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 Research suggests that patients with cancer , particularly in the palliative care setting , are increasingly using aromatherapy and massage . There is good evidence that these therapies may be helpful for anxiety reduction for short periods , but few studies have looked at the longer term effects . This study was design ed to compare the effects of four-week courses of aromatherapy massage and massage alone on physical and psychological symptoms in patients with advanced cancer . Forty-two patients were r and omly allocated to receive weekly massages with lavender essential oil and an inert carrier oil ( aromatherapy group ) , an inert carrier oil only ( massage group ) or no intervention . Outcome measures included a Visual Analogue Scale ( VAS ) of pain intensity , the Verran and Snyder-Halpern ( VSH ) sleep scale , the Hospital Anxiety and Depression ( HAD ) scale and the Rotterdam Symptom Checklist ( RSCL ) . We were unable to demonstrate any significant long-term benefits of aromatherapy or massage in terms of improving pain control , anxiety or quality of life . However , sleep scores improved significantly in both the massage and the combined massage ( aromatherapy and massage ) groups . There were also statistically significant reductions in depression scores in the massage group . In this study of patients with advanced cancer , the addition of lavender essential oil did not appear to increase the beneficial effects of massage . Our results do suggest , however , that patients with high levels of psychological distress  respond best to these therapies OBJECTIVES To develop and test the feasibility and acceptability of a structured design for a massage therapy clinical trial that included a treatment arm design ed to control for the non-specific effects of a massage therapy intervention . DESIGN Pilot r and omized controlled clinical trial . SETTING University-integrated medicine research clinic . INTERVENTIONS Participants were r and omized to a structured Swedish-style massage therapy intervention , a light-touch bodywork control intervention , or usual medical care .  Details of the interventions are provided . MAIN OUTCOME MEASURES The primary outcome measures were the adherence of the participants to the study protocol and the perception of the intervention experience . RESULTS Forty-four participants were r and omized . Participants often found adherence to the twice-weekly outpatient bodywork interventions to be somewhat difficult ; while , overall , 84 % of participants completed the study , only 76 % of those in an intervention arm successfully completed the trial . Participants r and omized to the massage arm expressed uniformly positive attitudes both before and after the intervention . While some participants r and omized to the light-touch bodywork arm initially expressed some reservations about their r and omization assignment , all participants available for interview were pleased with their experience after the intervention period . CONCLUSIONS The proposed design was found to be relatively straightforward to implement and acceptable to participants . Early disappointment with not receiving massage therapy expressed by the light-touch intervention participants dissipated quickly . Twice-weekly outpatient intervention appointments were found to be highly burdensome for many patients actively undergoing chemotherapy , thus reducing adherence 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 Evaluating the effectiveness of nursing interventions in decreasing pain is a top priority for clinical research . Unfortunately , most of the research on cancer pain relief has been limited to treatment studies involving the administration of analgesics . Research is needed to determine which nonanalgesic methods of pain control are effective and under what conditions . Consequently , an experimental study was design ed to test the effectiveness of massage as an intervention for cancer pain . Twenty-eight patients were r and omly assigned to a  massage or control group .  The patients in the massage group were given a 10 minute massage to the back ; the patients in the control group were visited for 10 minutes . For males , there was a significant decrease in pain level immediately after the massage . For females , there was not a significant decrease in pain level immediately after the massage . There were no significant differences between pain 1 hour and 2 hours after the massage in comparison with the initial pain for males or females . Massage was shown to be an effective short-term nursing intervention for pain in males in this sample Complementary therapies are increasingly used to reduce side effects of cancer treatment , without evidence for their effectiveness . In a r and omized , prospect i ve , 2-period , crossover intervention study , the authors tested the effects of therapeutic massage ( MT ) and healing touch ( HT ) , in comparison to presence alone or st and ard care , in inducing relaxation and reducing symptoms in 230 subjects . MT and HT lowered blood pressure , respiratory rate ( RR ) , and heart rate ( HR ) . MT lowered anxiety and HT lowered fatigue , and both lowered totalmooddisturbance . Pain ratings were lower after MT and HT , with 4-week nonsteroidal antiinflammatory drug use less during MT . There were no effects on nausea . Presence reduced RR and HR but did not differ from st and ard care on any measure of pain , nausea , mood states , anxiety , or fatigue . MT and HT are more effective than presence alone or st and ard care in reducing pain , mood disturbance , and fatigue in patients receiving cancer chemotherapy OBJECTIVES Women with breast cancer are at risk for elevated depression , anxiety , and decreased natural killer ( NK ) cell number . Stress has been linked to increased tumor development by decreasing NK cell activity . The objectives of this study included examining massage therapy for women with breast cancer for ( 1 ) improving mood and biological measures associated with mood enhancement ( serotonin , dopamine ) , ( 2 ) reducing stress and stress hormone levels , and ( 3 ) boosting immune measures . METHODS Thirty-four women ( M age=53 ) diagnosed with Stage 1 or 2 breast cancer were r and omly assigned postsurgery to a massage therapy group ( to receive 30-min massages three times per week for 5 weeks ) or a control group . The massage consisted of stroking , squeezing , and stretching techniques to the head , arms , legs/feet , and back . On the first and last day of the study , the women were assessed on ( 1 ) immediate effects measures of anxiety , depressed mood , and vigor and ( 2 ) longer term effects on depression , anxiety and hostility , functioning , body image , and avoidant versus intrusive coping style , in addition to urinary catecholamines ( norepinephrine , epinephrine , and dopamine ) and serotonin levels . A subset of 27 women ( n=15 massage ) had blood drawn to assay immune measures . RESULTS The immediate massage therapy effects included reduced anxiety , depressed mood , and anger . The longer term massage effects included reduced depression and hostility and increased urinary dopamine , serotonin values , NK cell number , and lymphocytes . CONCLUSIONS Women with Stage 1 and 2 breast cancer may benefit from thrice-weekly massage therapy for reducing depressed mood , anxiety , and anger and for enhancing dopamine , serotonin , and NK cell number and lymphocytes Massage is increasingly applied to relieve symptoms in patients with cancer . This practice is supported by evidence from small r and omized trials . No study has examined massage therapy outcome in a large group of patients . At Memorial Sloan-Kettering Cancer Center , patients report symptom severity pre- and post-massage therapy using 0 - 10 rating scales of pain , fatigue , stress/anxiety , nausea , depression and " other . " Changes in symptom scores and the modifying effects of patient status ( in- or outpatient ) and type of massage were analyzed . Over a three-year period , 1,290 patients were treated .  Symptom scores were reduced by approximately 50 % , even for patients reporting high baseline scores . Out patients improved about 10 % more than in patients . Benefits persisted , with out patients experiencing no return toward baseline scores throughout the duration of 48-hour follow-up . These data indicate that massage therapy is associated with substantive improvement in cancer patients ' symptom scores To investigate changes in regional cerebral blood flow ( rCBF ) under the prone condition with and without light massage on the back , we measured rCBF quantitatively in healthy human subjects using positron emission tomography with H(2)15O . Biochemical tests showed that the light massage ( palm-pressure ) reduced levels of stress-related serum cortisol and salivary stress protein chromogranin-A measured after the PET examination . Absolute rCBF significantly increased in the parietal cortex ( precuneus ) under the prone condition compared with the supine condition , and this rCBF increase was in parallel with comfortable sensation and slowing heart rate during the massage . Correlation analysis in statistical parametric mapping showed that the amygdalar and basal forebrain rCBF correlated with parasympathetic function ( heart rate reduction ) , indicating involvement of the forebrain-amygdala system in mediating activities in the autonomic nervous system in the presence of comfortable sensation . To conclude , prone posture itself can stimulate the precuneus region to raise awareness , and the light massage on the back may help accommo date the brain to comfortable stimulation Context Some patients nearing death seek pain relief with massage , but little is known about the effectiveness of massage in managing pain in palliative care setting s. Contribution In this r and omized trial in 380 patients with advanced cancer , improvement in  pain and mood immediately after treatment was greater with massage than with simple touch . Unfortunately , there were no sustained differences in pain , quality of life , or analgesic use during 3 weeks . Adverse effects were infrequent and similar in both groups . Implication Massage may offer some immediate relief for patients with advanced cancer , but the absence of sustained effects demonstrates the need for more effective strategies to manage pain at the end of life . The Editors Symptom relief is central to end-of-life care ; however , many terminally ill individuals experience serious