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: Women diagnosed with breast cancer received massage therapy or practice d progressive muscle relaxation ( PMR ) for 30-min sessions 3 times a week for 5 weeks or received st and ard treatment . The massage therapy and relaxation groups reported less depressed mood , anxiety , and pain immediately after their first and last sessions . By the end of the study , however , only the massage therapy group reported being less depressed and less angry and having more vigor . Dopamine levels , Natural Killer cells , and lymphocytes also increased from the first to the last day of the study for the massage therapy group . These findings highlight the benefit of these complementary therapies , most particularly massage therapy , for women with breast cancer BACKGROUND Arthralgia is a common and debilitating side-effect experienced by breast cancer patients receiving aromatase inhibitors ( AIs ) and often results in premature drug discontinuation . METHODS We conducted a r and omised controlled trial of electro-acupuncture ( EA ) as compared to waitlist control ( WLC ) and sham acupuncture ( SA ) in postmenopausal women with breast cancer who self-reported arthralgia attributable to AIs . Acupuncturists performed 10 EA/SA treatments over 8 weeks using a manualised protocol with 2 Hz electro-stimulation delivered by a TENS unit . Acupuncturists administered SA using Streitberger ( non-penetrating ) needles at non-traditional acupuncture points without electro-stimulation . The primary end-point was pain severity by Brief Pain Inventory ( BPI ) between EA and WLC at Week 8 ; durability of response at Week 12 and comparison of EA to SA were secondary aims . FINDINGS Of the 67 r and omly assigned patients , mean reduction in pain severity was greater in the EA group than in the WLC group at Week 8 ( -2.2 versus -0.2 , p=0.0004 ) and at Week 12 ( -2.4 versus -0.2 , p<0.0001 ) . Pain-related interference measured by BPI also improved in the EA group compared to the WLC group at both Week 8 ( -2.0 versus 0.2 , p=0.0006 ) and Week 12 ( -2.1 versus -0.1 , p=0.0034 ) . SA produced a magnitude of change in pain severity and pain-related interference at Week 8 ( -2.3 , -1.5 respectively ) and Week 12 ( -1.7 , -1.3 respectively ) similar to that of EA . Participants in both EA and SA groups reported few minor adverse events . INTERPRETATIONS Compared to usual care , EA produced clinical ly important and durable improvement in arthralgia related to AIs in breast cancer patients , and SA had a similar effect . Both EA and SA were safe Background Use of complementary and alternative medicine ( CAM ) by women with breast cancer is often said to be increasing , yet few data exist to confirm this commonly held belief . The purpose of this paper is to compare overall patterns of CAM use , as well as use of specific products and therapies at two different points in time ( 1998 vs 2005 ) by women diagnosed with breast cancer . Methods Surveys were mailed to women r and omly selected from the Ontario Cancer Registry ( Canada ) in the spring of 1998 ( n = 557 ) and again in the spring of 2005(n = 877 ) . Results The response rates were 76.3 % in 1998 and 63 % in 2005 . In 1998 , 66.7 % of women reported using either a  CAM product/therapy or seeing a CAM therapist at some time in their lives as compared with 81.9 % in 2005 ( p = 0.0002 ) . Increases were seen in both use of CAM products/therapies ( 62 % in 1998 vs. 70.6 % in 2005 ) and visits to CAM practitioners ( 39.4 % of respondents in 1998 vs 57.4 % of respondents in 2005 ) . Women in 2005 reported that 41 % used  CAM  for treating their breast cancer . The most commonly used products and practitioners for treating breast cancer as reported in 2005 were green tea , vitamin E , flaxseed , vitamin C , massage therapists and dietitians/nutritionists . Conclusion  CAM use ( both self-medication with products and visits to CAM practitioners ) increased significantly from 1998 to 2005 . Now that more than 80 % of all women with breast cancer report using CAM ( 41 % in a specific attempt to management their breast cancer ) , CAM use can no longer be regarded as an " alternative " or unusual approach to managing breast cancer Up to 50 % of women receiving aromatase inhibitor ( AI ) complain of AI-associated musculoskeletal symptoms ( AIMS S ) and 15 % discontinue treatment . We conducted a r and omized , sham-controlled trial to evaluate whether acupuncture improves AIMS S and to explore potential mechanisms . Postmenopausal women with early stage breast cancer , experiencing AIMS S were r and omized to eight weekly real or sham acupuncture sessions . We evaluated changes in the Health Assessment Question naire Disability Index ( HAQ-DI ) and pain visual analog scale ( VAS ) following the intervention compared to baseline . Serum estradiol , β-endorphin , and proinflammatory cytokine concentrations were measured pre and post-intervention . We enrolled 51 women of whom 47 were evaluable , including 23 r and omized to real and 24 to sham acupuncture . Baseline characteristics were balanced between groups with the exception of a higher HAQ-DI score in the real acupuncture group ( p = 0.047 ) . We did not observe a statistically significant difference in reduction of HAQ-DI ( p = 0.30 ) or VAS ( p = 0.31 ) between the two groups . Following eight weekly treatments , we observed a statistically significant reduction of IL-17 ( p ≤ 0.009 ) in both groups . No significant modulation was seen in estradiol , β-endorphin , or other proinflammatory cytokine concentrations in either group . We did not observe a significant difference in AIMS S changes between real and sham acupuncture . As sham acupuncture used in this study may not be equivalent to placebo , further studies with a non-acupuncture arm may be required to establish whether acupuncture is beneficial for the treatment of AIMS Background Aromatase inhibitors ( AIs ) are recommended as adjuvant hormone treatment for postmenopausal women with early breast cancer . A substantial proportion of women taking AIs experience joint pain and stiffness . Studies have suggested that acupuncture may be effective in treating joint pain . Objective A pilot study was conducted to evaluate the feasibility , safety and efficacy of using acupuncture to treat AI-induced arthralgia . Methods A total of 32 patients were r and omised to receive either sham or real electroacupuncture ( EA ) twice weekly for 6 weeks . Outcomes of joint pain , stiffness and physical function were measured with the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , overall pain severity and interference with the BPI-SF and quality of life ( QOL ) with the Functional Assessment of Cancer Therapy-General ( FACT-G ) instrument . H and strength was assessed by a grip test , and a serum marker of inflammation ( C reactive protein ( CRP ) ) was also measured . All assessment s were performed at baseline , 6 weeks and 12 weeks , except for blood sample s at baseline and 6 weeks only . Results No serious adverse events were reported during or after acupuncture treatments . There were no significant differences in outcome measures . However , positive trends were observed in stiffness and physical function at week 12 in favour of real EA . Conclusions Findings suggest that acupuncture is feasible and safe in patients with breast cancer with joint pain caused by AI . A larger study with adequately powered to confirm these results and detect clinical ly relevant effects is needed Objective To determine the feasibility and acceptability of acupuncture in managing fatigue and well-being in breast cancer survivors . Methods A r and omised controlled trial compared acupuncture was with sham acupuncture and wait list controls was performed in Sydney , Australia . A total of 30 women with fatigue following breast cancer treatment participated in the trial . Women received six sessions of acupuncture over 8 weeks . Outcomes related to an assessment of interest to participate in the trial and identification of appropriate recruitment strategies , appropriateness of eligibility criteria and compliance with treatment attendance . Clinical outcomes assessed fatigue and well-being . In-depth interviews were undertaken with seven women , who described their experience of acupuncture . Results Our study demonstrated feasibility with appropriate trial entry criteria , good acceptability and treatment compliance with the study interventions , and with the completion of outcome forms . There was a significant reduction in fatigue for women receiving acupuncture compared with control after 2 weeks mean difference ( MD ) 5.3 , 95 % CI 4.5 to 6.2 , p=0.05 , and a significant improvement in well-being at 6 weeks for acupuncture compared with the sham and wait list control , MD 2.7 , 95 % CI 2.1 to 3.2 , p=0.006 . Women described their experience of acupuncture positively , and interview data may also offer explanations for the improved outcomes of well-being , with women reporting an improvement in