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 purpose of this study was to determine whether 20 patients who received an early postmastectomy rehabilitation treatment program  showed more improvement in range of shoulder motion and functional activities than 13 patients who received instruction for exercise only .  Data were obtained at preoperatively , three days after operation , at discharge and at postdischarge one month for each patient on parameters such as range of motion of the ipsilateral shoulder joint , upper extremity circumferential measurements , as well as 10 elements of shoulder function . Postoperatively , both groups showed an increased range of motion of the shoulder joint and improved functional activities , but the group that received postoperative rehabilitation management had a better range of shoulder motion and less difficulty in five items for functional assessment . This study also showed that an early rehabilitation program did not increase postoperative complications . We concluded that an early rehabilitation program or intensive instruction program only by a well-trained physical therapist or physiatrist was beneficial to postmastectomy patients in regaining the function and range of shoulder motion , and significantly better in a rehabilitation group Purpose This study aims to develop a psychometrically rigorous instrument to measure the unmet needs of adult cancer survivors who are 1 to 5 years post-cancer diagnosis . “ Unmet needs ” distinguishes between problems which survivors experience and problems which they desire help in managing . Methods The survey was developed from a comprehensive literature review , qualitative analysis of the six most important unmet needs of 71 cancer survivors , review of the domains and items by survivors and experts , cognitive interviews and a pilot test of 100 survivors . A stratified r and om sample of 550 cancer survivors , selected from a population -based Cancer Registry , completed a mailed survey to establish reliability and validity . Results The final 89-item  Survivors Unmet Needs Survey ( SUNS ) has high acceptability , item test – retest reliability and internal consistency ( Chronbach ’s alpha 0.990 ) , face , content and construct validity . Five subscales measure Emotional Health needs ( 33 items , 19.4 % of variance ) , Access and Continuity of Care ( 22 items , 15.1 % ) , Relationships ( 15 items , 12.1 % ) , Financial Concerns ( 11 items , 10.3 % ) and Information needs ( eight items , 8.1 % of the variance ) . Conclusions This instrument has strong psychometric properties and is useful for determining the prevalence and predictors of cancer survivors ’ unmet needs across types of cancer , length of survivorship and socio-demographic characteristics . Use of the SUNS will enable more effective targeting of programmes and services and guide policy and health planning decisions . Relevance This study is an important step toward evidence -based planning and management of problems which the growing survivor population requires assistance in managing Few r and omized controlled trials have examined the effects of combined aerobic and resistance training in breast cancer survivors soon after completing adjuvant therapy . Breast cancer survivors ( N = 58 ) within 2 years of completing adjuvant therapy were r and omly assigned to an immediate exercise group ( IEG ; n = 29 ) or a delayed exercise group ( DEG ; n = 29 ) . The IEG completed 12 weeks of supervised aerobic and resistance exercise , three times per week . The DEG completed the program during the next 12 weeks . Participants completed patient-rated outcomes at baseline , 6 , 12 , 18 and 24 weeks . The primary endpoint was overall quality of life ( QoL ) measured by the Functional Assessment of Cancer Therapy-Breast scale . Secondary endpoints were fatigue , social physique anxiety , and physical fitness . Follow-up data was obtained on 97 % of participants and exercise adherence was 61.3 % . Repeated measures analyses of variance revealed a significant group by time interaction for overall QoL ( P < 0.001 ) . Specifically , QoL increased in the IEG from baseline to 12 weeks by 20.8 points compared to a decrease in the DEG of 5.3 points ( mean group difference = 26.1 ; 95 % CI = 18.3–32.7 ; P < 0.001 ) . From 12 to 24 weeks , QoL increased in the DEG by 29.5 points compared to an increase of 6.5 points in the IEG ( mean group difference = 23.0 ; 95 % CI = 16.3–29.1 ; P < 0.001 ) . Similar results were obtained for the secondary endpoints . Combined aerobic and resistance exercise soon after the completion of breast cancer therapy produces large and rapid improvements in health-related outcomes Breast cancer radiotherapy can be an emotionally difficult experience . Despite this , few studies have examined the effectiveness of psychological interventions to reduce negative affect , and