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: CONTEXT Pain and depression are two of the most prevalent and treatable cancer-related symptoms , each present in at least 20%-30 % of oncology patients . OBJECTIVE To determine the associations of pain and depression with health-related quality of life ( HRQL ) , disability , and health care use in cancer patients . METHODS The Indiana Cancer Pain and Depression study is a r and omized clinical trial comparing telecare management vs. usual care for patients with cancer-related pain and /or clinical ly significant depression . In this article , baseline data on patients enrolled from 16 urban or rural community-based oncology practice s are analyzed to test the associations of pain and depression with HRQL , disability , and health care use . RESULTS Of the 405 participants , 32 % had depression only , 24 % pain only , and 44 % both depression and pain . The average Hopkins Symptom Checklist 20-item depression score in the 309 depressed participants was 1.64 ( on 0 - 4 scale ) , and the average Brief Pain Inventory ( BPI ) severity score in the 274 participants with pain was 5.2 ( on 0 - 10 scale ) , representing at least moderate levels of symptom severity . Symptom-specific disability was high , with participants reporting an average of 16.8 of the past 28 days ( i.e. , 60 % of their days in the past four weeks ) in which they were either confined to bed ( 5.6 days ) or had to reduce their usual activities by 50 % ( 11.2 days ) because of pain or depression . Moreover , 176 ( 43 % ) participants reported being unable to work because of health-related reasons . Depression and pain had both individual and additive adverse associations with quality of life . Most patients were currently not receiving care from a mental health or pain specialist . CONCLUSION Depression and pain are prevalent and disabling across a wide range of types and phases of cancer , commonly co-occur , and have additive adverse effects . Enhanced detection and management of this disabling symptom dyad is warranted 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 Pancreatic cancer is often accompanied by severe abdominal or back pain . It 's the first study to evaluate the analgesic effect of electroacupuncture on pancreatic cancer pain . A r and omized controlled trial compared electroacupuncture with control acupuncture using the placebo needle . METHODS Sixty patients with pancreatic cancer pain were r and omly assigned to the electroacupuncture group ( n = 30 ) and the placebo control group ( n = 30 ) . Patients were treated on Jiaji ( Ex-B2 ) points T8-T12 bilaterally for 30 min once a day for 3 days . Pain intensity was assessed with numerical rated scales ( NRS ) before the treatment ( Baseline ) , after 3 treatments , and 2 days follow-up . RESULTS Baseline characteristics were similar in the two groups . After 3 treatment , pain intensity on NRS decreased compared with Baseline ( -1.67 , 95 % confidence interval [ CI ] -1.46 to -1.87 ) in the electroacupuncture group ; there was little change ( -0.13 , 95 % CI 0.08 to -0.35 ) in control group ; the difference between two groups was statistically significant ( P < 0.001 ) . Follow-up also found a significant reduction in pain intensity in the electroacupuncture group compared with the control group ( P < 0.001 ) . CONCLUSIONS Electroacupuncture was an effective treatment for relieving pancreatic cancer pain 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 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND Within a pilot trial regarding chemotherapy-induced neutropenia , the secondary aim of the main study was explored . This involved measuring the effects-as shown on two key measurement scales reflecting quality of life (QoL)-of verum versus sham acupuncture on patients with ovarian cancer during chemotherapy .  OBJECTIVE The aim of this sub study was to determine the feasibility of determining the effects of verum acupuncture versus sham acupuncture on QoL in patients with ovarian cancer during chemotherapy .  