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 Patients with cancer grapple with a confusing array of disease- and treatment-related symptoms while trying to maintain functioning in usual roles and daily activities . Research is needed to sort out and identify symptom clusters as a basis for a rational approach to symptom management . OBJECTIVE The aim of this study was to test , through secondary analysis , a mediation hypothesis about the direct and indirect relationships between fatigue and depressive symptoms through a pathway involving functional status . METHODS Data from the experimental and control groups of a r and omized clinical intervention trial for fatigue management , collected after the second chemotherapy treatment or during the last week of radiotherapy  , were analyzed . The mediation pathway from fatigue to depressive symptoms through functional status was tested separately for groups receiving either an energy conservation intervention or a control intervention , equating for time and attention . RESULTS For the control group , the results indicate support for partial mediation . The previously significant relationship between fatigue and depressive symptoms was reduced after functional status was controlled , accounting for 43 % of the total mediated effect . The mediation hypothesis was not supported in the energy conservation group , indicating that the intervention may have changed the role of functional status in mediating the effect of fatigue on depressive symptoms . DISCUSSION In the control group , when routine activities became more difficult because of fatigue , individuals had more depressive symptoms . The results suggest that functional status is an important factor to consider in symptom management for fatigue . An appropriate intervention for fatigue would have two targets : the fatigue and strategies to reduce the likelihood of impaired functioning that could result in elevated depressive symptoms PURPOSE This report describes the strength and significance of the association between antecedent and mediating variables across four categories of quality of life ( QOL ) outcomes in 132 disease free women with ovarian germ cell survivors . METHODS Survivors ( n=132 ) participated in a mailed question naire and computer-assisted telephone survey .  Participants in four prospect i ve GOG protocol s were contacted their treating physician for verbal consent to be approached by investigators at the Indiana University Cancer Center about a quality of life study . Similar patients treated at the MD And erson Cancer Center were also included . If women verbally consented after being contacted by investigators at Indiana University , an informed consent and question naire packet was sent via mail . After return of the written informed consent and background question naire , a trained research assistant scheduled a computer-assisted interview to complete data collection . RESULTS Median follow-up from diagnosis was 10.2 years . Mediating variables of self-efficacy or social support played a significant role ( p=0.05 to p=0.001 ) in all four QOL categories : physical functioning , psychological functioning , sexual functioning , and spiritual functioning . Being a younger age at diagnosis and married were positively related to sexual functioning ( p=0.05 ) . Menstrual and gynecological symptoms were inversely related . IMPLICATION S Results indicate that clinicians may want to be especially sensitive to identifying a survivor 's social support and confidence ( self efficacy ) in h and ling issues evolving from treatment since these skills may be related to overall quality of life outcomes 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 Some studies indicate that age at the time of surgery has a general effect on outcomes . The impact of age on the quality of life ( QOL ) of patients with rectal cancer , however , has not been investigated . The present study was conducted to address this issue . Over a 5-year period the European Organization for Research and Treatment of Cancer (EORTC)-QLQ-C-30 and a tumor-specific module were prospect ively administered to patients before surgery , at discharge , and at 3 , 6 , 12 , and 24 months postoperatively . Comparisons were made between age groups . A total of 519 patients participated in the study . QOL data were available for 253 patients . Significant differences were observed only between patients aged 69 years and younger ( ≤69 years ) ( 169/253 ) and those aged 70 years and older ( ≥70 years ) ( 85/253 ) . Physical and role functioning was better for patients ≤69 years ; patients ≥70 years suffered from increased pain and fatigue . Younger patients had more difficulty with sexual enjoyment , and over time sexual strain was worse for patients aged ≥70 years during the early postoperative period but improved , whereas patients aged ≤69 years had increasing levels of strain over time . The findings in this study