none to date have explicitly examined interventions to improve positive affect among breast cancer radiotherapy patients . The present study examined the effectiveness of a multimodal psychotherapeutic approach , combining cognitive-behavioral therapy and hypnosis ( CBTH ) , to reduce negative affect and increase positive affect in 40 women undergoing breast cancer radiotherapy . Participants were r and omly assigned to receive either CBTH or st and ard care . Participants completed weekly self-report measures of positive and negative affect . Repeated and univariate analyses of variance revealed that the CBTH approach reduced levels of negative affect [ F(1 , 38)=13.49 ; p=.0007 , omega(2)=.56 ] , and increased levels of positive affect [ F(1 , 38)=9.67 ; p=.0035 , omega(2)=.48 ] , during the course of radiotherapy . Additionally , relative to the control group , the CBTH group demonstrated significantly more intense positive affect [ F(1 , 38)=7.09 ; p=.0113 , d=.71 ] and significantly less intense negative affect [ F(1 , 38)=10.30 ; p=.0027 , d=.90 ] during radiotherapy . The CBTH group also had a significantly higher frequency of days where positive affect was greater than negative affect ( 85 % of days assessed for the CBTH group versus 43 % of the Control group ) [ F(1 , 38)=18.16 ; p=.0001 , d=1.16 ] . Therefore , the CBTH intervention has the potential to improve the affective experience of women undergoing breast cancer radiotherapy Background Premature menopause is a major concern of younger women undergoing adjuvant therapy for breast cancer . Hormone replacement therapy is contraindicated in women with a history of breast cancer . Non-hormonal medications show a range of bothersome side-effects . There is growing evidence that cognitive behavioral therapy ( CBT ) and physical exercise can have a positive impact on symptoms in naturally occurring menopause . The objective of this study is to investigate the efficacy of these interventions among women with breast cancer experiencing treatment-induced menopause . Methods / design In a r and omized , controlled , multicenter trial , we are evaluating the effectiveness of CBT/relaxation , of physical exercise and of these two program elements combined , in reducing menopausal symptoms , improving sexual functioning , reducing emotional distress , and in improving the health-related quality of life of younger breast cancer patients who experience treatment-induced menopause . 325 breast cancer patients ( aged < 50 ) are being recruited from hospitals in the Amsterdam region , and r and omly allocated to one of the three treatment groups or a ' waiting list ' control group . Self-administered question naires are completed by the patients at baseline , and at 12 weeks ( T1 ) and 6 months ( T2 ) post- study entry . Upon completion of the study , women assigned to the control group will be given the choice of undergoing either the CBT or physical exercise program . Discussion Cognitive behavioral therapy and physical exercise are potentially useful treatments among women with breast cancer undergoing treatment-induced , premature menopause . For these patients , hormonal and non-hormonal therapies are contraindicated or have a range of bothersome side-effects . Hence , research into these interventions is needed , before dissemination and implementation in the current health care system can take place . Trial registration The study is registered at the Netherl and s Trial Register ( NTR1165 ) and Clinical Trials.gov ( NCT00582244 ) Background Short term exercise interventions have been shown to be beneficial for breast cancer survivors soon after treatments but longer term adherence is needed . Purpose To examine the effects of a supervised exercise program on motivational variables in breast cancer survivors using Self-Determination Theory ( SDT ) . MethodS ixty breast cancer survivors were r and omized in a cross-over design to either an immediate exercise group  ( IEG ; n = 30 )  that exercised from baseline to week 12 or a delayed exercise group  ( DEG  ; n = 30 )  that exercised from week 12 to 24 .  SDT variables were assessed at baseline , 6 , 12 , 18 and 24 weeks using the  Behavioral Regulation for Exercise Question niare-2 and the Basic Psychological Needs Satisfaction Scale . Results Fifty-eight participants completed the follow-up assessment s and achieved a 61.3 % adherence rate . Analyses of variance revealed significant time by group interactions for almost all psychological needs and motivations that favored the exercise intervention time periods . For example , autonomy increased in the IEG from baseline to 12 weeks by 2.0 points compared to the DEG where scores decreased by 0.1 points ( mean group difference = 2.0 , p < 0.001 ) . The cross-over results further supported the main findings . ConclusionS upervised exercise soon after breast cancer treatments