***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: BACKGROUND The main goal of this study was to assess frequency , clinical correlates , and independent predictors of fatigue in a homogeneous cohort of well-defined glioblastoma patients at baseline prior to combined radio-chemotherapy .  METHODS We prospect ively included 65 glioblastoma patients at postsurgical baseline and assessed fatigue , sleepiness , mean bedtimes , mood disturbances , and  clinical characteristics such as clinical performance status , presenting symptomatology , details on neurosurgical procedure , and tumor location and diameter as well as pharmacological treatment including antiepileptic drugs , antidepressants , and use of corticosteroids . Data on fatigue and sleepiness were measured with the Fatigue Severity Scale and the Epworth Sleepiness Scale , respectively , and compared with 130 age- and sex-matched healthy controls . RESULTS We observed a significant correlation between fatigue and sleepiness scores in both patients ( r = 0.26 ; P = .04 ) and controls ( r = 0.36 ; P < .001 ) . Only fatigue appeared to be more common in glioblastoma patients than in healthy controls ( 48 % vs 11 % ; P < .001 ) but not the frequency of sleepiness ( 22 % vs 19 % ; P = .43 ) . Female sex was associated with increased fatigue frequency among glioblastoma patients but not among control participants . Multiple linear regression analyses identified depression , left-sided tumor location , and female sex as strongest associates of baseline fatigue severity . CONCLUSIONS Our findings indicate that glioblastoma patients are frequently affected by fatigue at baseline , suggesting that factors other than those related to radio- or chemotherapy have significant impact , particularly depression and tumor localization BACKGROUND Recurrent glioblastoma multiforme ( GBM ) is resistant to most therapeutic endeavors , with low response rates and survival rarely exceeding six months . There are no clearly established chemotherapeutic regimens and the aim of treatment is palliation with improvement in the quality of life . PATIENTS AND METHODS We report an open-label , uncontrolled , multicenter phase II trial of temozolomide in 138 patients ( intent-to-treat [ ITT ] population ) with glioblastoma multiforme at first relapse and a Karnofsky performance status ( KPS ) > or = 70 . One hundred twenty-eight patients were histologically confirmed with GBM or gliosarcoma ( GS ) by independent central review . Chemotherapy-naïve patients were treated with temozolomide 200 mg/m2/day orally for the first five days of a 28-day cycle . Patients previously treated with nitrosourea-containing adjuvant chemotherapy  received 150 mg/m2/day for the first five days of a 28-day cycle . In the absence of grade 3 or 4 toxicity , patients on the 150 mg/m2 dose schedule were eligible for a 200 mg/m2 dose on the next cycle . RESULTS The primary endpoint was six-month progression-free survival assessed with strict radiological and clinical criteria . Secondary endpoints included radiological response and Health-related Quality of Life ( HQL ) . Progression-free survival at six months was 18 % ( 95 % confidence interval ( CI ) : 11%-26 % ) for the eligible-histology population . Median progression-free survival and median overall survival were 2.1 months and 5.4 months , respectively . The six-month survival rate was 46 % . The objective response rate ( complete response and partial response ) determined by independent central review of gadolinium-enhanced magnetic resonance imaging ( MRI ) scans was 8 % for both the ITT and eligible-histology population s , with an additional 43 % and 45 % of patients , respectively , having stable disease ( SD ) . Objective ly assessed response and maintenance of a progression-free status were both associated with HQL benefits ( characterized by improvements over baseline in HQL domains ) . Temozolomide had an acceptable safety profile , with only 9 % of therapy cycles requiring a dose reduction due to thrombocytopenia . There was no evidence of cumulative hematologic toxicity . CONCLUSIONS Temozolomide demonstrated modest clinical efficacy , with an acceptable safety profile and measurable improvement in quality of life in patients with recurrent GBM . The use of this drug should be explored further in an adjuvant setting and in combination with other agents The objective was to set the basis for a prospect i ve , multicentre data collection on newly diagnosed adult glioblastoma patients diagnosed in Lombardia by means of a common data base used by neurological and neurosurgical units of various hospitals , providing epidemiological , therapy and follow-up data . All adult patients with a newly diagnosed glioblastoma in 9 Lombardia hospitals from 31 March 2003 to 31 March 2004 were followed prospect ively by a form elaborated by the Lombardia Neuro-oncology Group . Demographic data were recorded , as well as symptoms at onset , entity of tumour resection , post-surgical Karnofsky Performance Score , radio- and chemotherapy , presence/absence of venous thrombosis , type of antiepileptic treatment , time to tumour progression and survival time ( ST ) .  