confirmed that QOL is dynamic over time and that age has an impact on QOL and sexuality . Patients aged ≥70 years are affected by impaired physical functioning , global health , and fatigue , whereas increased treatment strain during the early postoperative period improves over time . Patients aged ≤69 years experience increased strain because of impaired sexual function Ovarian cancer patients may experience  psychological disorders  due to the aggressive nature of the illness and treatment . We investigated the presence of psychological disorders longitudinally in women with a new diagnosis of ovarian cancer and the factors that predicted development and maintenance of these disorders . Patients were assessed in a prospect i ve longitudinal study at the beginning of chemotherapy treatment , mid-treatment , end of treatment and 3 months follow-up for depression , anxiety , perceived social support , neuroticism and cognitive strategies to control unwanted thoughts .  A total of 121 patients were recruited and 85 patients were assessed at all four time points . Three different longitudinal profiles of anxiety and depression caseness were found : non-cases ( never cases ) , occasional cases ( cases on at least one but not all four occasions ) and stable cases ( cases on all four occasions ) . Most of the women were occasional cases of anxiety ( 52 % , 44 ) , whereas for depression , the majority of women were non-cases ( 55 % , 47 ) . A subset of patients were stable cases of anxiety ( 22 % , 19 ) . Neuroticism and marital status were significant independent predictors of anxiety caseness profile . Neuroticism and use of anti-depressants  were independent predictors of depression caseness profile . Social support was not related to psychological morbidity PURPOSE We previously evaluated fatigue , menopausal symptoms , and cognitive dysfunction in patients receiving adjuvant therapy for breast cancer and matched healthy women . Here we report assessment of these women 1 and 2 years later . PATIENTS AND METHODS Patients without relapse and controls were evaluated by the Functional Assessment of Cancer Treatment-General Quality of Life question naire , with subscales for fatigue and endocrine symptoms , and by the High Sensitivity Cognitive Screen . RESULTS There were 104 , 91 , and 83 patients and 102 , 81 , and 81 controls assessed at baseline and at 1 and 2 years , respectively . Median Functional Assessment of Cancer Treatment-Fatigue scores ( range , 0 to 52 ) for patients improved from 31 ( on chemotherapy ) to 43 and 45 at 1 and 2 years , respectively , but were stable in controls ( 46 to 48 ) . Median Functional Assessment of Cancer Treatment-Endocrine Symptoms scores ( range , 0 to 72 ) for patients improved from 57 ( on chemotherapy ) to 59 and 61 at 1 and 2 years , respectively , and were stable in controls ( 64 to 65 ) . Differences between patients and controls remained significant for these scales . The incidence of moderate-severe cognitive dysfunction by the High Sensitivity Cognitive Screen  decreased in patients from 16 % ( on chemotherapy ) to 4.4 % and 3.8 % and in controls from 5 % to 3.6 % and 0 % at 1 and 2 years , respectively . There were minimal differences between estrogen receptor-positive patients who started hormonal therapy ( mainly tamoxifen ) after chemotherapy and estrogen receptor-negative patients who did not . Differences in quality of life between patients and controls were significant only at baseline . CONCLUSION Fatigue , menopausal symptoms , and cognitive dysfunction are important adverse effects of chemotherapy that improve in most patients . Hormonal treatment has minimal impact on them The objective of this study was to evaluate the problems with miction , defecation , and sexuality after a  radical hysterectomy with or without adjuvant radiotherapy  for the treatment of cervical cancer stage I – IIA . This study included an observational longitudinal study of self-reported bladder , defecation , and sexual problems with a baseline score . Ninety-four women were included in the study . An age-matched control group consisted of 224 women . The patients showed significantly more negative effects on sexual function compared with both the controls and their situation before the treatment throughout 24 months of follow-up . The problems included less lubrication , a narrow and short vagina , senseless areas around the labia , dyspareunia , and sexual dissatisfaction . Up to 12 months after the treatment , the patients complained significantly more of little or no urge to urinate and diarrhea as compared with the controls . Adjuvant radiotherapy did not increase the risk of bladder dysfunction , colorectal motility disorders , and sexual functions . We conclude that a radical hysterectomy for the treatment of early-stage cervical carcinoma is associated with adverse effects mainly on sexual functioning PURPOSE The purpose of the study was to examine the