***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: Purpose Bladder cancer ( BC ) is one of the most common cancers worldwide . BC diagnosis and surveillance is based on cystoscopy ( CS ) . CS impact on patient ’s depression , anxiety , and sexual satisfaction ( SS ) is not sufficiently studied . There are no data on patient ’s comfort with flexible or rigid CS . Methods We prospect ively evaluated pain perception ( PP ) , depression , anxiety , and SS of 100 male patients who previously underwent at least one rigid CS in our department as surveillance after TURB procedure due to non-muscle-invasive BC and were scheduled for the next CS examination . The patients were r and omized for flexible or rigid CS .  Before CS , patients described their recalled rigid CS-related pain by NRS and fulfilled HADS and SS question naires . After CS , PP was re-evaluated immediately and HADS and SS within 7–10 days following the CS . Results The baseline scores include 5.2 ± 2.6 points for rigid CS recalled pain , 7.2 ± 3.0 points for HADS anxiety , 5.8 ± 3.5 for depression , and 27.8 ± 5.1 for SS . The flexible CS-related  pain was approximately three times lower than the recalled pain level and also than the current rigid CS related ( p < 0.001 ) . Mean SS score was two points lowered after rigid CS ( p < 0.001 ) . One point decrease in anxiety level was observed after flexible CS ( p < 0.001 ) . Multivariate analysis supported the hypothesis of patients benefiting from flexible CS in terms of pain perception , anxiety symptoms , and SS . Conclusions Our study demonstrates the superiority of flexible CS in terms of pain alleviation , and shifts in SS and anxiety levels To test the feasibility of a r and omised trial in muscle‐invasive bladder cancer ( MIBC ) and compare outcomes in patients who receive neoadjuvant chemotherapy followed by radical cystectomy ( RC ) or selective bladder preservation ( SBP )  , where definitive treatment [ RC or radiotherapy ( RT ) ] is determined by response to chemotherapy Background The use of web-based monitoring for lung cancer patients is growing in interest because of promising recent results suggesting improvement in cancer and re source utilization outcomes . It remains an open question whether the overall survival ( OS ) in these patients could be improved by using a web-mediated follow-up rather than classical scheduled follow-up and imaging . Methods Advanced-stage lung cancer patients without evidence of disease progression after or during initial treatment were r and omly assigned in a multicenter phase III trial to compare a web-mediated follow-up algorithm ( experimental arm ) , based on weekly self-scored patient symptoms , with routine follow-up with CT scans scheduled every three to six months according to the disease stage ( control arm ) . In the experimental arm , an alert email was automatically sent to the oncologist when self-scored symptoms matched predefined criteria . The primary outcome was OS . Results From June 2014 to January 2016 , 133 patients were enrolled and 121 were retained in the intent-to-treat analysis ; 12 deemed ineligible after r and om assignment were not subsequently followed . Most of the patients ( 95.1 % ) had stage III or IV disease . The median follow-up was nine months . The median OS was 19.0 months ( 95 % confidence interval [ CI ] = 12.5 to noncalculable ) in the experimental and 12.0 months ( 95 % CI = 8.6 to 16.4 ) in the control arm ( one-sided P = .001 ) ( hazard ratio = 0.32 , 95 % CI = 0.15 to 0.67 , one-sided P = .002 ) . The performance status at first detected relapse was 0 to 1 for 75.9 % of the patients in the experimental arm and for 32.5 % of those in the control arm ( two-sided P < .001 ) . Optimal treatment was initiated in 72.4 % of the patients in the experimental arm and in 32.5 % of those in the control arm ( two-sided P < .001 ) . Conclusions A web-mediated follow-up algorithm based on self-reported symptoms improved OS due to early relapse detection and better performance status at relapse Purpose To examine quality of life ( QoL ) , health status , sexual function , and anxiety in patients with primary hematuria who later appear to have bladder cancer ( BC ) and patients with other diagnoses . Methods From July 2007 to July 2010 , 598 patients with primary hematuria were enrolled in this prospect i ve , multicenter study . Question naires ( WHOQOL-BREF , SF-12 , IIEF , STAI-10-item Trait ) were completed before cystoscopy . Diagnosis was subsequently derived from medical files . BC patients were compared with patients with other causes of hematuria . Results Cancer was diagnosed in 131 patients ( 21.9 % ) , including 102 patients ( 17.1 % ) with BC . No differences were found in the WHOQOL-BREF versus SF-12 psychological or physical health domains . The erectile function was significantly worse in the BC group ( 9.3 vs. 14.6 for OC , p = 0.02 ) . Patients with muscle-invasive BC ( MIBC ) had the lowest percentage anxious personalities of all BC patients ( p = 0.04 ) . Conclusions Cancer was found in 21.9 % of the patients with hematuria . Pre-diagnosis patients with BC have comparable QoL and HS to patients with OC . Erectile dysfunction was highest in patients with BC . MIBC patients had the lowest percentage anxious personalities of the patients with BC PURPOSE There is growing interest to enhance symptom monitoring during routine cancer care using patient-reported outcomes , but evidence of impact on clinical outcomes is limited . METHODS We r and omly assigned patients receiving routine outpatient chemotherapy for advanced solid tumors at Memorial Sloan Kettering Cancer Center to report 12 common symptoms via tablet computers or to receive usual care consisting of symptom monitoring at the discretion of clinicians . Those with home computers received weekly e-mail prompts to report between visits . Treating physicians received symptom printouts at visits , and nurses received e-mail alerts when participants reported severe or worsening symptoms . The primary outcome was change in health-related quality of life ( HRQL ) at 6 months compared with baseline , measured by the EuroQol EQ-5D Index . Secondary endpoints included emergency room ( ER ) visits , hospitalizations , and survival . RESULTS Among 766 patients allocated , HRQL improved among more participants in the intervention group than usual care ( 34 % v 18 % ) and worsened among fewer ( 38 % v 53 % ; P < .001 ) . Overall , mean HRQL declined by less in the intervention group than usual care ( 1.4- v 7.1-point drop ; P < .001 ) . Patients receiving intervention were less frequently admitted to the ER ( 34 % v 41 % ; P = .02 ) or hospitalized ( 45 % v 49 % ; P = .08 ) and remained on chemotherapy longer ( mean , 8.2 v 6.3 months ; P = .002 ) . Although 75 % of the intervention group was alive at 1 year , 69 % with usual care survived the year ( P = .05 ) , with differences also seen in quality -adjusted survival ( mean of 8.7 v. 8.0 months ; P = .004 ) . Benefits were greater for participants lacking prior computer experience . Most patients receiving intervention ( 63 % ) reported severe symptoms during the study . Nurses frequently initiated clinical actions in response to e-mail alerts . CONCLUSION Clinical benefits were associated with symptom self-reporting during cancer care Objectives : i ) To evaluate objective response , toxicity , and quality of life ( QoL ) of gemcitabine monotherapy as second-line treatment in patients with cisplatin-refractory , metastatic transitional cell carcinoma ( TCC ) . ii ) To assess prognostic parameters for response to treatment and for improvement of QoL parameters . Patients and Methods : 30 patients were prospect ively enrolled in this open-label , nonr and omized multicenter phase II trial . Patients received up to 6 courses of gemcitabine monotherapy ( 1,250 mg/m2 on day 1 and 8 of a 21-day course ) . 28 of 30 patients were available for response evaluation . Results : Objective response ( OR ) was seen in 3/28 ( 11 % ) of patients ( 2 complete remissions , 1 partial remission ) . The mean time to progression ( TTP ) was 4.9 ± 3.5 months and mean disease-specific survival time was 8.7 ± 4.7 months . 