may help to develop a positive exercise motivational profile among breast cancer survivors that could portend longer term adherence Surgery and radiotherapy commonly cause adverse musculoskeletal problems , particularly loss of strength and range of motion , in the upper quadrant of breast cancer patients . Few well- design ed studies have investigated whether these impairments can be prevented . Stretching is an effective technique for increasing range of motion , hence the aim of this study was to investigate whether a stretching program reduced acute musculoskeletal impairments in patients undergoing radiotherapy for breast cancer . Sixty-four women were recruited prior to commencement of radiotherapy following breast cancer surgery . Participants were r and omised to either a control or stretch group . Participants in both groups were review ed by the physical therapist on a weekly basis for approximately 6 weeks , and were given general information about skin care and lymphedema . The control group received no advice about exercise . The stretch group received instruction on low-load , prolonged pectoral stretches , which were to be performed daily and were checked at weekly visits . Shoulder range of motion , strength , arm circumference , and quality of life measurements were taken prior to , and at completion of radiotherapy , and at 7 months after radiotherapy . There was no difference in any outcome between groups . Breast symptoms increased for both groups during radiotherapy , without loss of strength or range of movement . The incidence of lymphedema during the study was low for both groups and did not differ between groups . The pectoral stretching program did not influence the outcomes measured because the symptoms reported by patients were not a consequence of contracture Background Fatigue is a major problem of cancer patients . Thirty percent of cancer survivors report serious fatigue three years after finishing treatment . There is evidence that physical exercise during cancer treatment reduces fatigue . This may also lead to an improvement of quality of life . Such findings may result in a decrease of healthcare related expenditures and societal costs due to sick leave . However , no studies are known that investigated these hypotheses . Therefore , the primary aim of our study is to assess the effect of exercise during cancer treatment on reducing complaints of fatigue and on reducing health service utilisation and sick leave . Methods / Design The Physical Activity during Cancer Treatment study is a multicentre r and omised controlled trial in 150 breast and 150 colon cancer patients undergoing cancer treatment . Participants will be r and omised to an  exercise or a control group .  In addition to the usual care , the exercise group will participate in an 18-week supervised group exercise programme . The control group will be asked to maintain their habitual physical activity pattern . Study endpoints will be assessed after 18 weeks ( short term ) and after 9 months ( long term ) . Vali date d question naires will be used . Primary outcome : fatigue ( Multidimensional Fatigue Inventory and Fatigue Quality List ) and cost-effectiveness , health service utilisation and sick leave . Secondary outcome : health related quality of life ( European Organisation Research and Treatment of Cancer- Quality of Life question naire-C30 , Short Form 36 healthy survey ) , impact on functioning and autonomy ( Impact on functioning and autonomy question naire ) , anxiety and depression ( Hospital Anxiety and Depression Scale ) , physical fitness ( aerobic peak capacity , muscle strength ) , body composition and cognitive-behavioural aspects . To register health service utilisation and sick leave , participants will keep diaries including the EuroQuol-5D . Physical activity level will be measured using the Short Question naire to Assess Health-Enhancing Physical Activity and will be monitored with an exercise log and a pedometer . Discussion This study investigates the (cost)-effectiveness of exercise during adjuvant treatment of patients with breast or colon cancer . If early physical exercise proves to be ( cost ) effective , establishing st and ardised physical exercise programmes during cancer treatment will be planned . Trial registration Current Controlled trials IS RCT N43801571 , Dutch Trial Register Background The aim of this clinical study was to evaluate quality of life ( QoL ) in early-stage breast cancer patients and to investigate the effects of a comprehensive rehabilitation program comparing women undergoing sentinel node biopsy ( SNB ) versus complete axillary lymph node dissection ( ALND ) .  QoL was assessed with the Functional Assessment of Cancer Therapy — General and Functional Assessment of Cancer Therapy — Breast ( FACT-B ) question naire . Methods Eighty-nine women with histologically 