sleep , mood and relaxation . Conclusions Fatigue is a common symptom experienced by people recovering from treatment , and an appropriately powered trial to evaluate the effect of acupuncture is needed . Clinical Trial Registration Australian New Zeal and Clinical Trials Registry , www.anzctr.org.au ACTRN12610000720011 OBJECTIVES The aim of the present study was to examine the effect of massage on nausea , anxiety , and depression in patients with breast cancer undergoing chemotherapy . DESIGN This work was a single-center , prospect i ve , r and omized , controlled trial . SETTING S/LOCATION This study was conducted in an oncology clinic , in a hospital in southwestern Sweden . SUBJECTS Thirty-nine ( 39 ) women ( mean age = 51.8 ) with breast cancer undergoing chemotherapy were enrolled . INTERVENTIONS The patients were r and omly assigned to a massage therapy group ( 20 minutes of massage on five occasions ) or a control group ( five 20-minute visits ) . OUTCOME MEASURES All patients recorded nausea and anxiety on the Visual Analogue Scale before and after each intervention . They also completed the Hospital Anxiety and Depression Scale . RESULTS Massage treatment significantly reduced nausea compared with control treatment ( p = 0.025 ) when improvement was measured as a percentage of the five treatment periods . Differences in anxiety and depression between the two treatment regimes could not be statistically demonstrated . CONCLUSIONS This study complements previous studies on the effect of massage and supports the conclusion that massage reduces nausea in these patients Background Cancer-related fatigue ( CRF ) is a prominent clinical problem . There are calls for multi-modal interventions . Methods We assessed the feasibility of delivering patient education integrated with acupuncture for relief of CRF in a pilot r and omized controlled trial ( RCT ) with breast cancer survivors using usual care as control . Social cognitive and integrative medicine theories guided integration of patient education with acupuncture into a coherent treatment protocol . The intervention consisted of two parts . First , patients were taught to improve self-care by optimizing exercise routines , improving nutrition , implementing some additional evidence -based cognitive behavioral techniques such as stress management in four weekly 50-minute sessions . Second , patients received eight weekly 50-minute acupuncture sessions . The pre-specified primary outcome , CRF , was assessed with the Brief Fatigue Inventory ( BFI ) . Secondary outcomes included three dimensions of cognitive impairment assessed with the FACT-COGv2 . Results Due to difficulties in recruitment , we tried several methods that led to the development of a tailored recruitment strategy : we enlisted oncologists into the core research team and recruited patients completing treatment from oncology waiting rooms . Compared to usual care control , the intervention was associated with a 2.38-point decline in fatigue as measured by the BFI ( 90 % Confidence Interval from 0.586 to 5.014 ; p < 0.10 ) . Outcomes associated with cognitive dysfunction were not statistically significant . Conclusions Patient education integrated with acupuncture had a very promising effect that warrants conducting a larger RCT to confirm findings . An effective recruitment strategy will be essential for the successful execution of a larger-scale trial . Trial registration Background : Breast cancer patients frequently experience psychological distress during the chemotherapy period . Objectives : This study aim ed to evaluate the effect of relaxation with guided imagery on patients with breast cancer . Patients and Methods : A two-group , pretest-posttest , quasi-experimental design with a r and omized controlled trial was conducted . Sixty-five breast cancer patients from one medical center in Taiwan were enrolled in the study . These patients were r and omly assigned to the experimental group ( n = 32 ) or to the control group ( n = 33 ) . Both groups received chemotherapy self-care education , but the experimental group also received relaxation with guided imagery training . The training on relaxation with guided imagery was conducted before chemotherapy , and the patients were supplied with a compact disc detailing the performance of relaxation with guided imagery for 20 minutes daily at home for 7 days after chemotherapy . Results : The experimental group showed significant decreases in insomnia ( -0.34 ± 0.83 , P < 0.05 ) , pain ( -0.28  