One hundred and thirty-four newly diagnosed glioblastoma patients were enrolled during the first year of the study . Male/female ratio was 1.6:1 . Median age was 61 years . The most common single sign/symptom at disease onset included seizures , followed by mood/cognition changes and headache . In 71 patients , the tumour involved 1 brain lobe at diagnosis . Twenty-five patients underwent biopsy , 51 partial removal and 51 grossly total removal . At analysis of predictive value on ST , grossly total resection and chemotherapy were significantly associated with a longer ST . Age younger than 50 showed a trend to predictive value . A very high proportion of patients were treated with  antiepileptic drugs  , even in the absence of seizures . Median ST was 12 months in our cohort . Data in newly diagnosed glioblastoma patients in Lombardia are in line with other case series reported in other population BACKGROUND Patients with advanced , incurable cancer receiving anticancer treatment often experience multidimensional symptoms . We hypothesize that real-time monitoring of both symptoms and clinical syndromes will improve symptom management by oncologists and patient outcomes . PATIENTS AND METHODS In this prospect i ve multicenter cluster-r and omized phase-III trial , patients with incurable , symptomatic , solid tumors , who received new outpatient chemotherapy with palliative intention , were eligible . Immediately before the weekly oncologists ' visit , patients completed the palm-based E-MOSAIC assessment ( Edmonton-Symptom- Assessment -Scale , ≤3 additional symptoms , estimated nutritional intake , body weight change , Karnofsky Performance Status , medications for pain , fatigue , nutrition ) . A cumulative , longitudinal monitoring sheet ( LoMoS ) was printed immediately . Eligible experienced oncologists were defined as one cluster each and r and omized to receive the immediate print-out LoMoS ( intervention ) or not ( control ) . Primary analysis limited to patients having uninterrupted ( > 4/6 visits with same oncologist ) patient-oncologist sequences was a mixed model for the difference in patients global quality of life ( G-QoL ; items 29/30 of EORTC-QlQ-c30 ) between baseline ( BL ) and week 6 . Intention-to-treat ( ITT ) analysis included all eligible patients . RESULTS In 8 centers , 82 oncologists treated 264 patients ( median 66 years ; overall survival intervention 6.3 , control 5.4 months ) with various tumors . The between-arm difference in G-QoL of 102 uninterrupted patients ( intervention : 55 ; control : 47 ) was 6.8 ( P = 0.11 ) in favor of the intervention ; in a sensitivity analysis ( oncologists treating ≥2 patients ; 50 , 39 ) , it was 9.0 ( P = 0.07 ) . ITT analysis revealed improvement in symptoms ( difference last study visit-BL : intervention -5.4 versus control 2.1 , P = 0.003 ) and favored the intervention for communication and coping . More patients with high symptom load received immediate symptom management ( chart review , nurse-patient interview ) by oncologists getting the LoMoS. CONCLUSION Monitoring of patient symptoms , clinical syndromes and their management clearly reduced patients ' symptoms , but not QoL. Our results encourage the implementation of real-time monitoring in the routine workflow of oncologist with a computer solution This retrospective study of 133 patients with glioblastoma multiforme evaluates  survival times post-radiation in patients stratified in respect to age , presenting symptoms , tumour location , extent of surgery , and radiation dose delivered . Presenting features were coded as seizure , loss of consciousness , headache , speech or visual disturbance , weakness and confusion , as were tumour sites within the brain . Other parameters assessed included side of brain , age , extent of surgery and radiation dose . Statistical evaluation was undertaken by univariate and multivariate analyses to identify factors leading to enhanced survival . The median survival post-radiation was 10 months . A trend to improved early survival was demonstrated in patients presenting with acute and debilitating symptoms . The