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: The efficacy of energy conservation and activity management ( ECAM ) for fatigue reduction and maintenance of functional performance has never been evaluated in adults with cancer who are undergoing treatment PURPOSE To determine the effects of breast cancer-specific print material s and step pedometers on  physical activity ( PA ) and quality of life ( QoL ) in breast cancer survivors . PATIENTS AND METHODS Breast cancer survivors ( N = 377 ) were r and omly assigned to receive one of the following : a st and ard public health recommendation for PA , previously developed breast cancer-specific PA print material s , a step pedometer , or a combination of breast cancer-specific print material s and step pedometers . The primary outcome was self-reported moderate/vigorous PA minutes per week . Secondary outcomes were QoL ( Functional Assessment of Cancer Therapy-Breast ) , fatigue , self-reported brisk walking , and objective step counts . Assessment s were conducted at baseline and postintervention ( 12 weeks ) . RESULTS Attrition was 10.3 % ( 39 of 377 ) . On the basis of linear mixed-model analyses , PA increased by 30 minutes/week in the st and ard recommendation group compared with 70 minutes/week in the print material group ( mean difference , 39 minutes/week ; 95 % CI = -10 to 89 ; d = 0.25 ; P = .117 ) , 89 minutes/week in the pedometer group ( mean difference , 59 minutes/week ; 95 % CI , 11 to 108 ; d = 0.38 ; P = .017 ) , and 87 minutes/week in the combined group ( mean difference , 57 minutes/week ; 95 % CI , 8 to 106 ; d = 0.37 ; P = .022 ) . For brisk walking minutes/week , all three intervention groups reported significantly greater increases than the st and ard recommendation group . The combined group also reported significantly improved QoL ( mean difference , 5.8 ; 95 % CI , 2.0 to 9.6 ; d = 0.33 ; P = .003 ) and reduced fatigue ( mean difference , 2.3 ; 95 % CI , 0.0 to 4.7 ; d = 0.25 ; P = .052 ) compared with the st and ard recommendation group . CONCLUSION Breast cancer-specific PA print material s and pedometers may be effective strategies for increasing PA and QoL in breast cancer survivors . A combined approach appears to be optimal . CLINICAL TRIAL REGISTRATION Clinical Trials.gov Identifier OBJECTIVE A r and omised controlled trial ( RCT ) demonstrated that cognitive behaviour therapy ( CBT ) for fatigue during curative cancer treatment was effective shortly after cancer treatment . This study aim ed to identify which patient characteristics predict fatigue improvement after CBT . In addition , the long-term effectiveness was investigated . METHODS Patients with various malignancies participated in the RCT ( n = 210 ) . Participants were assessed before cancer treatment ( T1 ) , postintervention ( T2 ) , which was at least 2 months after cancer treatment , and after 1-year follow-up ( T3 ) . Monthly fatigue assessment s were completed between T2 and T3 . A regression analysis with interactions was performed to determine if domains of quality of life ( EORTC-QLQ-C30 ) functioning ( Health Survey Short Form-36 ) or psychological distress ( Symptom Checklist-90 ) moderated the effect of CBT on fatigue . Analyses of covariance were used to study the long-term effectiveness of CBT . RESULTS Fatigue at T2 was predicted by a significant interaction between self-reported cognitive functioning and CBT . No interactions were found between other domains of quality of life , functioning , psychological distress and CBT .  At T3 , no significant difference on fatigue was found between CBT and usual care . Exploratory analyses showed that the difference nearly reached significance until 7 months postintervention . CONCLUSIONS Patients who experienced more concentration and memory problems at T1 benefited more from CBT for fatigue and are indicators . After a year of follow-up , the effect of CBT for fatigue was no longer observed , and the effect on fatigue seemed to be diminished 7 months postintervention . The implication is that CBT for fatigue should be offered to patients with cancer with the highest chance to benefit Objective The objective of this pilot study was to describe the effects of a 16-week home-based rehabilitative exercise program on cancer-related fatigue ( CRF ) , other symptoms , functional status , and quality of life ( QOL ) for patients with non-small cell lung cancer ( NSCLC ) after thoracotomy starting within days after hospital discharge and continuing through the initiation and completion of chemotherapy .  