***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 objective was to investigate how prostate cancer and its treatment affects sexual , urinary and bowel functions and to what extent eventual complications cause distress . A question naire was sent to 431 men aged 50 - 80 years with prostate cancer diagnosed in 1992 in the Stockholm area ( Sweden ) and 435 r and omly selected men with a similar age distribution .  Sexual function , as compared with their youth , was diminished in a majority of all men . The prostate cancer patients were , however , more likely to report low frequency and /or intensity in all aspects of sexual function . A majority of the men were distressed by a waning sexual capacity . The proportion of men with prostate cancer who were severely distressed owing to a decline in sexual function was larger than in the reference group . The willingness to trade off an intact sexual function for long-term survival varied considerably among the men in the reference group . Urinary and bowel symptoms were less common than a waning sexual function in both groups , and few appeared to be severely distressed by urinary or bowel symptoms . A decline in sexual functions was the most common cause of disease-specific distress in men with prostate cancer OBJECTIVE To evaluate a single cycle of adjuvant chemotherapy compared with longer duration chemotherapy for premenopausal women or chemoendocrine therapy for postmenopausal women with operable breast cancer using a quality -of-life-oriented end point , Q-TWiST ( quality -adjusted analysis of TWiST : Time Without Symptoms and Toxicity ) . DESIGN Multicenter r and omized clinical trial -- International Breast Cancer Study Group ( IBCSG : formerly Ludwig Group ) Trial V. SETTING IBCSG participating centers in Sweden , Switzerl and , Australia , Yugoslavia , Spain , New Zeal and , Italy , Germany , and South Africa . PATIENTS Data were available for 1229 eligible patients with node-positive breast cancer who were r and omized to receive one of three adjuvant treatments after at least a total mastectomy and axillary clearance . INTERVENTIONS Patients received either a single cycle of perioperative chemotherapy consisting of cyclophosphamide , methotrexate , fluorouracil , and leucovorin ; or six cycles ( 6 months ) of a conventionally timed chemotherapy consisting of cyclophosphamide , methotrexate , fluorouracil , and prednisone for premenopausal women or this combination plus tamoxifen for postmenopausal women ; or both perioperative and conventionally timed chemotherapy for a 7-month course of adjuvant therapy . RESULTS At 5 years of median follow-up , patients who received the longer duration therapies had an improved 5-year disease-free survival percentage ( 53 % compared with 36 % ; P less than 0.001 ) and 5-year overall survival percentage ( 73 % compared with 63 % ; P = 0.001 ) compared with those who received the single perioperative cycle alone . By 3.5 years , the greater burden of toxic effects associated with the longer duration treatments was balanced by their superior control of disease . Within 5 years of follow-up , even after subtracting time with adjuvant treatment toxicity , patients gained an average of 2.2 months of Q-TWiST if treated with the longer duration therapies compared with the single cycle ( P = 0.03 ) . The gain for premenopausal patients was 2.8 months ( P = 0.05 ) , whereas the gain for postmenopausal women was 1.5 months ( P greater than 0.2 ) . CONCLUSIONS Six or seven months of adjuvant chemotherapy or chemoendocrine therapy improve both the quantity and quality of life for patients with node-positive breast cancer compared with a single short course of perioperative combination chemotherapy PURPOSE When faced with treatment choices for early stage prostate cancer , patients must balance the survival benefit of a treatment with its morbidity . Little is known about how patients balance these trade-offs . To further our underst and ing of patient decision making we assessed patient utilities for prostate cancer treatment related morbidities . We determined whether patient utilities were predicted by sociodemographic characteristics or baseline genitourinary function . MATERIAL S AND METHODS We evaluated 401 men undergoing prostate needle biopsy for suspicion of prostate cancer at university , Veterans Affairs and public hospitals . Study design included a prospect i ve cross-sectional cohort with correlation and multivariate analysis . Subjects were studied with 2 established health related quality of life instruments . Patient  utilities  were assessed with an interactive software application . RESULTS On multivariate analysis utility for current general health was a significant predictor of utilities for treatment related morbidities . Surprisingly baseline urinary , sexual and bowel function scores did not correlate well with respective utilities for potential incontinence , impotence or radiation proctitis . In other words , men with good and imperfect baseline function were equally willing to risk impairment to preserve life . CONCLUSIONS Men who perceived that general health was better appear to place higher value on quantity of life , while those who already are suffering from poor general health place higher value on quality of life . Ethnicity appears to modify some effects of other variables on patient preference . Utility assessment provides a quantitative tool to aid physicians in counseling patients when making treatment decisions for localized prostate cancer BACKGROUND Previous retrospective studies have shown that physical functioning in older cancer survivors is affected after treatment , yet prospect i ve data are lacking . The aim of this study was to assess change in physical functioning in different age groups of patients with hormone receptor-positive breast cancer who were enrolled in the Tamoxifen Exemestane Adjuvant Multinational ( TEAM ) phase III trial . METHODS Two physical parameters were assessed . Physical functioning was assessed using the European Organisation for Research and Treatment of Cancer ( EORTC ) QLQ-C30 question naire 1 year ( T1 ) and 2 years ( T2 ) after diagnosis . Physical activity was measured in metabolic equivalent of task ( MET ) hours/week at T1 and T2 .  Physical activity  before diagnosis ( T0 ) was assessed retrospectively at the T1 question naire . Patients were divided into three age groups : < 60 , 60 - 69 , and ≥70 years . Decline in physical functioning was assessed using linear regression analysis . Differences in mean values of physical activity levels were calculated using repeated- measures one-way analysis of variance . RESULTS A total of 431 patients were included for analysis . In all age groups , physical activity levels at T1 and T2 were significantly lower than prediagnostic physical activity levels ( T0 ) ( p < .001 for all age groups ) . Age ≥70 years was independently associated with decline in physical functioning between T1 and T2 ( β = -4.62 , 95 % confidence interval -8.73 to -0.51 , p = .028 ) . CONCLUSION Patients aged 70 years or older treated with breast surgery and adjuvant hormonal therapy  did not improve between years 1 and 2 after diagnosis to the same extent as did younger patients . IMPLICATION S FOR PRACTICE Although older patients constitute a large share of the breast cancer population , little is known about the effect and consequences of treatment of breast cancer in this specific age group . This study revealed that , unlike younger patients , older patients do not regain their physical abilities  after surgical and adjuvant treatment for breast cancer . In older adults , the effect of treatment on physical functioning and independency could be more relevant than survival outcomes . Clinicians and older patients should be aware of the impact of treatment on physical functioning and prevent older patients from experiencing physical decline , which could lead to institutionalization and loss of independence . There is a need for age-specific guidelines that take into account the heterogeneity of the older population and for evidence -based treatment that focuses not only on cancer-specific outcomes but also on the consequences of treatment for physical and cognitive functioning and quality of life Between 1978 and 1981 , 463 evaluable postmenopausal patients 65 years of age or younger with operable breast cancer and metastases in axillary lymph nodes were entered in Ludwig Breast Cancer Study III ( Ludwig III ) and r and omly allocated to receive chemoendocrine therapy with cyclophosphamide , methotrexate , 5-fluorouracil , low-dose continuous prednisone , and tamoxifen ( CMFp + T ) for 12 monthly cycles , or endocrine therapy alone with prednisone and tamoxifen ( p + T ) for 1 year , or no adjuvant treatment after mastectomy ( observation ) . At 60 months ' median follow-up , the 5-year disease-free survival ( DFS ) rates were 59 % for CMFp + T , 41 % for p + T , and 31 % for observation ( P less than .0001 ) , and the 5-year overall survival ( OS ) rates were 71 % for CMFp + T , 64 % for p + T , and 59 % for observation ( P = .16 ; CMFp + T v observation , P = .07 ) . A new quality of life-oriented endpoint was defined to assist in the selection of therapeutic approach after surgery for postmenopausal patients : the time without symptoms of disease and subjective toxic effects of treatment ( TWiST ) . Despite the larger initial discount due to subjective toxicity with chemoendocrine therapy , by 5 years postmastectomy the net difference in average TWiST for treated patients compared with the observation group was positive and approximately equal for both adjuvant treatment programs . Adjuvant chemoendocrine therapy for postmenopausal women appears to be justified due to an emerging OS advantage and increasing TWiST gained for the treated patients A recent Cochrane review of trials involving elderly women with