was undertaken to determine the effect , if any , of treatment for cancer diagnosed during childhood or adolescence on fertility . PATIENTS AND METHODS We review ed the fertility of female participants in the Childhood Cancer Survivor Study ( CCSS ) , which consisted of 5-year survivors , and a cohort of r and omly selected siblings who responded to a question naire . Medical records of all members of the cohort were abstract ed to obtain chemotherapeutic agents administered ; the cumulative dose of drug administered for several drugs of interest ; and the doses , volumes , and date s of administration of all radiation therapy . RESULTS There were 5,149 female CCSS participants , and there were 1,441 female siblings of CCSS participants who were age 15 to 44 years . The relative risk ( RR ) for survivors of ever being pregnant was 0.81 ( 95 % CI , 0.73 to 0.90 ; P < .001 ) compared with female siblings . In multivariate models among survivors only , those who received a hypothalamic/pituitary radiation dose > or = 30 Gy ( RR , 0.61 ; 95 % CI , 0.44 to 0.83 ) or an ovarian/uterine radiation dose greater than 5 Gy were less likely to have ever been pregnant ( RR , 0.56 for 5 to 10 Gy ; 95 % CI , 0.37 to 0.85 ; RR , 0.18 for > 10 Gy ; 95 % CI , 0.13 to 0.26 ) . Those with a summed alkylating agent dose ( AAD ) score of three or four or who were treated with lomustine or cyclophosphamide were less likely to have ever been pregnant . CONCLUSION This large study demonstrated that fertility is decreased among female CCSS participants . The risk factors identified may be utilized for pretreatment counseling of patients and their parents The aim was to evaluate the effects of additional exercises during inpatient stays on bone mass in pediatric bone tumor patients . 21 patients were non-r and omly allocated either to the  exercise group ( n = 10 ) or the control group ( n = 11 ) . DXA of the lumbar spine , the non-affected femur and both calcanei was performed after completion of neoadjuvant chemotherapy ( baseline ) , as well as 6 and 12 months after baseline . Bone mineral content ( BMC ) , bone mineral density ( BMD ) and height-corrected lumbar spine Z-scores were determined . Group changes after 6 and 12 months were compared by covariance analyses . Additionally ,  daily physical activities ( PA )  were assessed by means of accelerometry . After adjusting for initial age , height and weight , mean reductions in lumbar spine and femoral BMC were lower in the exercise group ( not significant ) . Effect sizes during the observational period for lumbar spine and femur BMC were generally small ( partial η² = 0.03 ) . The exercise group demonstrated substantially higher PA levels in terms of gait cycles per day , per hour and moderate PA ( activities above 40 gait cycles per minute ) . Additional exercises for bone tumor patients are feasible during hospitalization . Though the intervention did not influence BMC , it appeared beneficial regarding PA promotion with respect to volume and intensity 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 A series of studies have shown that physical activity improves cancer patients  functional capacity and quality of life ( QOL ) . Few of these studies have included physical exercise carried out in a group setting . However , patient 's experience with the in-group processes remains unexplored . This study investigated group cohesion and changes in QOL in 55 cancer patients undergoing chemotherapy who participated in a 9 h weekly group exercise programme for 6 weeks . The study used a method triangulation component design . Seven qualitative group interviews were conducted post-intervention . QOL ( SF-36 ; EORTC QLQ-C30 ) was assessed at baseline and after Week 6 . The interviews revealed that group cohesion was an interim goal aim ed to maximize peak performance potential by patients . Group cohesion was characterized by a special ' esprit de corps ' and enabled the group members to feel like sport teams . The programme made purpose ful togetherness possible while allowing the patients an opportunity to let their illness fade into the background . Question naire data showed significant improvements in mental health , social and emotional functioning . This study identified a conceptualization of group cohesion that forms a valuable basis for a larger r and omized controlled trial to conclude whether the observed changes are a result of this specific intervention PURPOSE To evaluate the effectiveness of a supervised home-based flexible training program on cardiorespiratory fitness ( CRF ) , mental distress , and health-related quality of life ( HRQOL ) parameters in young and middle-aged cancer patients shortly after curative chemotherapy . PATIENTS AND METHODS One hundred eleven patients age 18 to 50 years who had received chemotherapy for lymphomas or breast , gynecologic , or testicular cancer completed the trial . These patients were r and omly allocated to either an intervention group ( n = 59 ) , which underwent a 14-week training program , or a control group ( n = 52 ) that received st and ard care . Primary outcome was change in CRF , as determined by Astr and -Rhyming indirect bicycle ergometer test ( maximum oxygen uptake [ VO(2max ) ] ) , between baseline ( T0 ) and follow-up ( T1 ) . Secondary outcomes were mental distress , as assessed by the Hospital Anxiety and Depression Scale , and HRQOL , as assessed by the European Organisation for Research and Treatment of Cancer Core Quality of Life Question naire . Two-way analysis of covariance was used to analyze changes from T0 to T1 . RESULTS VO(2max ) increased by 6.4 mL/kg(-1)/min(-1 ) in patients in the intervention group and by 3.1 mL/kg(-1)/min(-1 ) in patients in the control group ( P < .01 ) . The fatigue score decreased by 17.0 points in the control group compared with only 5.8 points in the intervention group ( P < .01 ) . There were no intergroup differences in mental distress or HRQOL . CONCLUSION A supervised , home-based , flexible training program has significant effect on CRF in young and middle-aged cancer patients shortly after curative chemotherapy , but it has no favorable effect on patients ' experience of fatigue , mental distress , or HRQOL BACKGROUND Children with acute lymphoblastic leukemia ( ALL ) are at risk for developing musculoskeletal complications during and after their medical treatment . The objective of this study was to examine the feasibility of an in-hospital physical therapy- and home exercise program during the first four phases of medical treatment , for children with newly diagnosed ALL . PROCEDURE Nine patients , between the ages of 2 - 14 years old were enrolled within 2 weeks of diagnosis in the study . Each patient was evaluated at study entry , after each of the first four phases of therapy and each time patients were re-admitted to the hospital . Following the initial physical therapy evaluation an individualized home exercise program was developed , consisting of stretching , strengthening , and aerobic exercises . The following end points were measured at each evaluation : gross motor assessment as measured by gross motor function measure ( GMFM ) , health-related quality of life as measured by the PedsQL and parent satisfaction question naire . RESULTS This study was feasible with 98 % of the evaluation sessions completed . The GMFM and PedsQL improved steadily throughout the study ; however , the PedsQL slightly decreased from interim maintenance to delayed intensification . The parents reported being satisfied with the physical therapy program . CONCLUSION We demonstrated that an in-hospital- and home exercise physical therapy program during the first four phases of medical treatments is feasible for children with ALL . Future r and omized studies are needed to confirm whether an initial physical therapy program at diagnosis in children with ALL will limit functional impairments , improve overall fitness and increase health-related quality of life PURPOSE Lymphoma patients commonly experience declines in physical functioning and quality of life ( QoL )  that may be reversed with exercise training . PATIENTS AND METHODS We conducted a r and omized controlled trial in Edmonton , Alberta , Canada , between 2005 and 2008 that stratified 122 lymphoma patients by major disease type and current treatment status and r and omly assigned them to usual care ( UC ; n = 62 ) or 12 weeks of supervised aerobic exercise training ( AET ; n = 60 ) . Our primary end point was patient-rated physical functioning assessed by the Trial Outcome Index-Anemia . Secondary end points were overall QoL , psychosocial functioning , cardiovascular fitness , and body composition . RESULTS Follow-up assessment for our primary end point was 96 % ( 117 of 122 ) at postintervention and 90 % ( 110 of 122 ) at 6-month follow-up . Median adherence to the supervised exercise program was 92 % . At postintervention , AET was superior to UC for patient-rated physical functioning ( mean group difference , + 9.0 ; 95 % CI , 2.0 to 16.0 ; P = .012 ) , overall QoL ( P = .021 ) , fatigue ( P = .013 ) , happiness ( P = .004 ) , depression ( P = .005 ) , general health ( P < .001 ) , cardiovascular fitness ( P < .001 ) , and lean body mass ( P = .008 ) . Change in peak cardiovascular fitness mediated the change in patient-rated physical functioning . AET did not interfere with chemotherapy completion rate or treatment response . At 6-month follow-up , AET was still borderline or significantly superior to UC for overall QoL ( P = .054 ) , happiness ( P = .034 ) , and depression ( P = .00 