Material s and methods Five patients with NSCLC completed the Brief Fatigue Inventory ( measuring CRF severity ) and the MD And erson Symptom Inventory ( measuring symptom severity ) before and after thoractomy , and at the end of each week of the 16-week exercise program . Additionally , the Medical Outcomes Study Short Form-36 ( measuring physical and mental functional status ) and the Quality of Life Index ( measuring QOL ) were completed before and after thoracotomy , after weeks 3 , 6 , 12 , and 16 ( the end of the exercise program ) . Further , the 6-minute walk test  ( measuring functional capacity ) was administered before thoracotomy , prior to the initiation of chemotherapy and /or radiation therapy , and at the end of the 16-week exercise program , after completion of chemotherapy . Results Participants had a mean age of 63 years and a mean of five comorbid conditions ; the exercise program was initiated within 4 days after hospital discharge . Participants ’ CRF severity scores were reduced to mild levels , while the mean number of symptoms decreased from 9 postthoracotomy to 6 after the exercise program , with mean levels of severity and interference decreasing to below prethoracotomy levels . Likewise , participants ’ functional status and QOL after completing the exercise program improved to near or above prethoracotomy levels . Conclusion The home-based , light-intensity exercise program for NSCLC patients receiving and completing adjuvant chemotherapy postthoracotomy showed promising trends in improving CRF severity , other symptom severity , functional status , and QOL . Further testing via a two-arm r and omized controlled trial is being conducted An earlier r and omised-controlled trial demonstrated the positive effects of cognitive behaviour therapy ( CBT ) , especially design ed for fatigued cancer survivors in reducing fatigue , functional impairments and psychological distress . In the current prospect i ve study , we were able to examine the long-term effect of CBT in patients who completed the therapy . Predictors of fatigue severity at follow-up were exploratory investigated . Sixty-eight patients who completed CBT  were assessed at pretreatment , post-treatment and at follow-up ( mean follow-up 1.9 years ( s.d . 1.0 ) , range : 1–4 years ) . To analyse possible predictors of treatment outcome a linear regression ( enter ) was carried out . Improvements on fatigue severity , functional impairment and psychological distress after CBT appeared to remain stable during a follow-up period . Patients who were not fatigued anymore at follow-up were not different from a reference group of non-fatigued cancer survivors . The explorative regression analysis showed that fatigue severity , psychological distress and somatic attributions at pretreatment contributed to persistent fatigue severity at follow-up . Cognitive behaviour therapy , especially design ed for post-cancer fatigue , is successful in reducing fatigue and functional impairment in cancer survivors . Moreover , these positive effects were maintained at about 2 years after finishing CBT BACKGROUND Breast cancer surgery is associated with side effects , including postsurgical pain , nausea , and fatigue . We carried out a r and omized clinical trial to test the hypotheses that a brief presurgery hypnosis intervention would decrease intraoperative anesthesia and analgesic use and side effects associated with breast cancer surgery and that it would be cost effective . METHODS We r and omly assigned 200 patients who were scheduled to undergo excisional breast biopsy or lumpectomy ( mean age 48.5 years ) to a 15-minute presurgery hypnosis session conducted by a psychologist or nondirective empathic listening ( attention control ) . Patients were not blinded to group assignment . Intraoperative anesthesia use ( i.e. , of the analgesics lidocaine and fentanyl and the sedatives propofol and midazolam ) was assessed . Patient-reported