***TASK***
the task is to simplify the input abstract of a biomedical literature

***INPUT***
the input is the abstract of a biomedical literature

***OUTPUT***
the output is the simplified abstract for the input abstract of a biomedical literature

***DOCUMENTATION***

***EXAMPLES***

Input: The primary analysis of overall effect using hazard ratios derived from published survival curves involved six trials (692 women). No significant difference was seen (hazard ratio 0.94, 95% CI 0.79 to 1.12, P = 0.5). A test for heterogeneity gave a P value of 0.1. A pooled estimate of reported response rates in eight trials involving 817 women showed a significant advantage for chemotherapy over endocrine therapy with a relative risk of 1.25 (95% CI 1.01 to 1.54, P = 0.04). However the point estimates for the two largest trials were in opposite directions, and an overall test for heterogeneity gave a P value of 0.0009. There was little information available on toxicity and quality of life. Six of the seven fully published trials commented on increased toxicity with chemotherapy, mentioning nausea, vomiting and alopecia. Three of the seven trials mentioned aspects of quality of life, with differing results. Only one trial formally measured quality of life, concluding that it was better with chemotherapy. In women with metastatic breast cancer and where hormone receptors are present, a policy of treating first with endocrine therapy rather than chemotherapy is recommended except in the presence of rapidly progressive disease.
Output:

This review found that while initial treatment with chemotherapy rather than endocrine therapy may be associated with a higher response rate, the two initial treatments had a similar effect on overall survival. No single group of patients who might benefit from or be harmed by one treatment over the other were identified, although there was little information to address this question. Six of the seven fully published trials commented on increased toxicity associated with chemotherapy including nausea, vomiting and alopecia. Three of the seven trials mentioned aspects of quality of life but their findings provided differing results. Only one trial formally measured quality of life (QOL), concluding that QOL was better with chemotherapy. Based on these trials, no conclusions can be made as to the QOL achieved with either treatment. Accurate information about hormone receptor status is now routinely available for many women with metastatic breast cancer, and hormonal treatments have improved in their effectiveness in the last 10 years. In women with metastatic breast cancer where hormone receptors are present, a policy of treating first with endocrine therapy rather than chemotherapy appears to be better, on the basis of the trials and outcomes in this review, except in the presence of rapidly progressive disease.