***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 European Study Group for Pancreatic Cancer ( ESPAC-1 ) study is the largest study of adjuvant treatment for pancreatic ductal adenocarcinoma to date and confirmed a survival advantage for adjuvant chemotherapy but not for chemoradiation . The importance of parallel evaluation of survival and quality of life ( QoL ) has been recognized as fundamental and the aim was to assess QoL and quality adjusted survival . A longitudinal QoL study on a subset of ESPAC-1 patients who prospect ively completed the EORTC QLQ C-30 question naire  during treatment and follow-up . An integrated quality -survival product method was used to adjust any treatment effect on survival by a function of measured QoL , calculated over a restricted 24-month-period ( QALM-24 ) . Three hundred and sixteen patients completed 1,201 question naires . There were no differences between treatment groups in dimension scores at baseline ( r and omization ) . For the  chemotherapy group , the mean Quality Adjusted Life Months over 24 months ( QALM-24 ) was 9.6 ( 95 % CI : 8.7 , 11.2 ) months compared with the mean QALM-24 of 8.6 ( 95 % CI : 7.6 , 10.5 ) months for the no chemotherapy group . For the chemoradiation group , the mean QALM-24 was 7.1 ( 95 % CI : 6.0 , 9.0 ) months compared with the mean QALM-24 of 8.1 ( 95 % CI : 7.0 , 10.0 ) months for the no chemoradiation group . The previously reported survival advantage supporting the use of adjuvant chemotherapy is maintained when adjusted using quality adjusted survival methodology . Chemotherapy provided on average an additional 1.0 quality -adjusted life months within a restricted 2-year time period from the time of resection PURPOSE To determine the effects of primary chemoembolization on the health-related quality of life ( HRQOL ) of patients with hepatocellular carcinoma ( HCC ) . MATERIAL S AND METHODS Single-center prospect i ve data collection with longitudinal analysis of HRQOL scores obtained via the Short Form-36 ( SF-36 ) assessment tool was performed before and during serial chemoembolization procedures in 73 patients with HCC . Baseline HRQOL scores were evaluated for significant ( P < .05 ) change within the total patient population during 4 , 8 , and 12 months of treatment , and separately within a subset of 23 patients who underwent three or more chemoembolization procedures . RESULTS Patients had decreased pretreatment baseline scores within all eight scales of the SF-36 compared with healthy age-adjusted norms . Within the total population , mental health scores improved after 4 months of chemoembolization ( rate of change , 5.6 ; P = .05 ; n = 48 ) , but no significant change was present at 8 or 12 months . Subset patients experienced improvements of mental health scores after the first ( score change , 13 ; P = .008 ; n = 21 ) and second procedures ( score change , 12.2 ; P = .002 ; n = 23 ) and improvements of bodily pain scores ( score change , 9.9 ; P = .047 ; n = 21 ) after the initial procedure . Vitality scores worsened ( score change , -7.8 ; P = .044 ; n = 21 ) in the subset after the first chemoembolization . CONCLUSIONS Patients with HCC are likely to perceive improved mental health during the first 4 months of primary treatment with chemoembolization . In addition , if patients ultimately undergo more than two procedures , they are likely to perceive improved mental health during the first two sessions , with decreased bodily pain during the initial session . Patient-perceived vitality will likely worsen after the initial procedure OBJECTIVES : A dramatic rise in incidence , an aging population , and expensive palliative treatments have led to an escalating burden on clinicians managing inoperable esophageal cancer with only limited evidence of effectiveness . This study compares the clinical effectiveness and cost-effectiveness of self-exp and ing metal stents ( SEMSs ) with other palliative therapies to aid clinicians in making an evidence -based treatment choice . METHODS : We conducted a prospect i ve , multicenter , r and omized , controlled , clinical trial with 215 patients followed until death or study closure . The primary outcome measures were dysphagia , quality of life ( QL ) 6 weeks following treatment , and total cost of treatment . Secondary outcome measures included treatment-associated morbidity , mortality , survival , and cost-effectiveness . An intention-to-treat analysis was carried out . RESULTS : There was a significant