pain and other side effects as measured on a visual analog scale ( 0 - 100 ) were assessed at discharge , as was use of analgesics in the recovery room . Institutional costs and time in the operating room were assessed via chart review . RESULTS Patients in the hypnosis group required less propofol ( means = 64.01 versus 96.64 microg ; difference = 32.63 ; 95 % confidence interval [ CI ] = 3.95 to 61.30 ) and lidocaine ( means = 24.23 versus 31.09 mL ; difference = 6.86 ; 95 % CI = 3.05 to 10.68 ) than patients in the control group . Patients in the hypnosis group also reported less pain intensity ( means = 22.43 versus 47.83 ; difference = 25.40 ; 95 % CI = 17.56 to 33.25 ) , pain unpleasantness ( means = 21.19 versus 39.05 ; difference = 17.86 ; 95 % CI = 9.92 to 25.80 ) , nausea ( means = 6.57 versus 25.49 ; difference = 18.92 ; 95 % CI = 12.98 to 24.87 ) , fatigue ( means = 29.47 versus 54.20 ; difference = 24.73 ; 95 % CI = 16.64 to 32.83 ) , discomfort ( means = 23.01 versus 43.20 ; difference = 20.19 ; 95 % CI = 12.36 to 28.02 ) , and emotional upset ( means = 8.67 versus 33.46 ; difference = 24.79 ; 95 % CI = 18.56 to 31.03 ) . No statistically significant differences were seen in the use of fentanyl , midazolam , or recovery room analgesics .  Institutional costs for surgical breast cancer procedures were $ 8561 per patient at Mount Sinai School of Medicine . Patients in the hypnosis group cost the institution $ 772.71 less per patient than those in the control group ( 95 % CI = 75.10 to 1469.89 ) , mainly due to reduced surgical time . CONCLUSIONS Hypnosis was superior to attention control regarding propofol and lidocaine use ; pain , nausea , fatigue , discomfort , and emotional upset at discharge ; and institutional cost . Overall , the present data support the use of hypnosis with breast cancer surgery patients PURPOSE To determine 1-year outcomes of a four-component behavioral therapy ( BT ) sleep intervention ( Individualized Sleep Promotion Plan [ ISPP ] ) versus a healthy eating control ( HEC ) on cancer-related fatigue in women receiving breast cancer adjuvant chemotherapy treatment ( CTX ) . PATIENTS AND METHODS A total of 219 participants from 12 oncology clinics were r and omly assigned in a clinical trial . Before CTX , research nurses coached intervention participants to develop a BT plan including stimulus control , modified sleep restriction , relaxation therapy , and sleep hygiene . BT plans were revised before each CTX and 30 , 60 , and 90 days after the last CTX and reinforced 7 to 9 days later . HEC participants received nutritional information and equal attention . Pittsburgh Sleep Quality Index ( PSQI ) , Daily Diary , Wrist Actigraph , and Piper Fatigue Scale measures and Repeated Linear Mixed Model analysis following the Intent to Treat paradigm were used . RESULTS Sleep quality differed over 1 years time ( F [ 4,162 ] = 7.7 , P < .001 ; by group , F [ 1,173 ] = 4.8 , P = .029 ; and over time by group , F [ 4,162 ] = 3.3 , P = .013 ) . Pairwise comparisons revealed significant differences between groups at 90 days ( P = .002 ) but not at 1 year ( P = .052 ) . Seven days of diary and actigraphy data did not corroborate with monthly reflections ( PSQI ) . The night awakenings ( Actigraph ) pattern was significantly different by group over time ( P = .046 ) , with no differences between groups at 90 days or at 1 year . Fatigue was lower at 1 year than before CTX ; no group effects were found . CONCLUSION The BT group , on average , experienced significant improvement on global sleep quality compared with the HEC group , but not on objective sleep or fatigue outcomes Cancer and its treatment can induce subjective and objective evidence of diminished functional capacity encompassing physical fatigue and cognitive impairment . Dexmethylpheni date ( D-MPH ; the D-isomer of methylpheni date ) was evaluated for treatment of chemotherapy-related fatigue and cognitive impairment . A r and omized , double-blind , placebo-controlled , parallel-group study evaluated the potential therapeutic effect and safety of D-MPH in the treatment of patients with chemotherapy-related fatigue . Change from baseline in the Functional Assessment of Chronic Illness Therapy-Fatigue Subscale 