    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 purpose of this study was to determine whether 20 patients who received an early postmastectomy rehabilitation treatment program  showed more improvement in range of shoulder motion and functional activities than 13 patients who received instruction for exercise only .  Data were obtained at preoperatively , three days after operation , at discharge and at postdischarge one month for each patient on parameters such as range of motion of the ipsilateral shoulder joint , upper extremity circumferential measurements , as well as 10 elements of shoulder function . Postoperatively , both groups showed an increased range of motion of the shoulder joint and improved functional activities , but the group that received postoperative rehabilitation management had a better range of shoulder motion and less difficulty in five items for functional assessment . This study also showed that an early rehabilitation program did not increase postoperative complications . We concluded that an early rehabilitation program or intensive instruction program only by a well-trained physical therapist or physiatrist was beneficial to postmastectomy patients in regaining the function and range of shoulder motion , and significantly better in a rehabilitation group Purpose This study aims to develop a psychometrically rigorous instrument to measure the unmet needs of adult cancer survivors who are 1 to 5 years post-cancer diagnosis . “ Unmet needs ” distinguishes between problems which survivors experience and problems which they desire help in managing . Methods The survey was developed from a comprehensive literature review , qualitative analysis of the six most important unmet needs of 71 cancer survivors , review of the domains and items by survivors and experts , cognitive interviews and a pilot test of 100 survivors . A stratified r and om sample of 550 cancer survivors , selected from a population -based Cancer Registry , completed a mailed survey to establish reliability and validity . Results The final 89-item  Survivors Unmet Needs Survey ( SUNS ) has high acceptability , item test – retest reliability and internal consistency ( Chronbach ’s alpha 0.990 ) , face , content and construct validity . Five subscales measure Emotional Health needs ( 33 items , 19.4 % of variance ) , Access and Continuity of Care ( 22 items , 15.1 % ) , Relationships ( 15 items , 12.1 % ) , Financial Concerns ( 11 items , 10.3 % ) and Information needs ( eight items , 8.1 % of the variance ) . Conclusions This instrument has strong psychometric properties and is useful for determining the prevalence and predictors of cancer survivors ’ unmet needs across types of cancer , length of survivorship and socio-demographic characteristics . Use of the SUNS will enable more effective targeting of programmes and services and guide policy and health planning decisions . Relevance This study is an important step toward evidence -based planning and management of problems which the growing survivor population requires assistance in managing Few r and omized controlled trials have examined the effects of combined aerobic and resistance training in breast cancer survivors soon after completing adjuvant therapy . Breast cancer survivors ( N = 58 ) within 2 years of completing adjuvant therapy were r and omly assigned to an immediate exercise group ( IEG ; n = 29 ) or a delayed exercise group ( DEG ; n = 29 ) . The IEG completed 12 weeks of supervised aerobic and resistance exercise , three times per week . The DEG completed the program during the next 12 weeks . Participants completed patient-rated outcomes at baseline , 6 , 12 , 18 and 24 weeks . The primary endpoint was overall quality of life ( QoL ) measured by the Functional Assessment of Cancer Therapy-Breast scale . Secondary endpoints were fatigue , social physique anxiety , and physical fitness . Follow-up data was obtained on 97 % of participants and exercise adherence was 61.3 % . Repeated measures analyses of variance revealed a significant group by time interaction for overall QoL ( P < 0.001 ) . Specifically , QoL increased in the IEG from baseline to 12 weeks by 20.8 points compared to a decrease in the DEG of 5.3 points ( mean group difference = 26.1 ; 95 % CI = 18.3–32.7 ; P < 0.001 ) . From 12 to 24 weeks , QoL increased in the DEG by 29.5 points compared to an increase of 6.5 points in the IEG ( mean group difference = 23.0 ; 95 % CI = 16.3–29.1 ; P < 0.001 ) . Similar results were obtained for the secondary endpoints . Combined aerobic and resistance exercise soon after the completion of breast cancer therapy produces large and rapid improvements in health-related outcomes Breast cancer radiotherapy can be an emotionally difficult experience . Despite this , few studies have examined the effectiveness of psychological interventions to reduce negative affect , and none