***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 Increase of survival in pediatric acute lymphoblastic leukemia ( ALL ) has made outcomes such as health-related quality of life ( HRQL ) and economic burden more important . To make informed decisions on the use of healthcare re sources , costs as well as utilities need to be taken into account . Among the preference-based HRQL instruments , the Health Utilities Index ( HUI ) is the most employed in pediatric cancer . Information on utility scores during ALL treatment and in long-term survivors is available , but utility scores in short-term survivors are lacking . This study assesses utility scores , health state , and HRQL in short-term ( 6 months to 4 years ) ALL survivors . Methods Cross-sectional single-center cohort study of short-term ALL survivors using HUI3 proxy assessment s. Results Thirty-three survivors ( median 1.5 years off treatment ) reported 14 unique health states . The majority of survivors ( 61 % ) enjoyed a perfect health , but 21 % had three affected attributes . Overall , HRQL was nonsignificantly lower compared to the norm , although the difference was large and may be clinical ly relevant . Cognition was significantly impaired ( p = 0.03 ) . Conclusion Although 61 % of short-term survivors of ALL report no impairment , the health status of the other patients lead to a clinical ly important impaired HRQL compared to norms . Prospect i ve studies assessing utility scores associated with pediatric ALL should be performed , enabling valid and reliable cost-utility analyses for policy makers to make informed decisions The authors prospect ively assessed anxiety , depression , and behavior in children with st and ard‐risk acute lymphoblastic leukemia ( SR‐ALL ) during the first year of therapy and identified associated risk factors Background Glucocorticoids are important in the treatment of childhood acute lymphoblastic leukaemia ( ALL ) . However , cyclic administration of high dose glucocorticoids may cause rapid and substantial changes in quality of life ( QoL ) . The maintenance phase of the Dutch ALL-9 protocol consisted of alternating two weeks on and five weeks off dexamethasone ( 6 mg/m2/day ) . The present study was performed to assess the effect of dexamethasone on QoL during treatment for ALL according to this protocol . Methods In a multicentre prospect i ve cohort study , QoL was assessed halfway ( T1 ) and at the end of the two-year treatment ( T2 ) . A generic ( Child Health Question naire ) and disease specific ( PedsQL ™ cancer version ) QoL question naire were used to assess QoL in two periods : on and off dexamethasone , respectively . Results 41 children ( 56 % males ) were evaluated , mean age at diagnosis was 5.6 years .  The CHQ physical and psychosocial summary scores were significantly lower than population norms . At T1 and T2 , overall QoL showed no significant change . However , regarding specific domains ( pain , cognitive functioning , emotion/behaviour and physical functioning ) QoL decreased over time . QoL was significantly more impaired during periods on dexamethasone . Conclusion Dexamethasone was associated with decreased QoL. At the end of treatment , reported QoL during dexamethasone deteriorated even more on certain scales ( pain , cognitive functioning , emotion/behaviour and physical functioning ) . Knowledge of the specific aspects of QoL is essential to improve counselling and coping in paediatric oncology . Adverse effects of specific drugs on QoL should be taken into account when design ing treatment protocol St and ard risk acute lymphoblastic leukemia ( SR-ALL ) has high cure rates , but requires 2 - 3 years of therapy . We aim ed to ( i ) prospect ively evaluate health-related quality of life ( HRQOL ) during and after SR-ALL therapy , and ( ii ) identify associated predictors . Parents of 160 SR-ALL patients enrolled on Children 's Oncology Group ( COG ) therapeutic trial AALL0331 at 31 sites completed the  Pediatric Quality of Life Inventory ( PedsQL ) 4.0 Generic Core Scales ( physical , emotional and social functioning ) and Family Assessment Device-General Functioning ( FAD-GF ) at 1 , 6 and 12 months after diagnosis , and 3 months post-therapy . Mean PedsQL scores in physical , emotional and social functioning were impaired 1 month after diagnosis but steadily improved . Three months post-therapy , impaired physical and social functioning was observed in 27.8 and 25.8 % of patients , respectively . In repeated- measures analysis , problematic family functioning predicted emotional ( OR = 1.85 , 95 % CI 1.03 - 3.34 ) and social ( OR = 1.99 , 95 % CI 1.21 - 3.27 ) impairment . Larger household size was associated with social impairment ( OR = 1.21 , 95 % CI 1.02 - 1.45 ) . Adverse neurological event(s ) during therapy predicted post-therapy physical ( OR = 5.17 , 95 % CI 1.61 - 16.63 ) and social ( OR = 8.17 , 95 % CI 1.19 - 56.16 ) impairment . HRQOL 1 month after diagnosis was not predictive of HRQOL 3 months after therapy completion . In conclusion , children with SR-ALL experience considerable impairment in HRQOL at the end of induction , but rapidly improve . However , many still experience physical and social impairment 3 months post-therapy , suggesting a role for continued family and physical functioning support . Longer follow-up is needed to determine if post-therapy deficits change over time High survival rates after childhood cancer raise attention to possible psychosocial late effects . We focus on predictors of psychosocial outcomes based on diagnosis , treatment , demography , somatic disease , and method ological problems . Overall , survivors evaluate their health-related quality of life to be normal or even better than controls , although virtually all diagnostic subgroups report psychosocial impairment .  Central nervous system tumor survivors have significant psychosocial problems . Negative outcomes were associated with cranial radiation therapy , female gender , and young age at diagnosis . Significant method ological problems hamper current knowledge . Systematic registration of psychosocial and somatic problems at diagnosis and prospect ively through protocol s is needed BACKGROUND Health-related quality of life ( HRQoL ) from diagnosis until end of treatment for children with acute lymphoblastic leukaemia was investigated , examining effects of age , gender , risk-stratified treatment regimen , and therapy intensity ( one vs. two ' delayed intensifications ' [ DIs ] ) . METHOD In a multi-centre prospect i ve study , parents reported their child 's generic and disease-specific HRQoL and their own care-giving burden at five time points . From 1,428 eligible patients , 874 parents completed question naires  at least once during treatment . RESULTS At each time point , generic HRQoL was significantly lower than equivalent norm scores for healthy children . HRQoL decreased significantly at the start of treatment , before recovering gradually ( but remained below pre-treatment levels ) . Parents reported that older children worried more about side effects and their appearance , but showed less procedural anxiety than younger children . Concern for appearance was greater among girls than boys . Compared to Regimen B ( i.e. additional doxorubicin during induction and additional cyclophosphamide and cytarabine during consolidation chemotherapy ) , patients receiving Regimen A had fewer problems with pain and nausea . There were no statistically significant differences in HRQoL by number of DI blocks received . INTERPRETATION HRQoL is compromised at all stages of treatment , and is partly dependent on age . The findings increase underst and ing of the impact of therapy on children 's HRQoL and parental care-giving burden , and will contribute to the design of future trials 
    Output:
    
HRQoL findings were mixed , dependent on time since completion and comparison group .
Patient HRQoL was mostly lower compared to normative data , whilst higher compared to healthy control groups , patients on treatment , and patients with other types of cancers .
Lower HRQoL was also found to be associated with demographic ( age and sex ) , family dysfunction , and treatment-related factors .
Conclusions Completing treatment signalled a significant improvement in HRQoL for patients compared to being on treatment .
Overall , however , HRQoL was still significantly lower than the population during the early post-treatment period