    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: Women diagnosed with breast cancer received massage therapy or practice d progressive muscle relaxation ( PMR ) for 30-min sessions 3 times a week for 5 weeks or received st and ard treatment . The massage therapy and relaxation groups reported less depressed mood , anxiety , and pain immediately after their first and last sessions . By the end of the study , however , only the massage therapy group reported being less depressed and less angry and having more vigor . Dopamine levels , Natural Killer cells , and lymphocytes also increased from the first to the last day of the study for the massage therapy group . These findings highlight the benefit of these complementary therapies , most particularly massage therapy , for women with breast cancer BACKGROUND Arthralgia is a common and debilitating side-effect experienced by breast cancer patients receiving aromatase inhibitors ( AIs ) and often results in premature drug discontinuation . METHODS We conducted a r and omised controlled trial of electro-acupuncture ( EA ) as compared to waitlist control ( WLC ) and sham acupuncture ( SA ) in postmenopausal women with breast cancer who self-reported arthralgia attributable to AIs . Acupuncturists performed 10 EA/SA treatments over 8 weeks using a manualised protocol with 2 Hz electro-stimulation delivered by a TENS unit . Acupuncturists administered SA using Streitberger ( non-penetrating ) needles at non-traditional acupuncture points without electro-stimulation . The primary end-point was pain severity by Brief Pain Inventory ( BPI ) between EA and WLC at Week 8 ; durability of response at Week 12 and comparison of EA to SA were secondary aims . FINDINGS Of the 67 r and omly assigned patients , mean reduction in pain severity was greater in the EA group than in the WLC group at Week 8 ( -2.2 versus -0.2 , p=0.0004 ) and at Week 12 ( -2.4 versus -0.2 , p<0.0001 ) . Pain-related interference measured by BPI also improved in the EA group compared to the WLC group at both Week 8 ( -2.0 versus 0.2 , p=0.0006 ) and Week 12 ( -2.1 versus -0.1 , p=0.0034 ) . SA produced a magnitude of change in pain severity and pain-related interference at Week 8 ( -2.3 , -1.5 respectively ) and Week 12 ( -1.7 , -1.3 respectively ) similar to that of EA . Participants in both EA and SA groups reported few minor adverse events . INTERPRETATIONS Compared to usual care , EA produced clinical ly important and durable improvement in arthralgia related to AIs in breast cancer patients , and SA had a similar effect . Both EA and SA were safe Background Use of complementary and alternative medicine ( CAM ) by women with breast cancer is often said to be increasing , yet few data exist to confirm this commonly held belief . The purpose of this paper is to compare overall patterns of CAM use , as well as use of specific products and therapies at two different points in time ( 1998 vs 2005 ) by women diagnosed with breast cancer . Methods Surveys were mailed to women r and omly selected from the Ontario Cancer Registry ( Canada ) in the spring of 1998 ( n = 557 ) and again in the spring of 2005(n = 877 ) . Results The response rates were 76.3 % in 1998 and 63 % in 2005 . In 1998 , 66.7 % of women reported using either a  CAM product/therapy or seeing a CAM therapist at some time in their lives as compared with 81.9 % in 2005 ( p = 0.0002 ) . Increases were seen in both use of CAM products/therapies ( 62 % in 1998 vs. 70.6 % in 2005 ) and visits to CAM practitioners ( 39.4 % of respondents in 1998 vs 57.4 % of respondents in 2005 ) . Women in 2005 reported that 41 % used  CAM  for treating their breast cancer . The most commonly used products and practitioners for treating breast cancer as reported in 2005 were green tea , vitamin E , flaxseed , vitamin C , massage therapists and dietitians/nutritionists . Conclusion  CAM use ( both self-medication with products and visits to CAM practitioners ) increased significantly from 1998 to 2005 . Now that more than 80 % of all women with breast cancer report using CAM ( 41 % in a specific attempt to management their breast cancer ) , CAM use can no longer be regarded as an " alternative " or unusual approach to managing breast cancer Up to 50 % of women receiving aromatase inhibitor ( AI ) complain of AI-associated musculoskeletal symptoms ( AIMS S ) and 15 % discontinue treatment . We conducted a r and omized , sham-controlled trial to evaluate whether acupuncture improves AIMS S and to explore potential mechanisms . Postmenopausal women with early stage breast cancer , experiencing AIMS S were r and omized to eight weekly real or sham acupuncture sessions . We evaluated changes in the Health Assessment Question naire Disability Index ( HAQ-DI ) and pain visual analog scale ( VAS ) following the intervention compared to baseline . Serum estradiol , β-endorphin , and proinflammatory cytokine concentrations were measured pre and post-intervention . We enrolled 51 women of whom 47 were evaluable , including 23 r and omized to real and 24 to sham acupuncture . Baseline characteristics were balanced between groups with the exception of a higher HAQ-DI score in the real acupuncture group ( p = 0.047 ) . We did not observe a statistically significant difference in reduction of HAQ-DI ( p = 0.30 ) or VAS ( p = 0.31 ) between the two groups . Following eight weekly treatments , we observed a statistically significant reduction of IL-17 ( p ≤ 0.009 ) in both groups . No significant modulation was seen in estradiol , β-endorphin , or other proinflammatory cytokine concentrations in either group . We did not observe a significant difference in AIMS S changes between real and sham acupuncture . As sham acupuncture used in this study may not be equivalent to placebo , further studies with a non-acupuncture arm may be required to establish whether acupuncture is beneficial for the treatment of AIMS Background Aromatase inhibitors ( AIs ) are recommended as adjuvant hormone treatment for postmenopausal women with early breast cancer . A substantial proportion of women taking AIs experience joint pain and stiffness . Studies have suggested that acupuncture may be effective in treating joint pain . Objective A pilot study was conducted to evaluate the feasibility , safety and efficacy of using acupuncture to treat AI-induced arthralgia . Methods A total of 32 patients were r and omised to receive either sham or real electroacupuncture ( EA ) twice weekly for 6 weeks . Outcomes of joint pain , stiffness and physical function were measured with the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , overall pain severity and interference with the BPI-SF and quality of life ( QOL ) with the Functional Assessment of Cancer Therapy-General ( FACT-G ) instrument . H and strength was assessed by a grip test , and a serum marker of inflammation ( C reactive protein ( CRP ) ) was also measured . All assessment s were performed at baseline , 6 weeks and 12 weeks , except for blood sample s at baseline and 6 weeks only . Results No serious adverse events were reported during or after acupuncture treatments . There were no significant differences in outcome measures . However , positive trends were observed in stiffness and physical function at week 12 in favour of real EA . Conclusions Findings suggest that acupuncture is feasible and safe in patients with breast cancer with joint pain caused by AI . A larger study with adequately powered to confirm these results and detect clinical ly relevant effects is needed Objective To determine the feasibility and acceptability of acupuncture in managing fatigue and well-being in breast cancer survivors . Methods A r and omised controlled trial compared acupuncture was with sham acupuncture and wait list controls was performed in Sydney , Australia . A total of 30 women with fatigue following breast cancer treatment participated in the trial . Women received six sessions of acupuncture over 8 weeks . Outcomes related to an assessment of interest to participate in the trial and identification of appropriate recruitment strategies , appropriateness of eligibility criteria and compliance with treatment attendance . Clinical outcomes assessed fatigue and well-being . In-depth interviews were undertaken with seven women , who described their experience of acupuncture . Results Our study demonstrated feasibility with appropriate trial entry criteria , good acceptability and treatment compliance with the study interventions , and with the completion of outcome forms . There was a significant reduction in fatigue for women receiving acupuncture compared with control after 2 weeks mean difference ( MD ) 5.3 , 95 % CI 4.5 to 6.2 , p=0.05 , and a significant improvement in well-being at 6 weeks for acupuncture compared with the sham and wait list control , MD 2.7 , 95 % CI 2.1 to 3.2 , p=0.006 . Women described their experience of acupuncture positively , and interview data may also offer explanations for the improved outcomes of well-being , with women reporting an improvement in sleep , mood and relaxation . Conclusions Fatigue is a common symptom experienced by people recovering from treatment , and an appropriately powered trial to evaluate the effect of acupuncture is needed . Clinical Trial Registration Australian New Zeal and Clinical Trials Registry , www.anzctr.org.au ACTRN12610000720011 OBJECTIVES The aim of the present study was to examine the effect of massage on nausea , anxiety , and depression in patients with breast cancer undergoing chemotherapy . DESIGN This work was a single-center , prospect i ve , r and omized , controlled trial . SETTING S/LOCATION This study was conducted in an oncology clinic , in a hospital in southwestern Sweden . SUBJECTS Thirty-nine ( 39 ) women ( mean age = 51.8 ) with breast cancer undergoing chemotherapy were enrolled . INTERVENTIONS The patients were r and omly assigned to a massage therapy group ( 20 minutes of massage on five occasions ) or a control group ( five 20-minute visits ) . OUTCOME MEASURES All patients recorded nausea and anxiety on the Visual Analogue Scale before and after each intervention . They also completed the Hospital Anxiety and Depression Scale . RESULTS Massage treatment significantly reduced nausea compared with control treatment ( p = 0.025 ) when improvement was measured as a percentage of the five treatment periods . Differences in anxiety and depression between the two treatment regimes could not be statistically demonstrated . CONCLUSIONS This study complements previous studies on the effect of massage and supports the conclusion that massage reduces nausea in these patients Background Cancer-related fatigue ( CRF ) is a prominent clinical problem . There are calls for multi-modal interventions . Methods We assessed the feasibility of delivering patient education integrated with acupuncture for relief of CRF in a pilot r and omized controlled trial ( RCT ) with breast cancer survivors using usual care as control . Social cognitive and integrative medicine theories guided integration of patient education with acupuncture into a coherent treatment protocol . The intervention consisted of two parts . First , patients were taught to improve self-care by optimizing exercise routines , improving nutrition , implementing some additional evidence -based cognitive behavioral techniques such as stress management in four weekly 50-minute sessions . Second , patients received eight weekly 50-minute acupuncture sessions . The pre-specified primary outcome , CRF , was assessed with the Brief Fatigue Inventory ( BFI ) . Secondary outcomes included three dimensions of cognitive impairment assessed with the FACT-COGv2 . Results Due to difficulties in recruitment , we tried several methods that led to the development of a tailored recruitment strategy : we enlisted oncologists into the core research team and recruited patients completing treatment from oncology waiting rooms . Compared to usual care control , the intervention was associated with a 2.38-point decline in fatigue as measured by the BFI ( 90 % Confidence Interval from 0.586 to 5.014 ; p < 0.10 ) . Outcomes associated with cognitive dysfunction were not statistically significant . Conclusions Patient education integrated with acupuncture had a very promising effect that warrants conducting a larger RCT to confirm findings . An effective recruitment strategy will be essential for the successful execution of a larger-scale trial . Trial registration Background : Breast cancer patients frequently experience psychological distress during the chemotherapy period . Objectives : This study aim ed to evaluate the effect of relaxation with guided imagery on patients with breast cancer . Patients and Methods : A two-group , pretest-posttest , quasi-experimental design with a r and omized controlled trial was conducted . Sixty-five breast cancer patients from one medical center in Taiwan were enrolled in the study . These patients were r and omly assigned to the experimental group ( n = 32 ) or to the control group ( n = 33 ) . Both groups received chemotherapy self-care education , but the experimental group also received relaxation with guided imagery training . The training on relaxation with guided imagery was conducted before chemotherapy , and the patients were supplied with a compact disc detailing the performance of relaxation with guided imagery for 20 minutes daily at home for 7 days after chemotherapy . Results : The experimental group showed significant decreases in insomnia ( -0.34 ± 0.83 , P < 0.05 ) , pain ( -0.28  
    Output:
    