***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 To investigate the benefit of chemotherapy in patients with symptomatic hormone-resistant prostate cancer using relevant end points of palliation in a r and omized controlled trial . PATIENTS AND METHODS We r and omized 161 hormone-refractory patients with pain to receive mitoxantrone plus prednisone or prednisone alone ( 10 mg daily ) . Nonresponding patients on prednisone  could receive mitoxantrone subsequently . The primary end point was a palliative response defined as a 2-point decrease in pain as assessed by a 6-point pain scale completed by patients ( or complete loss of pain if initially 1 + ) without an increase in analgesic medication and maintained for two consecutive evaluations at least 3 weeks apart . Secondary end points were a decrease of > or = 50 % in use of analgesic medication without an increase in pain , duration of response , and survival . Health-related quality of life was evaluated with a series of linear analog self- assessment scales ( LASA and the Prostate Cancer-Specific Quality -of-Life Instrument [ PROSQOLI ] ) , the core question naire of the European Organization for Research and Treatment of Cancer ( EORTC ) , and a disease-specific module . RESULTS Palliative response was observed in 23 of 80 patients ( 29 % ; 95 % confidence interval , 19 % to 40 % ) who received mitoxantrone plus prednisone , and in 10 of 81 patients ( 12 % ; 95 % confidence interval , 6 % to 22 % ) who received prednisone alone ( P = .01 ) . An additional seven patients in each group reduced analgesic medication > or = 50 % without an increase in pain . The duration of palliation was longer in patients who received chemotherapy ( median , 43 and 18 weeks ; P < .0001 , log-rank ) . Eleven of 50 patients r and omized to prednisone treatment responded after addition of mitoxantrone . There was no difference in overall survival . Treatment was well tolerated , except for five episodes of possible cardiac toxicity in 130 patients who received mitoxantrone . Most responding patients had an improvement in quality -of-life scales and a decrease in serum prostate-specific antigen ( PSA ) level . CONCLUSION Chemotherapy with mitoxantrone and prednisone provides palliation for some patients with symptomatic hormone-resistant prostate cancer The Qualitator is a daily diary card to measure Quality of Life , developed for use in chemotherapy trials for patients with advanced breast cancer . In a trial at King 's College Hospital , 29 patients completed the Qualitator  and their scores were compared with scores in the Linear Analogue Self- Assessment and Nottingham Health Profile taken four-weekly . In a separate study at Guy 's Hospital , 31 patients completed the diary . The Qualitator offers accurate prognostic data regarding subsequent UICC response and survival and is simple to use The objective of this study is to evaluate whether patient-reported baseline health-related quality of life ( HRQL ) measured by the Functional Assessment of Cancer Therapy-General ( FACT-G ) instrument is predictive of survival for patients with advanced lung cancer . Methods : Consecutive patients with advanced lung cancer planning to undergo palliative chemotherapy in the outpatient clinics of a Canadian tertiary care cancer centre were enrolled on study . FACT-G total scores and clinical predictors of survival ( age , sex , histology , stage of disease , previous weight loss , presence of liver metastases and performance status ) were prospect ively collected at baseline . Survival data was subsequently collected retrospectively from the Alberta Cancer Registry . Stratified Cox Proportional Hazards analysis was done examining the influence of baseline total FACT-G scores on survival , controlling for potential clinical confounders . Results : Median survival of the 42 patient cohort was 9.9 months with a 2-year survival of 16.7 % . Multivariate analysis indicated that baseline FACT-G total score is significantly associated with survival ( p= 0.004 ) . Conclusion : Baseline HRQL is a statistically significant predictor of survival for patients with advanced lung cancer . When used along with traditional clinical factors , patient-reported baseline HRQL assessment using the FACT-G provides additional prognostic information to the patient and clinician BACKGROUND The psychological response to breast cancer , such as a fighting spirit or an attitude of helplessness and hopelessness toward