operable primary breast cancer showed no significant difference in overall survival between surgery ( ±adjuvant tamoxifen ) and primary endocrine therapy using tamoxifen . We report the final results of a r and omised pilot trial comparing primary tamoxifen and wedge mastectomy as initial treatment in this population . One hundred and thirty-one women > 70 years with early operable primary breast cancer ( < 5 cm ) , unselected for oestrogen receptor ( ER ) , entered the trial in 1982 - 1987 . Sixty-eight patients were allocated to tamoxifen only and 67 to wedge mastectomy only , as primary treatment . At 20 years of follow-up , the median time to local failure was significantly shorter in the tamoxifen arm though approximately one-fifth of patients in this group did not develop local failure requiring mastectomy . There was no difference in regional recurrence , distant metastases or overall survival between the mastectomy and tamoxifen arms . In this small study , primary endocrine therapy achieved local control in 30 % of those surviving at 5 years and 20 % at 10 years , unselected for ER . The primary therapy used did not significantly affect regional recurrence , incidence of distant metastases or overall survival .  Primary endocrine therapy should certainly be considered in those patients with ER positive tumours and who are unfit ( based on life expectancy ) for or refuse surgery BACKGROUND Combined radiation therapy and chemotherapy after surgery , compared with postsurgical radiation therapy alone , has been shown to improve disease-free survival and overall survival significantly among patients with poor-prognosis ( i.e. , advanced stage disease or metastasis to regional lymph nodes ) resectable rectal cancer . However , the combined therapy is associated with more toxic effects , raising the question of whether the benefits of the treatment justify its quality -of-life costs for the individual patient . PURPOSE To assess the trade-offs between improved survival and increased treatment toxicity , we reanalyzed data from a r and omized clinical trial that compared the efficacy of combined adjuvant chemotherapy and radiation therapy with adjuvant radiation therapy alone in the treatment of patients with poor-prognosis resectable rectal cancer . METHODS The data were from a North Central Cancer Treatment Group trial in which 204 patients with poor-prognosis rectal cancer were r and omly assigned to receive either postoperative radiation therapy alone or radiation therapy plus fluorouracil-based chemotherapy . A quality -adjusted time without symptoms or toxicity ( Q-TWiST ) analysis was used to account for freedom from symptomatic disease and from early and late side effects of treatment . All reported P values are two-sided . RESULTS As reported previously , the combined therapy reduced the risk of relapse by 34 % ( 95 % confidence interval [ CI ] = 12%-50 % ; P = .0016 ) and reduced the overall death rate by 29 % ( 95 % CI = 7%-45 % ; P = .025 ) in comparison with adjuvant radiation therapy alone . In the 5 years following assignment to treatment , patients who received the combined therapy had more time with toxicity ( 3.1 months ; 95 % CI = 2.0 - 4.1 months ) , shorter survival after relapse ( 3.6 months less ; 95 % CI = 0.9 - 6.3 months less ) , and more TWiST ( 6.1 months ; 95 % CI = 0.2 - 12.0 months ) than patients who received adjuvant radiation therapy alone . Despite an increase in the amount of time that individuals spent with early and late toxic effects , the Q-TWiST analysis indicated that the combined therapy conferred significantly greater benefit for a wide range of patient preferences about living with the toxicity of treatment or the symptoms of overt disease . CONCLUSIONS AND IMPLICATION S Use of combined chemotherapy and radiation therapy as an adjuvant to surgery for patients with poor-prognosis resectable rectal cancer is justified , since the improved outcome in terms of delayed recurrence and increased survival balances the time spent with early and late toxic effects . The Q-TWiST method is an excellent way to compare treatment outcomes that include quality -of-life considerations The use of adjuvant chemotherapy for postmenopausal patients with early breast cancer remains controversial because the potential benefits in terms of prolongation of disease-free survival ( D 
    Output:
    
Older age , which may be linked to declining physical status , was associated with a preference for QoL over LoL.  Younger patients were more likely to undergo aggressive treatment to increase survival years .
Preference for QoL and LoL  was not influenced by gender , education , religion , having children , marital status , or type of cancer .
Patients with better health valued LoL and inversely those with poorer physical status preferred QoL. CONCLUSION Baseline QoL and future expectations of life seem to be key determinants of preference for  QoL  versus  LoL  in cancer patients .