data presented reveals improved outcomes for patients younger than 60 years , particularly if radical surgery is undertaken with higher dose radiation . It is postulated that patients presenting with acute signs and symptoms are investigated earlier and are referred more promptly for treatment Purpose Optimal long-lasting treatment with sunitinib and sorafenib is limited by dose modifications ( DMs ) due to adverse events ( AEs ) . These AEs may be underrecognized and their influence on health-related quality of life ( HRQL ) underestimated . Improved insight into the relationship between AEs and therapy decisions is needed . To improve decision making around managing symptoms and reduce DMs , this study was set up to explore the influence of patient-reported symptoms on therapy decisions . Methods In this multicenter cohort study , patient characteristics , reasons for and different forms of used dose modifications , and AEs were prospect ively obtained from cancer patients on sunitinib/sorafenib treatment . Used instruments to get insight into AEs were the patient-scored Utrecht Symptom Diary ( USD ) and the professional-scored Common Terminology Criteria for AEs version 3.0 . Results Median total treatment duration in 42 patients was 16 weeks . Median time till dose modification was 10 weeks . DMs occurred mostly due to multiple mild AEs . By using the USD , a higher prevalence of most AEs was found compared to the literature . Sixty percent of the patients experienced a decreased HRQL due to multiple AEs . Conclusions Because severe AEs due to sunitinib/sorafenib treatment seldom occur , it is more important to focus on treating and preventing multiple mild AEs with higher impact on HRQL , when trying to avoid dose modifications . Using patient self-reported measurement methods helps to early recognize symptoms and to differentiate among symptom intensities . This systematic approach might help to achieve the optimal dosing , which might improve PFS and OS PURPOSE Temozolomide is a novel oral alkylating agent with demonstrated efficacy as second-line therapy for patients with recurrent anaplastic astrocytoma and glioblastoma multiforme ( GBM ) . This phase II study was performed to determine the safety , tolerability , and efficacy of concomitant radiation plus temozolomide therapy followed by adjuvant temozolomide therapy in patients with newly diagnosed GBM . PATIENTS AND METHODS Sixty-four patients were enrolled onto this open-label , phase II trial . Temozolomide ( 75 mg/m(2)/d x 7 d/wk for 6 weeks ) was administered orally concomitant with fractionated radiotherapy ( 60 Gy total dose : 2 Gy x 5 d/wk for 6 weeks ) followed by temozolomide monotherapy ( 200 mg/m(2)/d x 5 days , every 28 days for six cycles ) . The primary end points were safety and tolerability , and the secondary end point was overall survival . RESULTS Concomitant radiation plus temozolomide therapy was safe and well tolerated . Nonhematologic toxicities were rare and mild to moderate in severity . During the concomitant treatment phase , grade 3 or 4 neutropenia , thrombocytopenia , or both were observed in 6 % of patients , including two severe infections with Pneumocystis carinii . During adjuvant temozolomide , 2 % and 6 % of cycles were associated with grade 3 and 4 neutropenia or thrombocytopenia , respectively . Median survival was 16 months , and the 1- and 2-year survival rates were 58 % and 31 % , respectively . Patients younger than 50 years old and patients who underwent debulking surgery had the best survival outcome . CONCLUSION Continuous daily temozolomide and concomitant radiation is safe . This regimen of concomitant chemoradiotherapy followed by adjuvant chemotherapy may prolong the survival of patients with glioblastoma . Further investigation is warranted , and a r and omized trial is ongoing BACKGROUND Most patients with glioblastoma are older than 60 years , but treatment guidelines are based on trials in patients aged only up to 70 years . We did a r and omised trial to assess the optimum palliative treatment in patients aged 60 years and older with glioblastoma . METHODS Patients with newly diagnosed glioblastoma were recruited from Austria , Denmark , France , Norway , Sweden , Switzerl and , and Turkey 
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Conclusions Eight out of ten of the most prevalent symptoms in glioma patients are related to the central nervous system and therefore specific for glioma .
Our findings emphasize the importance of tailored symptom care for glioma patients and may aid in the development of specific PROMs for glioma patients in different phases of the disease