    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: Developing an evidence base for making public health decisions will require using data from evaluation studies with r and omized and nonr and omized design s. Assessing individual studies and using studies in quantitative research syntheses require transparent reporting of the study , with sufficient detail and clarity to readily see differences and similarities among studies in the same area . The Consoli date d St and ards of Reporting Trials ( CONSORT ) statement provides guidelines for transparent reporting of r and omized clinical trials . We present the initial version of the Transparent Reporting of Evaluations with Nonr and omized Design s ( TREND ) statement . These guidelines emphasize the reporting of theories used and descriptions of intervention and comparison conditions , research design , and methods of adjusting for possible biases in evaluation studies that use nonr and omized design In recent years quality of life instruments have been featured as primary outcomes in many r and omized trials . One of the challenges facing the investigator using such measures is determining the significance of any differences observed , and communicating that significance to clinicians who will be applying the trial results . We have developed an approach to elucidating the significance of changes in score in quality of life instruments by comparing them to global ratings of change . Using this approach we have established a plausible range within which the minimal clinical ly important difference ( MCID ) falls . In three studies in which instruments measuring  dyspnea , fatigue , and emotional function in patients with chronic heart and lung disease were applied the MCID was represented by mean change in score of approximately 0.5 per item , when responses were presented on a seven point Likert scale . Furthermore , we have established ranges for changes in question naire scores that correspond to moderate and large changes in the domains of interest . This information will be useful in interpreting question naire scores , both in individuals and in groups of patients participating in controlled trials , and in the planning of new trials Cancer and treatment can negatively affect the body 's performance and appearance .  Exercise has been tested in a few studies for altered body image among middle-aged women with breast cancer . The aim of the study was to explore how young pre-cancer athletes of both genders experience disease- and treatment-related physical fitness and appearance changes while undergoing chemotherapy and participating in a 6-week group exercise intervention . A prospect i ve , explorative study using semi-structured interviews was conducted before and at termination of the intervention . The study included 22 cancer patients ( median age 28 years ) . The young athletes experienced a change from a high level of physical activity , body satisfaction and a positive self-identity to a low level of physical activity , body denial and a negative self-identity . In the program , the patients experienced increased physical strength and recapture of certain aspects of their former positive body perception . Deterioation of muscle functions caused by chemotherapy was particularly painful to these patients , independent of gender and age . Young physically active patients are heavily dependent on their physical capacity , body satisfaction and self-identity . This should be taken into account when design ing programs to rehabilitate and encourage these patients through the often-strenuous antineoplastic treatments PURPOSE This study was undertaken to determine the effect , if any , of treatment for cancer diagnosed during childhood or adolescence on fertility . PATIENTS AND METHODS We review ed the fertility of female participants in the Childhood Cancer Survivor Study ( CCSS ) , which consisted of 5-year survivors , and a cohort of r and omly selected siblings who responded to a question naire . Medical records of all members of the cohort were abstract ed to obtain chemotherapeutic agents administered ; the cumulative dose of drug administered for several drugs of interest ; and the doses , volumes , and date s of administration of all radiation therapy . RESULTS There were 5,149 female CCSS participants , and there were 1,441 female siblings of CCSS participants who were age 15 to 44 years . The relative risk ( RR ) for survivors of ever being pregnant was 0.81 ( 95 % CI , 0.73 to 0.90 ; P < .001 ) compared with female siblings . In multivariate models among survivors only , those who received a hypothalamic/pituitary radiation dose > or = 30 Gy ( RR , 0.61 ; 95 % CI , 0.44 to 0.83 ) or an ovarian/uterine radiation dose greater than 5 Gy were less likely to have ever been pregnant ( RR , 0.56 for 5 to 10 Gy ; 95 % CI , 0.37 to 0.85 ; RR , 0.18 for > 10 Gy ; 95 % CI , 0.13 to 0.26 ) . Those with a summed alkylating agent dose ( AAD ) score of three or four or who were treated with lomustine or cyclophosphamide were less likely to have ever been pregnant . CONCLUSION This large study demonstrated that fertility is decreased among female CCSS participants . The risk factors identified may be utilized for pretreatment counseling of patients and their parents The aim was to evaluate the effects of additional exercises during inpatient stays on bone mass in pediatric bone tumor patients . 21 patients were non-r and omly allocated either to the  exercise group ( n = 10 ) or the control group ( n = 11 ) . DXA of the lumbar spine , the non-affected femur and both calcanei was performed after completion of neoadjuvant chemotherapy ( baseline ) , as well as 6 and 12 months after baseline . Bone mineral content ( BMC ) , bone mineral density ( BMD ) and height-corrected lumbar spine Z-scores were determined . Group changes after 6 and 12 months were compared by covariance analyses . Additionally ,  daily physical activities ( PA )  were assessed by means of accelerometry . After adjusting for initial age , height and weight , mean reductions in lumbar spine and femoral BMC were lower in the exercise group ( not significant ) . Effect sizes during the observational period for lumbar spine and femur BMC were generally small ( partial η² = 0.03 ) . The exercise group demonstrated substantially higher PA levels in terms of gait cycles per day , per hour and moderate PA ( activities above 40 gait cycles per minute ) . Additional exercises for bone tumor patients are feasible during hospitalization . Though the intervention did not influence BMC , it appeared beneficial regarding PA promotion with respect to volume and intensity 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 A series of studies have shown that physical activity improves cancer patients  functional capacity and quality of life ( QOL ) . Few of these studies have included physical exercise carried out in a group setting . However , patient 's experience with the in-group processes remains unexplored . This study investigated group cohesion and changes in QOL in 55 cancer patients undergoing chemotherapy who participated in a 9 h weekly group exercise programme for 6 weeks . The study used a method triangulation component design . Seven qualitative group interviews were conducted post-intervention . QOL ( SF-36 ; EORTC QLQ-C30 ) was assessed at baseline and after Week 6 . The interviews revealed that group cohesion was an interim goal aim ed to maximize peak performance potential by patients . Group cohesion was characterized by a special ' esprit de corps ' and enabled the group members to feel like sport teams . The programme made purpose ful togetherness possible while allowing the patients an opportunity to let their illness fade into the background . Question naire data showed significant improvements in mental health , social and emotional functioning . This study identified a conceptualization of group cohesion that forms a valuable basis for a larger r and omized controlled trial to conclude whether the observed changes are a result of this specific intervention PURPOSE To evaluate the effectiveness of a supervised home-based flexible training program on cardiorespiratory fitness ( CRF ) , mental distress , and health-related quality of life ( HRQOL ) parameters in young and middle-aged cancer patients shortly after curative chemotherapy . PATIENTS AND METHODS One hundred eleven patients age 18 to 50 years who had received chemotherapy for lymphomas or breast , gynecologic , or testicular cancer completed the trial . These patients were r and omly allocated to either an intervention group ( n = 59 ) , which underwent a 14-week training program , or