to date have explicitly examined interventions to improve positive affect among breast cancer radiotherapy patients . The present study examined the effectiveness of a multimodal psychotherapeutic approach , combining cognitive-behavioral therapy and hypnosis ( CBTH ) , to reduce negative affect and increase positive affect in 40 women undergoing breast cancer radiotherapy . Participants were r and omly assigned to receive either CBTH or st and ard care . Participants completed weekly self-report measures of positive and negative affect . Repeated and univariate analyses of variance revealed that the CBTH approach reduced levels of negative affect [ F(1 , 38)=13.49 ; p=.0007 , omega(2)=.56 ] , and increased levels of positive affect [ F(1 , 38)=9.67 ; p=.0035 , omega(2)=.48 ] , during the course of radiotherapy . Additionally , relative to the control group , the CBTH group demonstrated significantly more intense positive affect [ F(1 , 38)=7.09 ; p=.0113 , d=.71 ] and significantly less intense negative affect [ F(1 , 38)=10.30 ; p=.0027 , d=.90 ] during radiotherapy . The CBTH group also had a significantly higher frequency of days where positive affect was greater than negative affect ( 85 % of days assessed for the CBTH group versus 43 % of the Control group ) [ F(1 , 38)=18.16 ; p=.0001 , d=1.16 ] . Therefore , the CBTH intervention has the potential to improve the affective experience of women undergoing breast cancer radiotherapy Background Premature menopause is a major concern of younger women undergoing adjuvant therapy for breast cancer . Hormone replacement therapy is contraindicated in women with a history of breast cancer . Non-hormonal medications show a range of bothersome side-effects . There is growing evidence that cognitive behavioral therapy ( CBT ) and physical exercise can have a positive impact on symptoms in naturally occurring menopause . The objective of this study is to investigate the efficacy of these interventions among women with breast cancer experiencing treatment-induced menopause . Methods / design In a r and omized , controlled , multicenter trial , we are evaluating the effectiveness of CBT/relaxation , of physical exercise and of these two program elements combined , in reducing menopausal symptoms , improving sexual functioning , reducing emotional distress , and in improving the health-related quality of life of younger breast cancer patients who experience treatment-induced menopause . 325 breast cancer patients ( aged < 50 ) are being recruited from hospitals in the Amsterdam region , and r and omly allocated to one of the three treatment groups or a ' waiting list ' control group . Self-administered question naires are completed by the patients at baseline , and at 12 weeks ( T1 ) and 6 months ( T2 ) post- study entry . Upon completion of the study , women assigned to the control group will be given the choice of undergoing either the CBT or physical exercise program . Discussion Cognitive behavioral therapy and physical exercise are potentially useful treatments among women with breast cancer undergoing treatment-induced , premature menopause . For these patients , hormonal and non-hormonal therapies are contraindicated or have a range of bothersome side-effects . Hence , research into these interventions is needed , before dissemination and implementation in the current health care system can take place . Trial registration The study is registered at the Netherl and s Trial Register ( NTR1165 ) and Clinical Trials.gov ( NCT00582244 ) Background Short term exercise interventions have been shown to be beneficial for breast cancer survivors soon after treatments but longer term adherence is needed . Purpose To examine the effects of a supervised exercise program on motivational variables in breast cancer survivors using Self-Determination Theory ( SDT ) . MethodS ixty breast cancer survivors were r and omized in a cross-over design to either an immediate exercise group  ( IEG ; n = 30 )  that exercised from baseline to week 12 or a delayed exercise group  ( DEG  ; n = 30 )  that exercised from week 12 to 24 .  SDT variables were assessed at baseline , 6 , 12 , 18 and 24 weeks using the  Behavioral Regulation for Exercise Question niare-2 and the Basic Psychological Needs Satisfaction Scale . Results Fifty-eight participants completed the follow-up assessment s and achieved a 61.3 % adherence rate . Analyses of variance revealed significant time by group interactions for almost all psychological needs and motivations that favored the exercise intervention time periods . For example , autonomy increased in the IEG from baseline to 12 weeks by 2.0 points compared to the DEG where scores decreased by 0.1 points ( mean group difference = 2.0 , p < 0.001 ) . The cross-over results further supported the main findings . ConclusionS upervised exercise soon after breast cancer treatments may