    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: The efficacy of energy conservation and activity management ( ECAM ) for fatigue reduction and maintenance of functional performance has never been evaluated in adults with cancer who are undergoing treatment PURPOSE To determine the effects of breast cancer-specific print material s and step pedometers on  physical activity ( PA ) and quality of life ( QoL ) in breast cancer survivors . PATIENTS AND METHODS Breast cancer survivors ( N = 377 ) were r and omly assigned to receive one of the following : a st and ard public health recommendation for PA , previously developed breast cancer-specific PA print material s , a step pedometer , or a combination of breast cancer-specific print material s and step pedometers . The primary outcome was self-reported moderate/vigorous PA minutes per week . Secondary outcomes were QoL ( Functional Assessment of Cancer Therapy-Breast ) , fatigue , self-reported brisk walking , and objective step counts . Assessment s were conducted at baseline and postintervention ( 12 weeks ) . RESULTS Attrition was 10.3 % ( 39 of 377 ) . On the basis of linear mixed-model analyses , PA increased by 30 minutes/week in the st and ard recommendation group compared with 70 minutes/week in the print material group ( mean difference , 39 minutes/week ; 95 % CI = -10 to 89 ; d = 0.25 ; P = .117 ) , 89 minutes/week in the pedometer group ( mean difference , 59 minutes/week ; 95 % CI , 11 to 108 ; d = 0.38 ; P = .017 ) , and 87 minutes/week in the combined group ( mean difference , 57 minutes/week ; 95 % CI , 8 to 106 ; d = 0.37 ; P = .022 ) . For brisk walking minutes/week , all three intervention groups reported significantly greater increases than the st and ard recommendation group . The combined group also reported significantly improved QoL ( mean difference , 5.8 ; 95 % CI , 2.0 to 9.6 ; d = 0.33 ; P = .003 ) and reduced fatigue ( mean difference , 2.3 ; 95 % CI , 0.0 to 4.7 ; d = 0.25 ; P = .052 ) compared with the st and ard recommendation group . CONCLUSION Breast cancer-specific PA print material s and pedometers may be effective strategies for increasing PA and QoL in breast cancer survivors . A combined approach appears to be optimal . CLINICAL TRIAL REGISTRATION Clinical Trials.gov Identifier OBJECTIVE A r and omised controlled trial ( RCT ) demonstrated that cognitive behaviour therapy ( CBT ) for fatigue during curative cancer treatment was effective shortly after cancer treatment . This study aim ed to identify which patient characteristics predict fatigue improvement after CBT . In addition , the long-term effectiveness was investigated . METHODS Patients with various malignancies participated in the RCT ( n = 210 ) . Participants were assessed before cancer treatment ( T1 ) , postintervention ( T2 ) , which was at least 2 months after cancer treatment , and after 1-year follow-up ( T3 ) . Monthly fatigue assessment s were completed between T2 and T3 . A regression analysis with interactions was performed to determine if domains of quality of life ( EORTC-QLQ-C30 ) functioning ( Health Survey Short Form-36 ) or psychological distress ( Symptom Checklist-90 ) moderated the effect of CBT on fatigue . Analyses of covariance were used to study the long-term effectiveness of CBT . RESULTS Fatigue at T2 was predicted by a significant interaction between self-reported cognitive functioning and CBT . No interactions were found between other domains of quality of life , functioning , psychological distress and CBT .  At T3 , no significant difference on fatigue was found between CBT and usual care . Exploratory analyses showed that the difference nearly reached significance until 7 months postintervention . CONCLUSIONS Patients who experienced more concentration and memory problems at T1 benefited more from CBT for fatigue and are indicators . After a year of follow-up , the effect of CBT for fatigue was no longer observed , and the effect on fatigue seemed to be diminished 7 months postintervention . The implication is that CBT for fatigue should be offered to patients with cancer with the highest chance to benefit Objective The objective of this pilot study was to describe the effects of a 16-week home-based rehabilitative exercise program on cancer-related fatigue ( CRF ) , other symptoms , functional status , and quality of life ( QOL ) for patients with non-small cell lung cancer ( NSCLC ) after thoracotomy starting within days after hospital discharge and continuing through the initiation and completion of chemotherapy .  