difference in mean dysphagia grade between treatment arms 6 weeks following treatment ( P=0.046 ) , with worse swallowing reported by rigid stent – treated patients ( mean dysphagia score difference=−0.49 ; 95 % confidence interval ( CI ) −0.10 to −0.89 , P=0.014 ) . Global QL scores were lower at both 1 and 6 weeks following treatment for patients treated by SEMSs ( mean difference QL index week 1=−0.66 ; 95 % CI : −0.02 to −1.30 , P=0.04 ; mean difference QL index week 6=−1.01 ; 95 % CI −0.30 to −1.72 , P=0.006 ) . These findings were associated with higher post-procedure pain scores in the SEMS patient group ( mean difference of the European Organisation for Research and Treatment of Cancer QLQ C-30 pain symptom score at week 1=11.13 ; 95 % CI : 2.89–19.4 ; P=0.01 ) . Although mean EQ-5D QL values differed between the treatments ( P<0.001 ) , this difference dissipated following generation of quality -adjusted life year values . Total costs varied between treatment arms but these findings canceled out when SEMSs were compared with non-SEMS therapies ( 95 % CI −845.15–1,332.62 ) . These results were robust to sensitivity analysis . There were no differences in the in-hospital mortality or early complication rates , but late complications were more frequent after rigid stenting ( risk ratio=2.47 ; 95 % CI 1.88–3.04 ) . There was a survival advantage for non-stent-treated patients ( log-rank statistic=4.21 , P=0.04 ) . CONCLUSIONS : The treatment choice for patients with inoperable esophageal cancer should be between a SEMS or a non-stent treatment after consideration has been given to both patient and tumor characteristics and clinician and patient preferences BACKGROUND AND OBJECTIVES This pilot study prospect ively evaluates the impact of esophageal resection on health-related quality of life ( HRQL ) and mood states at diagnosis and during the first year after surgery . METHODS Participants included 38 patients with planned esophageal resection . Two instruments were used : the Functional Assessment in Cancer Therapy core instrument with the esophageal subscale ( FACT-E ) , and the Profile of Mood States ( POMS ) . Subjects were evaluated after diagnosis and at 1 , 3 , 6 , 9 , and 12 months after surgical resection . RESULTS All subjects demonstrated a decrease in overall HRQL after resection with a gradual return toward baseline by month 9 . The functional and physical subscales of the FACT-E demonstrated the largest decrease at 1 month with a gradual return toward baseline . The POMS subscales that demonstrated the highest amount of disorder after surgery were tension , fatigue , and vigor . Although the trends were similar between patients undergoing surgery alone ( n = 18 ) and those with neoadjuvant therapy ( n = 20 ) , the group that had received surgery alone demonstrated a higher HRQL and less mood disorder during the postoperative period , as compared with the neoadjuvant group . CONCLUSIONS Patient perceptions of HRQL and mood states change over the first 12 months after esophageal resection . Although no statistically significant differences were found in this study , several trends were identified . Ongoing assessment s of these changes are important , and interventions need to be developed and implemented to produce an effective decrease in the impact of esophageal resection on HRQL and mood states , particularly after trimodality therapy Purpose Gemcitabine is the only drug approved for single-agent therapy in advanced pancreatic carcinoma ( APC ) .  Gemcitabine-based combination chemotherapy has not yet shown promising results . Methods This multicenter phase II study enrolled previously untreated patients with locally advanced and /or metastatic pancreatic adenocarcinoma . Patients received 1,000 mg/m2 gemcitabine , 100-min infusion , day 1 and 100 mg/m2 oxaliplatin , 2-h infusion , day 2 ; q2w . The primary end point was response rate ( RR ) . Results Thirteen study centers enrolled 48 eligible patients of which 44 were evaluable . The RR , median overall survival , and median time to progression were 18.2 % , 9.4 and 5.6 months , respectively . Sixteen patients ( 36.4 % ) experienced clinical benefit . The global quality of life scores improved by 11.71 . Grade 3/4 peripheral sensory neuropathy was noted ( 2.1 % ) , while the most common hematologic toxicity was anemia ( grade 3/4 , 6.3 % ) . Conclusions Gemcitabine and oxaliplatin combination chemotherapy showed a promising activity in APC patients and was well