pain and other physical and emotional symptoms ( 14 ) . Studies examining the efficacy of therapies that may mediate these symptoms deserve the highest priority . The Institute of Medicine and the National Institutes of Health recommend research directed at improving end-of-life care ( 5 , 6 ) . Pain associated with advanced cancer can cause physical and emotional distress , leading to decreased functional ability and quality of life . Massage may interrupt the cycle of distress through the therapist 's intention ( presence , communication , and desire to produce a therapeutic response ) , induction of a relaxation response , increased blood and lymphatic circulation , potentiation of analgesic effects , decreased inflammation and edema , manual release of muscle spasms , increased endogenous endorphin release , and competing sensory stimuli that override pain signals ( 711 ) . Despite theoretical bases supporting the use and growing acceptance of massage therapy , few r and omized clinical trials have assessed its efficacy . Large trials have been difficult to design and carry out ; challenges include frailty of patients with late-stage cancer and reluctance of health care providers to refer patients because of the possibility of r and omization to nonmassage therapy control ( 12 ) . Therapeutic massage can reduce pain and improve symptom distress and quality of life for patients with cancer at the end of life . The purpose of the REST ( Reducing End-of-Life Symptoms with Touch ) study was to evaluate the efficacy of massage compared with an exposure controlling for time , attention , and touch . We hypothesized that massage would decrease pain and explored effects on quality of life , physical and emotional symptom distress , and analgesic medicine use . Methods Design Overview We conducted this prospect i ve , 2-group , r and omized , single-blind trial between November 2003 and October 2006 . After we evaluated patients for inclusion and exclusion criteria , patients provided written informed consent . Then we r and omly assigned patients to a treatment group ( massage ) or control exposure ( simple touch ) . Figure 1 depicts the timing of the study procedures for a hypothetical participant . We collected individual characteristics , disease , pain characteristics , symptom distress , quality of life , functional status ( Karnofsky Performance Scale score ) ( 13 ) , expected helpfulness of massage for pain , and concurrent interventions ( pharmacologic and nonpharmacologic ) at baseline ( within 72 hours of study enrollment ) and at 3 subsequent weekly visits over the 3 to 4 weeks of participation 
    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 Research suggests that patients with cancer , particularly in the palliative care setting , are increasingly using aromatherapy and massage . There is good evidence that these therapies may be helpful for anxiety reduction for short periods , but few studies have looked at the longer term effects . This study was design ed to compare the effects of four-week courses of aromatherapy massage and massage alone on physical and psychological symptoms in patients with advanced cancer . Forty-two patients were r and omly allocated to receive weekly massages with lavender essential oil and an inert carrier oil ( aromatherapy group ) , an inert carrier oil only ( massage group ) or no intervention . Outcome measures included a Visual Analogue Scale ( VAS ) of pain intensity , the Verran and Snyder-Halpern ( VSH ) sleep scale , the Hospital Anxiety and Depression ( HAD ) scale and the Rotterdam Symptom Checklist ( RSCL ) . We were unable to demonstrate any significant long-term benefits of aromatherapy or massage in terms of improving pain control , anxiety or quality of life . However , sleep scores improved significantly in both the massage and the combined massage ( aromatherapy and massage ) groups . There were also statistically significant reductions in depression scores in the massage group . In this study of patients with advanced cancer , the addition of lavender essential oil did not appear to increase the beneficial effects of massage . Our results do suggest , however , that patients with high levels of psychological distress  respond best to these therapies OBJECTIVES To develop and test the feasibility and acceptability of a structured design for a massage therapy clinical trial that included a treatment arm design ed to control for the non-specific effects of a massage therapy intervention . DESIGN Pilot r and omized controlled clinical trial . SETTING University-integrated medicine research clinic . INTERVENTIONS Participants were r and omized to a structured Swedish-style massage therapy intervention , a light-touch bodywork control intervention , or usual medical care .  