13 of 28 patients did not progress ( OR + 10 stable diseases ) , and TTP ( 8.0 ± 2.7 months , p < 0.001 ) as well as survival time ( 10.2 ± 3.8 months , p < 0.05 ) differed significantly from those who showed progressive disease within 18 weeks of treatment . Pain values significantly improved in the group of responders from 4.3 ± 1.9 to 5.8 ± 1.3 points ( p < 0.05 ) . Response to cisplatin  pretreatment was the best prognosticator for the response to gemcitabine . Conclusions : Gemcitabine monotherapy as second-line treatment is justified in patients with metastatic TCC who are refractory to cisplatin treatment . Patients with initially OR  to cisplatin  benefit most from second-line treatment . QoL remains stable during treatment , and pain improves especially in patients with bone metastases OBJECTIVES To explore the effects of cancer on psychosocial aspects of Pakistani patients and their families , assessing the need for interventions to improve their quality of life . METHODS A prospect i ve , Cross-sectional study was performed on 200 patients visiting the oncology outpatient facility of AKUH from December 2010 to May 2011 through an interview . Responses were recorded on pre- design ed question naires including FACT-G QOL ( Functional Assessment of Cancer Therapy-General Quality Of Life ) component . RESULTS Out of the 200 patients 52 ( 26 % ) were males and 148 ( 74 % ) were females . Mean age was 51.8 + /- 14.2 years . Breast cancer accounted for the commonest cancer in females 116 ( 58 % ) and lung in males 30 ( 15 % ) , 100 ( 50 % ) patients were currently undergoing chemotherapy . In all 148 ( 74 % ) patients were well aware of their diagnosis and were able to cope better and 142 ( 71 % ) were well supported by families ( majority being financially stable ) . Major financial impact was found in 42 ( 21 % ) cases . Religious/spiritual help was sought by 138 ( 69 % ) patients predominantly females- 113 ( 76 % ) and 22 ( 11 % ) patients consulted a psychiatrist ; 20 ( 94 % ) subjects of this group felt this intervention was helpful . Responses regarding effect on the patient 's sexual life were poor and 126 ( 63 % ) denied answering the question . CONCLUSION In our study one third of cancer patients were found to be depressed mainly affecting those who were receiving multimodality treatment or facing financial issues . Religious help was the main coping strategy for them BACKGROUND Radical radiotherapy for muscle-invasive urinary bladder cancer can sterilize the tumour with preserved organ function . Here we studied symptoms , symptom distress and trade-off among long-term survivors and compared figures to those of population controls and patients who had undergone cystectomy .  MATERIAL S AND METHODS We identified 71 patients who had had urinary bladder cancer treated with radical radiotherapy before 1995 . For comparison , 325 patients treated with radical cystectomy and urostomy , continent or non-continent , during the same period and 460 individuals r and omly selected from the general population were included . Information was collected by means of an anonymously answered postal question naire to avoid investigator-related bias . RESULTS Answers were obtained from 58 ( 82 % ) radiated patients , 251 ( 85 % ) cystectomized patients and 310 ( 71 % ) population controls . Of the radiated patients , 74 % reported little or no distress from symptoms from the urinary tract , 38 % had had intercourse the previous month and 57 % ( men ) reported they had ejaculated . Among the cystectomized patients , 13 % had had intercourse and 0 % ( men ) had ejaculated . Moderate or much distress from symptoms from the gastrointestinal tract was reported by 32 % of the radiated patients , 24 % of the cystectomized patients and 9 % of the population controls . After radical radiotherapy , 46 % of the patients were willing to accept some risk of decreased survival to become symptom-free . CONCLUSIONS About 3/4 of these long-term survivors after radical radiotherapy for bladder cancer had a functioning urinary bladder with little or no distress from the urinary tract . The prevalence of sexual dysfunction was lower than after cystectomy and the prevalence of distress from the gastrointestinal tract was comparable OBJECTIVES The aim of the population -based study presented here was to evaluate quality of life ( QOL ) among bladder cancer survivors at least five years after diagnosis , ascertain the long term effects of treatments , and investigate important pathological and sociodemographic factors influencing the QOL of such survivors . METHODS A Functional 
    Output:
    
From the studies included the overall QoL seemed inversely related to the organ-specific impairment from sexual and urinary symptoms and increased with decreasing organ-specific symptoms for long term survivors > 6 months after treatment .