tolerated Purpose The quality of life ( QL ) of advanced gastric cancer patients receiving irinotecan , folinic acid and 5-fluorouracil ( 5-FU ) ( IF arm ) or cisplatin with 5-FU ( CF arm ) is presented . Methods Patients with measurable or evaluable advanced gastric cancer received IF weekly for 6/7 weeks or CF q4 weeks . QL was assessed using the EORTC QLQ-C30 at baseline , subsequently every 8 weeks until progression and thereafter every 3 months until death . The QL data were analysed using several statistical methods including summary measures and pattern-mixture modelling . Results A total of 333 patients were r and omised and treated ( IF 170 , CF 163 ) . The time-to-progression for IF and CF was 5.0 and 4.2 months ( P = 0.088 ) , respectively . The overall compliance rates for QL question naire completion were 60 and 56 % in the IF and CF arms , respectively . Significant treatment differences were observed for the physical functioning scale ( P = 0.024 ) , nausea\vomiting ( P = 0.001 ) and EQ-5D thermometer ( P = 0.020 ) in favour of the IF treatment arm . Conclusion There was a trend in favour of IF over CF in time-to-progression . The IF group also demonstrated a better safety profile than CF and a better QL on a number of multi-item scales , suggesting that IF offers an alternative first-line platinum-free treatment option for advanced gastric cancer BACKGROUND Previous work highlighted a number of method ological constraints when reporting health-related quality of life ( HRQOL ) outcomes from r and omized controlled trials ( RCTs ) . Given this , the objective of this study was to investigate whether the quality of such HRQOL reports has improved over time . MATERIAL S AND METHODS On the basis of a predefined set of criteria , 159 RCTs with a HRQOL end point , published between 1990 and 2004 were identified and analyzed . Each study was evaluated by a number of issues ( e.g. sample size and industry sponsorship ) and by the " minimum st and ard checklist for evaluating HRQOL outcomes in cancer clinical trials " . RESULTS The quality of HRQOL reports , as measured by the overall checklist score , was independently related to more recently published studies ( P < 0.0001 ) . This relationship was independent of industry funded , HRQOL end point ( primary versus secondary ) , cancer disease site , size of the study and HRQOL difference between treatment arms . While only 39.3 % of studies published between 1990 and 2000 ( 89/159 RCTs ) were identified as being probably robust , thus likely to support clinical decision making , this percentage was 64.3 % for studies published after 2000 ( 70/159 RCTs ) . CONCLUSION Since we found a significant learning curve in HRQOL trial reporting since 1990 , it can be expected that HRQOL data will increasingly impact on clinical decision making and treatment policies in the near future BACKGROUND A previous study reported a significant survival benefit for octreotide compared with no treatment in patients with advanced hepatocellular carcinoma ( HCC ) . This was investigated further in this multicentre study . PATIENTS AND METHODS Two hundred and seventy two patients with HCC who were ineligible for curative treatments or had relapsed following potentially curative therapies were r and omised to receive long-acting octreotide , 30 mg as an intramuscular injection once every 4 weeks for up to 2 years , or placebo . RESULTS At the time of the final analysis , median overall survival ( OS ) was 6.53 months ( 95 % confidence interval [ CI ] , 4.8 - 8.3 ) for octreotide versus 7.03 months ( 95 % CI , 5.43 - 8.53 ) for placebo ( p=0.34 ) . Progression-free survival ( p=0.26 ) also did not differ significantly between the two treatment groups . No objective 
    Output:
    
Studies in curative treatments for oesophagogastric cancer show that surgery and chemoradiation therapy has a major short-term detrimental effect on HRQL , but recovery occurs within 6 months in long-term survivors but those not achieving a survival benefit report very poor HRQL .
In advanced oesophageal cancer , 18 mm self-exp and able metal stents and nonstent therapies lead to better short-term HRQL scores than nonexp and able stents and are the recommended st and ard of care .
A small survival advantage and improved HRQL is conferred by adjuvant and palliative gemcitabine chemotherapy in patients with pancreatic cancer .
SUMMARY This review identified few well- design ed studies that also included a robust assessment of HRQL .