Details of the interventions are provided . MAIN OUTCOME MEASURES The primary outcome measures were the adherence of the participants to the study protocol and the perception of the intervention experience . RESULTS Forty-four participants were r and omized . Participants often found adherence to the twice-weekly outpatient bodywork interventions to be somewhat difficult ; while , overall , 84 % of participants completed the study , only 76 % of those in an intervention arm successfully completed the trial . Participants r and omized to the massage arm expressed uniformly positive attitudes both before and after the intervention . While some participants r and omized to the light-touch bodywork arm initially expressed some reservations about their r and omization assignment , all participants available for interview were pleased with their experience after the intervention period . CONCLUSIONS The proposed design was found to be relatively straightforward to implement and acceptable to participants . Early disappointment with not receiving massage therapy expressed by the light-touch intervention participants dissipated quickly . Twice-weekly outpatient intervention appointments were found to be highly burdensome for many patients actively undergoing chemotherapy , thus reducing adherence 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 Evaluating the effectiveness of nursing interventions in decreasing pain is a top priority for clinical research . Unfortunately , most of the research on cancer pain relief has been limited to treatment studies involving the administration of analgesics . Research is needed to determine which nonanalgesic methods of pain control are effective and under what conditions . Consequently , an experimental study was design ed to test the effectiveness of massage as an intervention for cancer pain . Twenty-eight patients were r and omly assigned to a  massage or control group .  The patients in the massage group were given a 10 minute massage to the back ; the patients in the control group were visited for 10 minutes . For males , there was a significant decrease in pain level immediately after the massage . For females , there was not a significant decrease in pain level immediately after the massage . There were no significant differences between pain 1 hour and 2 hours after the massage in comparison with the initial pain for males or females . Massage was shown to be an effective short-term nursing intervention for pain in males in this sample Complementary therapies are increasingly used to reduce side effects of cancer treatment , without evidence for their effectiveness . In a r and omized , prospect i ve , 2-period , crossover intervention study , the authors tested the effects of therapeutic massage ( MT ) and healing touch ( HT ) , in comparison to presence alone or st and ard care , in inducing relaxation and reducing symptoms in 230 subjects . MT and HT lowered blood pressure , respiratory rate ( RR ) , and heart rate ( HR ) . MT lowered anxiety and HT lowered fatigue , and both lowered totalmooddisturbance . Pain ratings were lower after MT and HT , with 4-week nonsteroidal antiinflammatory drug use less during MT . There were no effects on nausea . Presence reduced RR and HR but did not differ from st and ard care on any measure of pain , nausea , mood states , anxiety , or fatigue . MT and HT are more effective than presence alone or st and ard care in reducing pain , mood disturbance , and fatigue in patients receiving cancer chemotherapy OBJECTIVES Women with breast cancer are at risk for elevated depression , anxiety , and decreased natural killer ( NK ) cell number . Stress has been linked to increased tumor development by decreasing NK cell activity . The objectives of this study included examining massage therapy for women with breast cancer for ( 1 ) improving mood and biological measures associated with mood enhancement ( serotonin , dopamine ) , ( 2 ) reducing stress and stress hormone levels , and ( 3 ) boosting immune measures . METHODS Thirty-four women ( M age=53 ) diagnosed with Stage 1 or 2 breast cancer were r and omly assigned postsurgery to a massage therapy group ( to receive 30-min massages three times per week for 5 weeks ) or a control group . The massage consisted of stroking , squeezing , and stretching techniques to the head , arms , legs/feet , and back . On the first and last day of the study , the women were assessed on ( 1 ) immediate effects measures of anxiety , depressed mood , and vigor and ( 2 ) longer term effects on depression , anxiety and hostility , functioning , body image , and avoidant versus intrusive coping style , in addition to urinary catecholamines ( norepinephrine , epinephrine , and dopamine ) and serotonin levels . A subset of 27 women ( n=15 massage ) had blood drawn to assay immune measures . RESULTS The immediate massage therapy effects included reduced anxiety , depressed mood , and anger . The longer term massage effects included reduced depression and hostility and increased urinary dopamine , serotonin values , NK cell number , and lymphocytes . CONCLUSIONS Women with Stage 1 and 2 breast cancer may benefit from thrice-weekly massage therapy for reducing depressed mood , anxiety , and anger and for enhancing dopamine , serotonin , and NK cell number and lymphocytes Massage is increasingly applied to relieve symptoms in patients with cancer . This practice is supported by evidence from small r and omized trials . No study has examined massage therapy outcome in a large group of patients . At Memorial Sloan-Kettering Cancer Center , patients report symptom severity pre- and post-massage therapy using 0 - 10 rating scales of pain , fatigue , stress/anxiety , nausea , depression and " other . " Changes in symptom scores and the modifying effects of patient status ( in- or outpatient ) and type of massage were analyzed . Over a three-year period , 1,290 patients were treated .  