DESIGN This was a r and omized , sham-controlled trial . SETTING The trial was conducted at two cancer centers . PATIENTS Patients with ovarian cancer ( N=21 ) who were receiving chemotherapy-primarily intravenous carboplatin and paclitaxel-participated  in this sub study . INTERVENTION The participants were given either active or sham acupuncture 1 week prior to cycle 2 of chemotherapy . There were ten sessions of acupuncture , with manual and electro-stimulation over a 4-week period . MAIN OUTCOME MEASURES The European Organization for Research and Treatment of Cancer- Quality -of-Life Question naire-Core 30 Item ( EORTC-QLQ-C30 ) and the Quality of Life Question naire-Ovarian Cancer Module-28 Item ( QLQ-OV28 ) were administered to the patients at baseline and at the end of their acupuncture sessions . RESULTS Of the original 21 , 15 patients ( 71 % ) completed the study , and 93 % of them completed the question naires . The EORTC-QLQ-C30 subscores were improved in the acupuncture arm , including the mean scores of social function ( SF ) , pain , and insomnia ( p=0.05 ) . However , after adjusting for baseline differences , only the SF score was significantly higher in the active acupuncture arm , compared with the sham acupuncture arm ( p=0.03 ) . CONCLUSIONS It appears feasible to conduct a r and omized sham-controlled acupuncture trial measuring QoL for patients with ovarian cancer who are undergoing chemotherapy . Acupuncture may have a role in improving QoL during chemotherapy The present study describes the development of a comprehensive quality of reporting assessment tool and its application to acupuncture RCTs from 1997–2007 . This Oregon CONSORT STRICTA Instrument ( OCSI ) is based on the revised CONSORT guidelines as modified by the STRICTA recommendations for acupuncture trials . Each of the result ing 27 OCSI items were applied to English language prospect i ve RCTs that compared acupuncture , using manual and /or electro-stimulation , to no treatment , a sham procedure , or usual biomedical care .  The 333 RCTs that met inclusion criteria were dispersed among 27 countries and 141 journals .  Mean quality of reporting score for all articles was 63.0 % ( SD 16.5 ) . Mean OCSI scores revealed a 30.9 % improvement over the ten-year period ( P < .001 ) . Our findings suggest that to enhance quality of reporting , authors should better attend to seven specific OCSI items in three categories : practitioner training , adverse events , and aspects of r and omization and blinding ( n = 5 ) . The broad diversity in geographical origin , publication site and quality of reporting , viewed in light of the considerable room for improvement in mean OCSI scores , emphasizes the importance of making STRICTA as well as CONSORT more widely known to journals and to the acupuncture research community BACKGROUND It is not known if verum ( real ) acupuncture is effective for nausea and vomiting ( emesis ) during radiotherapy . PATIENTS AND METHODS We r and omly treated 215 blinded cancer patients with verum : penetrating ' deqi ' creating acupuncture ( n = 109 ) or non-penetrating sham needles ( n = 106 ) two to three times per week . The patients documented emesis daily during the radiotherapy period . Primary end point was the number of patients with at least one episode of nausea . RESULTS In the verum and the sham acupuncture group , 70 % and 62 % experienced nausea at least once during the radiotherapy period ( relative risk 1.1 , 95 % CI 0.9 - 1.4 ) for a mean number of 10.1 and 8.7 days . Twenty five percent and 28 % vomited , and 42 % and 37 % used  antiemetic drugs  at least once , respectively . Ninety-five percent in the verum acupuncture group and 96 % in the sham acupuncture group believed that the treatment had been effective against nausea . In both groups , 67 % experienced positive effects on relaxation , mood , sleep or pain reduction and 89 % wished to receive the treatment again . CONCLUSION Acupuncture creating deqi is not more effective than sham in radiotherapy-induced nausea , but in this study , nearly all patients in both groups experienced that the treatment was effective for nausea In evidence -based medicine , r and omized controlled trials ( RCTs ) are the preferred method for evaluating the efficacy of interventions . In regard to acupuncture RCTs , the most difficult issues are the design of the control group and implementation of the principle of “ double-blinding . ” We compared the advantages and limitations associated with different control group design s in acupuncture RCTs , to assist research ers in this field OBJECTIVE To search for a safe and effective method for alleviating  cancer pain . METHODS Sixty-six cases of late cancer with pain were first divided into 3 different degrees of pain , mild , moderate and severe , and then the patients with pain of each same degree were r and omly divided into an acupuncture group treated by acupuncture at 3 - 5 of the most severe tender points , and a medication group treated with oral administration according to the WHO Three Step Administration Principle , i.e. the patients with mild pain took aspirin , moderate pain took codeine and severe pain took morphine . RESULTS Both two methods could effectively control cancer pain . The total effective rate of 94. 