effect of communication on rectal cancer patients ’  quality of life over four years . Previous studies have either used short follow-up periods or examined only certain aspects of quality of life , such as anxiety and depression . METHODS In a prospect i ve , observational study , rectal cancer patients , recruited by clinicians over a two-year period , were sent question naires over four years . The clinical details of these patients were recorded by the Munich Cancer Registry . The psychological scores from the European Organization for Research and Treatment of Cancer QLQ-C30 and CR38 were the main outcome variables . RESULTS Thirty-nine percent of the sample reported that some aspect of the communication  they received was unclear ( incomprehensible or too little ) . More than 60 percent wished to speak more with their physician . Younger patients and those in larger hospitals were more likely to report unclear communication ( P < 0.05 ) . Analyses of covariance , controlled for age , gender , adjuvant therapy , stoma , education , clinic , and comorbidity , demonstrated that role , emotional , and social functioning scores were consistently lower in patients reporting unclear communication . Additionally , these patients experienced more problems sleeping , poorer body image , more financial worries , and a worse future perspective . Repeated measures analyses indicated that sleeping problems and emotional and social functioning difficulties persisted for at least three years . CONCLUSION Reports of unclear communication were associated with poorer quality of life in rectal cancer patients without disease progression To evaluate the impact of tamoxifen on subjective and psychosexual well-being in breast cancer patients in relation to type of prior chemotherapy and menopausal status . Longitudinal interview study in breast cancer patients during and after adjuvant tamoxifen use . Menopausal status was defined by last menstrual period and serum oestradiol and FSH levels . Gynaecology outpatient clinic , Tertiary Referral Hospital , January 1995 to September 1999 . Breast cancer patients < 56 years of age , participating in a r and omised trial comparing adjuvant high-dose ( n=45 ) and st and ard-dose ( n=53 ) chemotherapy , followed by radiotherapy and tamoxifen .  Relative incidence and correlation of subjective and psychosexual symptoms during and after tamoxifen . During tamoxifen the most frequent complaints were hot flushes (  
    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 Patients with cancer grapple with a confusing array of disease- and treatment-related symptoms while trying to maintain functioning in usual roles and daily activities . Research is needed to sort out and identify symptom clusters as a basis for a rational approach to symptom management . OBJECTIVE The aim of this study was to test , through secondary analysis , a mediation hypothesis about the direct and indirect relationships between fatigue and depressive symptoms through a pathway involving functional status . METHODS Data from the experimental and control groups of a r and omized clinical intervention trial for fatigue management , collected after the second chemotherapy treatment or during the last week of radiotherapy  , were analyzed . The mediation pathway from fatigue to depressive symptoms through functional status was tested separately for groups receiving either an energy conservation intervention or a control intervention , equating for time and attention . RESULTS For the control group , the results indicate support for partial mediation . The previously significant relationship between fatigue and depressive symptoms was reduced after functional status was controlled , accounting for 43 % of the total mediated effect . The mediation hypothesis was not supported in the energy conservation group , indicating that the intervention may have changed the role of functional status in mediating the effect of fatigue on depressive symptoms . DISCUSSION In the control group , when routine activities became more difficult because of fatigue , individuals had more depressive symptoms . The results suggest that functional status is an important factor to consider in symptom management for fatigue . An appropriate intervention for fatigue would have two targets : the fatigue and strategies to reduce the likelihood of impaired functioning that could result in elevated depressive symptoms PURPOSE This report describes the strength and significance of the association between antecedent and mediating variables across four categories of quality of life ( QOL ) outcomes in 132 disease free women with ovarian germ cell survivors . METHODS Survivors ( n=132 ) participated in a mailed question naire and computer-assisted telephone survey .  