Symptom scores were reduced by approximately 50 % , even for patients reporting high baseline scores . Out patients improved about 10 % more than in patients . Benefits persisted , with out patients experiencing no return toward baseline scores throughout the duration of 48-hour follow-up . These data indicate that massage therapy is associated with substantive improvement in cancer patients ' symptom scores To investigate changes in regional cerebral blood flow ( rCBF ) under the prone condition with and without light massage on the back , we measured rCBF quantitatively in healthy human subjects using positron emission tomography with H(2)15O . Biochemical tests showed that the light massage ( palm-pressure ) reduced levels of stress-related serum cortisol and salivary stress protein chromogranin-A measured after the PET examination . Absolute rCBF significantly increased in the parietal cortex ( precuneus ) under the prone condition compared with the supine condition , and this rCBF increase was in parallel with comfortable sensation and slowing heart rate during the massage . Correlation analysis in statistical parametric mapping showed that the amygdalar and basal forebrain rCBF correlated with parasympathetic function ( heart rate reduction ) , indicating involvement of the forebrain-amygdala system in mediating activities in the autonomic nervous system in the presence of comfortable sensation . To conclude , prone posture itself can stimulate the precuneus region to raise awareness , and the light massage on the back may help accommo date the brain to comfortable stimulation Context Some patients nearing death seek pain relief with massage , but little is known about the effectiveness of massage in managing pain in palliative care setting s. Contribution In this r and omized trial in 380 patients with advanced cancer , improvement in  pain and mood immediately after treatment was greater with massage than with simple touch . Unfortunately , there were no sustained differences in pain , quality of life , or analgesic use during 3 weeks . Adverse effects were infrequent and similar in both groups . Implication Massage may offer some immediate relief for patients with advanced cancer , but the absence of sustained effects demonstrates the need for more effective strategies to manage pain at the end of life . The Editors Symptom relief is central to end-of-life care ; however , many terminally ill individuals experience serious pain and other physical and emotional symptoms ( 14 ) . Studies examining the efficacy of therapies that may mediate these symptoms deserve the highest priority . The Institute of Medicine and the National Institutes of Health recommend research directed at improving end-of-life care ( 5 , 6 ) . Pain associated with advanced cancer can cause physical and emotional distress , leading to decreased functional ability and quality of life . Massage may interrupt the cycle of distress through the therapist 's intention ( presence , communication , and desire to produce a therapeutic response ) , induction of a relaxation response , increased blood and lymphatic circulation , potentiation of analgesic effects , decreased inflammation and edema , manual release of muscle spasms , increased endogenous endorphin release , and competing sensory stimuli that override pain signals ( 711 ) . Despite theoretical bases supporting the use and growing acceptance of massage therapy , few r and omized clinical trials have assessed its efficacy . Large trials have been difficult to design and carry out ; challenges include frailty of patients with late-stage cancer and reluctance of health care providers to refer patients because of the possibility of r and omization to nonmassage therapy control ( 12 ) . Therapeutic massage can reduce pain and improve symptom distress and quality of life for patients with cancer at the end of life . The purpose of the REST ( Reducing End-of-Life Symptoms with Touch ) study was to evaluate the efficacy of massage compared with an exposure controlling for time , attention , and touch . We hypothesized that massage would decrease pain and explored effects on quality of life , physical and emotional symptom distress , and analgesic medicine use . Methods Design Overview We conducted this prospect i ve , 2-group , r and omized , single-blind trial between November 2003 and October 2006 . After we evaluated patients for inclusion and exclusion criteria , patients provided written informed consent . Then we r and omly assigned patients to a treatment group ( massage ) or control exposure ( simple touch ) . Figure 1 depicts the timing of the study procedures for a hypothetical participant . We collected individual characteristics , disease , pain characteristics , symptom distress , quality of life , functional status ( Karnofsky Performance Scale score ) ( 13 ) , expected helpfulness of massage for pain , and concurrent interventions ( pharmacologic and nonpharmacologic ) at baseline ( within 72 hours of study enrollment ) and at 3 subsequent weekly visits over the 3 to 4 weeks of participation 
    Output:
    