    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: CONTEXT Pain and depression are two of the most prevalent and treatable cancer-related symptoms , each present in at least 20%-30 % of oncology patients . OBJECTIVE To determine the associations of pain and depression with health-related quality of life ( HRQL ) , disability , and health care use in cancer patients . METHODS The Indiana Cancer Pain and Depression study is a r and omized clinical trial comparing telecare management vs. usual care for patients with cancer-related pain and /or clinical ly significant depression . In this article , baseline data on patients enrolled from 16 urban or rural community-based oncology practice s are analyzed to test the associations of pain and depression with HRQL , disability , and health care use . RESULTS Of the 405 participants , 32 % had depression only , 24 % pain only , and 44 % both depression and pain . The average Hopkins Symptom Checklist 20-item depression score in the 309 depressed participants was 1.64 ( on 0 - 4 scale ) , and the average Brief Pain Inventory ( BPI ) severity score in the 274 participants with pain was 5.2 ( on 0 - 10 scale ) , representing at least moderate levels of symptom severity . Symptom-specific disability was high , with participants reporting an average of 16.8 of the past 28 days ( i.e. , 60 % of their days in the past four weeks ) in which they were either confined to bed ( 5.6 days ) or had to reduce their usual activities by 50 % ( 11.2 days ) because of pain or depression . Moreover , 176 ( 43 % ) participants reported being unable to work because of health-related reasons . Depression and pain had both individual and additive adverse associations with quality of life . Most patients were currently not receiving care from a mental health or pain specialist . CONCLUSION Depression and pain are prevalent and disabling across a wide range of types and phases of cancer , commonly co-occur , and have additive adverse effects . Enhanced detection and management of this disabling symptom dyad is warranted 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 Pancreatic cancer is often accompanied by severe abdominal or back pain . It 's the first study to evaluate the analgesic effect of electroacupuncture on pancreatic cancer pain . A r and omized controlled trial compared electroacupuncture with control acupuncture using the placebo needle . METHODS Sixty patients with pancreatic cancer pain were r and omly assigned to the electroacupuncture group ( n = 30 ) and the placebo control group ( n = 30 ) . Patients were treated on Jiaji ( Ex-B2 ) points T8-T12 bilaterally for 30 min once a day for 3 days . Pain intensity was assessed with numerical rated scales ( NRS ) before the treatment ( Baseline ) , after 3 treatments , and 2 days follow-up . RESULTS Baseline characteristics were similar in the two groups . After 3 treatment , pain intensity on NRS decreased compared with Baseline ( -1.67 , 95 % confidence interval [ CI ] -1.46 to -1.87 ) in the electroacupuncture group ; there was little change ( -0.13 , 95 % CI 0.08 to -0.35 ) in control group ; the difference between two groups was statistically significant ( P < 0.001 ) . Follow-up also found a significant reduction in pain intensity in the electroacupuncture group compared with the control group ( P < 0.001 ) . CONCLUSIONS Electroacupuncture was an effective treatment for relieving pancreatic cancer pain 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 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND Within a pilot trial regarding chemotherapy-induced neutropenia , the secondary aim of the main study was explored . This involved measuring the effects-as shown on two key measurement scales reflecting quality of life (QoL)-of verum versus sham acupuncture on patients with ovarian cancer during chemotherapy .  OBJECTIVE The aim of this sub study was to determine the feasibility of determining the effects of verum acupuncture versus sham acupuncture on QoL in patients with ovarian cancer during chemotherapy .  