Material s and methods Five patients with NSCLC completed the Brief Fatigue Inventory ( measuring CRF severity ) and the MD And erson Symptom Inventory ( measuring symptom severity ) before and after thoractomy , and at the end of each week of the 16-week exercise program . Additionally , the Medical Outcomes Study Short Form-36 ( measuring physical and mental functional status ) and the Quality of Life Index ( measuring QOL ) were completed before and after thoracotomy , after weeks 3 , 6 , 12 , and 16 ( the end of the exercise program ) . Further , the 6-minute walk test  ( measuring functional capacity ) was administered before thoracotomy , prior to the initiation of chemotherapy and /or radiation therapy , and at the end of the 16-week exercise program , after completion of chemotherapy . Results Participants had a mean age of 63 years and a mean of five comorbid conditions ; the exercise program was initiated within 4 days after hospital discharge . Participants ’ CRF severity scores were reduced to mild levels , while the mean number of symptoms decreased from 9 postthoracotomy to 6 after the exercise program , with mean levels of severity and interference decreasing to below prethoracotomy levels . Likewise , participants ’ functional status and QOL after completing the exercise program improved to near or above prethoracotomy levels . Conclusion The home-based , light-intensity exercise program for NSCLC patients receiving and completing adjuvant chemotherapy postthoracotomy showed promising trends in improving CRF severity , other symptom severity , functional status , and QOL . Further testing via a two-arm r and omized controlled trial is being conducted An earlier r and omised-controlled trial demonstrated the positive effects of cognitive behaviour therapy ( CBT ) , especially design ed for fatigued cancer survivors in reducing fatigue , functional impairments and psychological distress . In the current prospect i ve study , we were able to examine the long-term effect of CBT in patients who completed the therapy . Predictors of fatigue severity at follow-up were exploratory investigated . Sixty-eight patients who completed CBT  were assessed at pretreatment , post-treatment and at follow-up ( mean follow-up 1.9 years ( s.d . 1.0 ) , range : 1–4 years ) . To analyse possible predictors of treatment outcome a linear regression ( enter ) was carried out . Improvements on fatigue severity , functional impairment and psychological distress after CBT appeared to remain stable during a follow-up period . Patients who were not fatigued anymore at follow-up were not different from a reference group of non-fatigued cancer survivors . The explorative regression analysis showed that fatigue severity , psychological distress and somatic attributions at pretreatment contributed to persistent fatigue severity at follow-up . Cognitive behaviour therapy , especially design ed for post-cancer fatigue , is successful in reducing fatigue and functional impairment in cancer survivors . Moreover , these positive effects were maintained at about 2 years after finishing CBT BACKGROUND Breast cancer surgery is associated with side effects , including postsurgical pain , nausea , and fatigue . We carried out a r and omized clinical trial to test the hypotheses that a brief presurgery hypnosis intervention would decrease intraoperative anesthesia and analgesic use and side effects associated with breast cancer surgery and that it would be cost effective . METHODS We r and omly assigned 200 patients who were scheduled to undergo excisional breast biopsy or lumpectomy ( mean age 48.5 years ) to a 15-minute presurgery hypnosis session conducted by a psychologist or nondirective empathic listening ( attention control ) . Patients were not blinded to group assignment . Intraoperative anesthesia use ( i.e. , of the analgesics lidocaine and fentanyl and the sedatives propofol and midazolam ) was assessed . Patient-reported pain