a control group ( n = 52 ) that received st and ard care . Primary outcome was change in CRF , as determined by Astr and -Rhyming indirect bicycle ergometer test ( maximum oxygen uptake [ VO(2max ) ] ) , between baseline ( T0 ) and follow-up ( T1 ) . Secondary outcomes were mental distress , as assessed by the Hospital Anxiety and Depression Scale , and HRQOL , as assessed by the European Organisation for Research and Treatment of Cancer Core Quality of Life Question naire . Two-way analysis of covariance was used to analyze changes from T0 to T1 . RESULTS VO(2max ) increased by 6.4 mL/kg(-1)/min(-1 ) in patients in the intervention group and by 3.1 mL/kg(-1)/min(-1 ) in patients in the control group ( P < .01 ) . The fatigue score decreased by 17.0 points in the control group compared with only 5.8 points in the intervention group ( P < .01 ) . There were no intergroup differences in mental distress or HRQOL . CONCLUSION A supervised , home-based , flexible training program has significant effect on CRF in young and middle-aged cancer patients shortly after curative chemotherapy , but it has no favorable effect on patients ' experience of fatigue , mental distress , or HRQOL BACKGROUND Children with acute lymphoblastic leukemia ( ALL ) are at risk for developing musculoskeletal complications during and after their medical treatment . The objective of this study was to examine the feasibility of an in-hospital physical therapy- and home exercise program during the first four phases of medical treatment , for children with newly diagnosed ALL . PROCEDURE Nine patients , between the ages of 2 - 14 years old were enrolled within 2 weeks of diagnosis in the study . Each patient was evaluated at study entry , after each of the first four phases of therapy and each time patients were re-admitted to the hospital . Following the initial physical therapy evaluation an individualized home exercise program was developed , consisting of stretching , strengthening , and aerobic exercises . The following end points were measured at each evaluation : gross motor assessment as measured by gross motor function measure ( GMFM ) , health-related quality of life as measured by the PedsQL and parent satisfaction question naire . RESULTS This study was feasible with 98 % of the evaluation sessions completed . The GMFM and PedsQL improved steadily throughout the study ; however , the PedsQL slightly decreased from interim maintenance to delayed intensification . The parents reported being satisfied with the physical therapy program . CONCLUSION We demonstrated that an in-hospital- and home exercise physical therapy program during the first four phases of medical treatments is feasible for children with ALL . Future r and omized studies are needed to confirm whether an initial physical therapy program at diagnosis in children with ALL will limit functional impairments , improve overall fitness and increase health-related quality of life PURPOSE Lymphoma patients commonly experience declines in physical functioning and quality of life ( QoL )  that may be reversed with exercise training . PATIENTS AND METHODS We conducted a r and omized controlled trial in Edmonton , Alberta , Canada , between 2005 and 2008 that stratified 122 lymphoma patients by major disease type and current treatment status and r and omly assigned them to usual care ( UC ; n = 62 ) or 12 weeks of supervised aerobic exercise training ( AET ; n = 60 ) . Our primary end point was patient-rated physical functioning assessed by the Trial Outcome Index-Anemia . Secondary end points were overall QoL , psychosocial functioning , cardiovascular fitness , and body composition . RESULTS Follow-up assessment for our primary end point was 96 % ( 117 of 122 ) at postintervention and 90 % ( 110 of 122 ) at 6-month follow-up . Median adherence to the supervised exercise program was 92 % . At postintervention , AET was superior to UC for patient-rated physical functioning ( mean group difference , + 9.0 ; 95 % CI , 2.0 to 16.0 ; P = .012 ) , overall QoL ( P = .021 ) , fatigue ( P = .013 ) , happiness ( P = .004 ) , depression ( P = .005 ) , general health ( P < .001 ) , cardiovascular fitness ( P < .001 ) , and lean body mass ( P = .008 ) . Change in peak cardiovascular fitness mediated the change in patient-rated physical functioning . AET did not interfere with chemotherapy completion rate or treatment response . At 6-month follow-up , AET was still borderline or significantly superior to UC for overall QoL ( P = .054 ) , happiness ( P = .034 ) , and depression ( P = .00 
    Output:
    