DESIGN This was a r and omized , sham-controlled trial . SETTING The trial was conducted at two cancer centers . PATIENTS Patients with ovarian cancer ( N=21 ) who were receiving chemotherapy-primarily intravenous carboplatin and paclitaxel-participated  in this sub study . INTERVENTION The participants were given either active or sham acupuncture 1 week prior to cycle 2 of chemotherapy . There were ten sessions of acupuncture , with manual and electro-stimulation over a 4-week period . MAIN OUTCOME MEASURES The European Organization for Research and Treatment of Cancer- Quality -of-Life Question naire-Core 30 Item ( EORTC-QLQ-C30 ) and the Quality of Life Question naire-Ovarian Cancer Module-28 Item ( QLQ-OV28 ) were administered to the patients at baseline and at the end of their acupuncture sessions . RESULTS Of the original 21 , 15 patients ( 71 % ) completed the study , and 93 % of them completed the question naires . The EORTC-QLQ-C30 subscores were improved in the acupuncture arm , including the mean scores of social function ( SF ) , pain , and insomnia ( p=0.05 ) . However , after adjusting for baseline differences , only the SF score was significantly higher in the active acupuncture arm , compared with the sham acupuncture arm ( p=0.03 ) . CONCLUSIONS It appears feasible to conduct a r and omized sham-controlled acupuncture trial measuring QoL for patients with ovarian cancer who are undergoing chemotherapy . Acupuncture may have a role in improving QoL during chemotherapy The present study describes the development of a comprehensive quality of reporting assessment tool and its application to acupuncture RCTs from 1997–2007 . This Oregon CONSORT STRICTA Instrument ( OCSI ) is based on the revised CONSORT guidelines as modified by the STRICTA recommendations for acupuncture trials . Each of the result ing 27 OCSI items were applied to English language prospect i ve RCTs that compared acupuncture , using manual and /or electro-stimulation , to no treatment , a sham procedure , or usual biomedical care .  The 333 RCTs that met inclusion criteria were dispersed among 27 countries and 141 journals .  Mean quality of reporting score for all articles was 63.0 % ( SD 16.5 ) . Mean OCSI scores revealed a 30.9 % improvement over the ten-year period ( P < .001 ) . Our findings suggest that to enhance quality of reporting , authors should better attend to seven specific OCSI items in three categories : practitioner training , adverse events , and aspects of r and omization and blinding ( n = 5 ) . The broad diversity in geographical origin , publication site and quality of reporting , viewed in light of the considerable room for improvement in mean OCSI scores , emphasizes the importance of making STRICTA as well as CONSORT more widely known to journals and to the acupuncture research community BACKGROUND It is not known if verum ( real ) acupuncture is effective for nausea and vomiting ( emesis ) during radiotherapy . PATIENTS AND METHODS We r and omly treated 215 blinded cancer patients with verum : penetrating ' deqi ' creating acupuncture ( n = 109 ) or non-penetrating sham needles ( n = 106 ) two to three times per week . The patients documented emesis daily during the radiotherapy period . Primary end point was the number of patients with at least one episode of nausea . RESULTS In the verum and the sham acupuncture group , 70 % and 62 % experienced nausea at least once during the radiotherapy period ( relative risk 1.1 , 95 % CI 0.9 - 1.4 ) for a mean number of 10.1 and 8.7 days . Twenty five percent and 28 % vomited , and 42 % and 37 % used  antiemetic drugs  at least once , respectively . Ninety-five percent in the verum acupuncture group and 96 % in the sham acupuncture group believed that the treatment had been effective against nausea . In both groups , 67 % experienced positive effects on relaxation , mood , sleep or pain reduction and 89 % wished to receive the treatment again . CONCLUSION Acupuncture creating deqi is not more effective than sham in radiotherapy-induced nausea , but in this study , nearly all patients in both groups experienced that the treatment was effective for nausea In evidence -based medicine , r and omized controlled trials ( RCTs ) are the preferred method for evaluating the efficacy of interventions . In regard to acupuncture RCTs , the most difficult issues are the design of the control group and implementation of the principle of “ double-blinding . ” We compared the advantages and limitations associated with different control group design s in acupuncture RCTs , to assist research ers in this field OBJECTIVE To search for a safe and effective method for alleviating  cancer pain . METHODS Sixty-six cases of late cancer with pain were first divided into 3 different degrees of pain , mild , moderate and severe , and then the patients with pain of each same degree were r and omly divided into an acupuncture group treated by acupuncture at 3 - 5 of the most severe tender points , and a medication group treated with oral administration according to the WHO Three Step Administration Principle , i.e. the patients with mild pain took aspirin , moderate pain took codeine and severe pain took morphine . RESULTS Both two methods could effectively control cancer pain . The total effective rate of 94. 
    Output:
    