Participants in four prospect i ve GOG protocol s were contacted their treating physician for verbal consent to be approached by investigators at the Indiana University Cancer Center about a quality of life study . Similar patients treated at the MD And erson Cancer Center were also included . If women verbally consented after being contacted by investigators at Indiana University , an informed consent and question naire packet was sent via mail . After return of the written informed consent and background question naire , a trained research assistant scheduled a computer-assisted interview to complete data collection . RESULTS Median follow-up from diagnosis was 10.2 years . Mediating variables of self-efficacy or social support played a significant role ( p=0.05 to p=0.001 ) in all four QOL categories : physical functioning , psychological functioning , sexual functioning , and spiritual functioning . Being a younger age at diagnosis and married were positively related to sexual functioning ( p=0.05 ) . Menstrual and gynecological symptoms were inversely related . IMPLICATION S Results indicate that clinicians may want to be especially sensitive to identifying a survivor 's social support and confidence ( self efficacy ) in h and ling issues evolving from treatment since these skills may be related to overall quality of life outcomes 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 Some studies indicate that age at the time of surgery has a general effect on outcomes . The impact of age on the quality of life ( QOL ) of patients with rectal cancer , however , has not been investigated . The present study was conducted to address this issue . Over a 5-year period the European Organization for Research and Treatment of Cancer (EORTC)-QLQ-C-30 and a tumor-specific module were prospect ively administered to patients before surgery , at discharge , and at 3 , 6 , 12 , and 24 months postoperatively . Comparisons were made between age groups . A total of 519 patients participated in the study . QOL data were available for 253 patients . Significant differences were observed only between patients aged 69 years and younger ( ≤69 years ) ( 169/253 ) and those aged 70 years and older ( ≥70 years ) ( 85/253 ) . Physical and role functioning was better for patients ≤69 years ; patients ≥70 years suffered from increased pain and fatigue . Younger patients had more difficulty with sexual enjoyment , and over time sexual strain was worse for patients aged ≥70 years during the early postoperative period but improved , whereas patients aged ≤69 years had increasing levels of strain over time . The findings in this study confirmed that QOL is dynamic over time and that age has an impact on QOL and sexuality . Patients aged ≥70 years are affected by impaired physical functioning , global health , and fatigue , whereas increased treatment strain during the early postoperative period improves over time . Patients aged ≤69 years experience increased strain because of impaired sexual function Ovarian cancer patients may experience  psychological disorders  due to the aggressive nature of the illness and treatment . We investigated the presence of psychological disorders longitudinally in women with a new diagnosis of ovarian cancer and the factors that predicted development and maintenance of these disorders . Patients were assessed in a prospect i ve longitudinal study at the beginning of chemotherapy treatment , mid-treatment , end of treatment and 3 months follow-up for depression , anxiety , perceived social support , neuroticism and cognitive strategies to control unwanted thoughts .  A total of 121 patients were recruited and 85 patients were assessed at all four time points . Three different longitudinal profiles of anxiety and depression caseness were found : non-cases ( never cases ) , occasional cases ( cases on at least one but not all four occasions ) and stable cases ( cases on all four occasions ) . Most of the women were occasional cases of anxiety ( 52 % , 44 ) , whereas for depression , the majority of women were non-cases ( 55 % , 47 ) . A subset of patients were stable cases of anxiety ( 22 % , 19 ) . Neuroticism and marital status were significant independent predictors of anxiety caseness profile . Neuroticism and use of anti-depressants  were independent predictors of depression caseness profile . Social support was not related to psychological morbidity PURPOSE We previously evaluated fatigue , menopausal symptoms , and cognitive dysfunction in patients receiving adjuvant therapy for breast cancer and matched healthy women . Here we report assessment of these women 1 and 2 years later . PATIENTS AND METHODS Patients without relapse and controls were evaluated by the Functional Assessment of Cancer Treatment-General Quality of Life question naire , with subscales for fatigue and endocrine symptoms , and by the High Sensitivity Cognitive Screen . RESULTS There were 104 , 91 , and 83 patients and 102 , 81 , and 81 controls assessed at baseline and at 1 and 2 years , respectively . Median Functional Assessment of Cancer Treatment-Fatigue scores ( range , 