and other side effects as measured on a visual analog scale ( 0 - 100 ) were assessed at discharge , as was use of analgesics in the recovery room . Institutional costs and time in the operating room were assessed via chart review . RESULTS Patients in the hypnosis group required less propofol ( means = 64.01 versus 96.64 microg ; difference = 32.63 ; 95 % confidence interval [ CI ] = 3.95 to 61.30 ) and lidocaine ( means = 24.23 versus 31.09 mL ; difference = 6.86 ; 95 % CI = 3.05 to 10.68 ) than patients in the control group . Patients in the hypnosis group also reported less pain intensity ( means = 22.43 versus 47.83 ; difference = 25.40 ; 95 % CI = 17.56 to 33.25 ) , pain unpleasantness ( means = 21.19 versus 39.05 ; difference = 17.86 ; 95 % CI = 9.92 to 25.80 ) , nausea ( means = 6.57 versus 25.49 ; difference = 18.92 ; 95 % CI = 12.98 to 24.87 ) , fatigue ( means = 29.47 versus 54.20 ; difference = 24.73 ; 95 % CI = 16.64 to 32.83 ) , discomfort ( means = 23.01 versus 43.20 ; difference = 20.19 ; 95 % CI = 12.36 to 28.02 ) , and emotional upset ( means = 8.67 versus 33.46 ; difference = 24.79 ; 95 % CI = 18.56 to 31.03 ) . No statistically significant differences were seen in the use of fentanyl , midazolam , or recovery room analgesics .  Institutional costs for surgical breast cancer procedures were $ 8561 per patient at Mount Sinai School of Medicine . Patients in the hypnosis group cost the institution $ 772.71 less per patient than those in the control group ( 95 % CI = 75.10 to 1469.89 ) , mainly due to reduced surgical time . CONCLUSIONS Hypnosis was superior to attention control regarding propofol and lidocaine use ; pain , nausea , fatigue , discomfort , and emotional upset at discharge ; and institutional cost . Overall , the present data support the use of hypnosis with breast cancer surgery patients PURPOSE To determine 1-year outcomes of a four-component behavioral therapy ( BT ) sleep intervention ( Individualized Sleep Promotion Plan [ ISPP ] ) versus a healthy eating control ( HEC ) on cancer-related fatigue in women receiving breast cancer adjuvant chemotherapy treatment ( CTX ) . PATIENTS AND METHODS A total of 219 participants from 12 oncology clinics were r and omly assigned in a clinical trial . Before CTX , research nurses coached intervention participants to develop a BT plan including stimulus control , modified sleep restriction , relaxation therapy , and sleep hygiene . BT plans were revised before each CTX and 30 , 60 , and 90 days after the last CTX and reinforced 7 to 9 days later . HEC participants received nutritional information and equal attention . Pittsburgh Sleep Quality Index ( PSQI ) , Daily Diary , Wrist Actigraph , and Piper Fatigue Scale measures and Repeated Linear Mixed Model analysis following the Intent to Treat paradigm were used . RESULTS Sleep quality differed over 1 years time ( F [ 4,162 ] = 7.7 , P < .001 ; by group , F [ 1,173 ] = 4.8 , P = .029 ; and over time by group , F [ 4,162 ] = 3.3 , P = .013 ) . Pairwise comparisons revealed significant differences between groups at 90 days ( P = .002 ) but not at 1 year ( P = .052 ) . Seven days of diary and actigraphy data did not corroborate with monthly reflections ( PSQI ) . The night awakenings ( Actigraph ) pattern was significantly different by group over time ( P = .046 ) , with no differences between groups at 90 days or at 1 year . Fatigue was lower at 1 year than before CTX ; no group effects were found . CONCLUSION The BT group , on average , experienced significant improvement on global sleep quality compared with the HEC group , but not on objective sleep or fatigue outcomes Cancer and its treatment can induce subjective and objective evidence of diminished functional capacity encompassing physical fatigue and cognitive impairment . Dexmethylpheni date ( D-MPH ; the D-isomer of methylpheni date ) was evaluated for treatment of chemotherapy-related fatigue and cognitive impairment . A r and omized , double-blind , placebo-controlled , parallel-group study evaluated the potential therapeutic effect and safety of D-MPH in the treatment of patients with chemotherapy-related fatigue . Change from baseline in the Functional Assessment of Chronic Illness Therapy-Fatigue Subscale 
    Output:
    