help to develop a positive exercise motivational profile among breast cancer survivors that could portend longer term adherence Surgery and radiotherapy commonly cause adverse musculoskeletal problems , particularly loss of strength and range of motion , in the upper quadrant of breast cancer patients . Few well- design ed studies have investigated whether these impairments can be prevented . Stretching is an effective technique for increasing range of motion , hence the aim of this study was to investigate whether a stretching program reduced acute musculoskeletal impairments in patients undergoing radiotherapy for breast cancer . Sixty-four women were recruited prior to commencement of radiotherapy following breast cancer surgery . Participants were r and omised to either a control or stretch group . Participants in both groups were review ed by the physical therapist on a weekly basis for approximately 6 weeks , and were given general information about skin care and lymphedema . The control group received no advice about exercise . The stretch group received instruction on low-load , prolonged pectoral stretches , which were to be performed daily and were checked at weekly visits . Shoulder range of motion , strength , arm circumference , and quality of life measurements were taken prior to , and at completion of radiotherapy , and at 7 months after radiotherapy . There was no difference in any outcome between groups . Breast symptoms increased for both groups during radiotherapy , without loss of strength or range of movement . The incidence of lymphedema during the study was low for both groups and did not differ between groups . The pectoral stretching program did not influence the outcomes measured because the symptoms reported by patients were not a consequence of contracture Background Fatigue is a major problem of cancer patients . Thirty percent of cancer survivors report serious fatigue three years after finishing treatment . There is evidence that physical exercise during cancer treatment reduces fatigue . This may also lead to an improvement of quality of life . Such findings may result in a decrease of healthcare related expenditures and societal costs due to sick leave . However , no studies are known that investigated these hypotheses . Therefore , the primary aim of our study is to assess the effect of exercise during cancer treatment on reducing complaints of fatigue and on reducing health service utilisation and sick leave . Methods / Design The Physical Activity during Cancer Treatment study is a multicentre r and omised controlled trial in 150 breast and 150 colon cancer patients undergoing cancer treatment . Participants will be r and omised to an  exercise or a control group .  In addition to the usual care , the exercise group will participate in an 18-week supervised group exercise programme . The control group will be asked to maintain their habitual physical activity pattern . Study endpoints will be assessed after 18 weeks ( short term ) and after 9 months ( long term ) . Vali date d question naires will be used . Primary outcome : fatigue ( Multidimensional Fatigue Inventory and Fatigue Quality List ) and cost-effectiveness , health service utilisation and sick leave . Secondary outcome : health related quality of life ( European Organisation Research and Treatment of Cancer- Quality of Life question naire-C30 , Short Form 36 healthy survey ) , impact on functioning and autonomy ( Impact on functioning and autonomy question naire ) , anxiety and depression ( Hospital Anxiety and Depression Scale ) , physical fitness ( aerobic peak capacity , muscle strength ) , body composition and cognitive-behavioural aspects . To register health service utilisation and sick leave , participants will keep diaries including the EuroQuol-5D . Physical activity level will be measured using the Short Question naire to Assess Health-Enhancing Physical Activity and will be monitored with an exercise log and a pedometer . Discussion This study investigates the (cost)-effectiveness of exercise during adjuvant treatment of patients with breast or colon cancer . If early physical exercise proves to be ( cost ) effective , establishing st and ardised physical exercise programmes during cancer treatment will be planned . Trial registration Current Controlled trials IS RCT N43801571 , Dutch Trial Register Background The aim of this clinical study was to evaluate quality of life ( QoL ) in early-stage breast cancer patients and to investigate the effects of a comprehensive rehabilitation program comparing women undergoing sentinel node biopsy ( SNB ) versus complete axillary lymph node dissection ( ALND ) .  QoL was assessed with the Functional Assessment of Cancer Therapy — General and Functional Assessment of Cancer Therapy — Breast ( FACT-B ) question naire . Methods Eighty-nine women with histologically 
    Output:
    