0 to 52 ) for patients improved from 31 ( on chemotherapy ) to 43 and 45 at 1 and 2 years , respectively , but were stable in controls ( 46 to 48 ) . Median Functional Assessment of Cancer Treatment-Endocrine Symptoms scores ( range , 0 to 72 ) for patients improved from 57 ( on chemotherapy ) to 59 and 61 at 1 and 2 years , respectively , and were stable in controls ( 64 to 65 ) . Differences between patients and controls remained significant for these scales . The incidence of moderate-severe cognitive dysfunction by the High Sensitivity Cognitive Screen  decreased in patients from 16 % ( on chemotherapy ) to 4.4 % and 3.8 % and in controls from 5 % to 3.6 % and 0 % at 1 and 2 years , respectively . There were minimal differences between estrogen receptor-positive patients who started hormonal therapy ( mainly tamoxifen ) after chemotherapy and estrogen receptor-negative patients who did not . Differences in quality of life between patients and controls were significant only at baseline . CONCLUSION Fatigue , menopausal symptoms , and cognitive dysfunction are important adverse effects of chemotherapy that improve in most patients . Hormonal treatment has minimal impact on them The objective of this study was to evaluate the problems with miction , defecation , and sexuality after a  radical hysterectomy with or without adjuvant radiotherapy  for the treatment of cervical cancer stage I – IIA . This study included an observational longitudinal study of self-reported bladder , defecation , and sexual problems with a baseline score . Ninety-four women were included in the study . An age-matched control group consisted of 224 women . The patients showed significantly more negative effects on sexual function compared with both the controls and their situation before the treatment throughout 24 months of follow-up . The problems included less lubrication , a narrow and short vagina , senseless areas around the labia , dyspareunia , and sexual dissatisfaction . Up to 12 months after the treatment , the patients complained significantly more of little or no urge to urinate and diarrhea as compared with the controls . Adjuvant radiotherapy did not increase the risk of bladder dysfunction , colorectal motility disorders , and sexual functions . We conclude that a radical hysterectomy for the treatment of early-stage cervical carcinoma is associated with adverse effects mainly on sexual functioning PURPOSE The purpose of the study was to examine the effect of communication on rectal cancer patients ’  quality of life over four years . Previous studies have either used short follow-up periods or examined only certain aspects of quality of life , such as anxiety and depression . METHODS In a prospect i ve , observational study , rectal cancer patients , recruited by clinicians over a two-year period , were sent question naires over four years . The clinical details of these patients were recorded by the Munich Cancer Registry . The psychological scores from the European Organization for Research and Treatment of Cancer QLQ-C30 and CR38 were the main outcome variables . RESULTS Thirty-nine percent of the sample reported that some aspect of the communication  they received was unclear ( incomprehensible or too little ) . More than 60 percent wished to speak more with their physician . Younger patients and those in larger hospitals were more likely to report unclear communication ( P < 0.05 ) . Analyses of covariance , controlled for age , gender , adjuvant therapy , stoma , education , clinic , and comorbidity , demonstrated that role , emotional , and social functioning scores were consistently lower in patients reporting unclear communication . Additionally , these patients experienced more problems sleeping , poorer body image , more financial worries , and a worse future perspective . Repeated measures analyses indicated that sleeping problems and emotional and social functioning difficulties persisted for at least three years . CONCLUSION Reports of unclear communication were associated with poorer quality of life in rectal cancer patients without disease progression To evaluate the impact of tamoxifen on subjective and psychosexual well-being in breast cancer patients in relation to type of prior chemotherapy and menopausal status . Longitudinal interview study in breast cancer patients during and after adjuvant tamoxifen use . Menopausal status was defined by last menstrual period and serum oestradiol and FSH levels . Gynaecology outpatient clinic , Tertiary Referral Hospital , January 1995 to September 1999 . Breast cancer patients < 56 years of age , participating in a r and omised trial comparing adjuvant high-dose ( n=45 ) and st and ard-dose ( n=53 ) chemotherapy , followed by radiotherapy and tamoxifen .  Relative incidence and correlation of subjective and psychosexual symptoms during and after tamoxifen . During tamoxifen the most frequent complaints were hot flushes (  
    Output:
    