the disease , has been suggested as a prognostic factor with an influence on survival . We have investigated the effect of psychological response on disease outcome in a large cohort of women with early-stage breast cancer . METHODS 578 women with early-stage breast cancer were enrolled in a prospect i ve survival study . Psychological response was measured by the  mental adjustment to cancer ( MAC ) scale , the Courtauld emotional control ( CEC ) scale  , and the  hospital anxiety and depression ( HAD ) scale 4 - 12 weeks and 12 months after diagnosis . The women were followed up for at least 5 years . Cox 's proportional-hazards regression was used to obtain the hazard ratios for the measures of psychological response , with adjustment for known clinical factors associated with survival . FINDINGS At 5 years , 395 women were alive and without relapse , 50 were alive with relapse , and 133 had died . There was a significantly increased risk of death from all causes by 5 years in women with a high score on the HAD scale category of depression ( hazard ratio 3.59 [ 95 % CI 1.39 - 9.24 ] ) . There was a significantly increased risk of relapse or death at 5 years in women with high scores on the helplessness and hopelessness category of the MAC scale compared with those with a low score in this category ( 1.55 [ 1.07 - 2.25 ] ) . There were no significant results found for the category of " fighting spirit " . INTERPRETATION For 5-year event-free survival a high helplessness/hopelessness score has a moderate but detrimental effect . A high score for depression is linked to a significantly reduced chance of survival ; however , this result is based on a small number of patients and should be interpreted with caution Measurement of health-related quality of life was integrated into a r and omized trial ( NMSG 4/90 ) comparing melphalan/prednisone to melphalan/prednisone + interferon alpha-2b in newly diagnosed multiple myeloma . One of the aims of the study was to assess the prognostic significance of quality -of-life scores , using the EORTC QLQ-C30 question naire . Univariate analysis showed a highly significant association with survival from the start of therapy for physical functioning as well as role and cognitive functioning , global quality of life , fatigue and pain . In multivariate analysis , physical functioning and W.H.O. performance status were independent prognostic factors ( P values = 0.001 for both ) when analysed in a Cox regression model with the somatic variables beta-2 microglobulin , skeletal disease and age . The best prediction for survival from the start of therapy was obtained by combining the beta-2 microglobulin and physical functioning scores in a variable consisting of three risk factor levels with an estimated median survival of 17 , 29 and 49 months , respectively . At a 12 months l and mark analysis , the relative risk for patients with physical functioning score 0 - 20 v 80 - 100 was 5.63 ( 99 % CI 2.76 - 11.49 ) , whereas the relative risk for patients without an objective response to chemotherapy compared to those with at least a minor response was 2.32 ( 99 % CI 1.44 - 3.74 ) . Quality -of-life assessment may be an independent and valuable addition to the known prognostic factors in multiple myeloma PURPOSE Evidence that psychosocial status and health-related quality of life ( HRQOL ) are associated with breast cancer ( BC ) outcomes is weak and inconsistent . We examined prognostic effects of these factors in a prospect i ve cohort study . PATIENTS AND METHODS Three hundred ninety-seven women with surgically resected T1 to T3 , N0/N1 , M0 BC completed the European Organization for Research and Treatment of Cancer Quality of Life Question naire ( Core 30 items ) , Profile of Mood States , Psychosocial Adjustment to Illness Scale , Impact of Events Scale , Mental Adjustment to Cancer Scale  , and the  Courtauld Emotional Control Scale 2 months after diagnosis and 1 year later . Data on tumor-related factors , treatment , and outcomes were obtained prospect ively from medical records , and Cox survival analyses were performed . RESULTS Mean age was 52.0 + /- 9.9 years . Two hundred twenty-five women had T1 , 136 women had T2 , 16 women had T3 , and 20 women had TX tumors ; 127 were N1 . One hundred thirteen women received adjuvant chemotherapy , 130 received hormone therapy , 45 received both , and 109 received neither . We investigated 140 prognostic associations ; four were found to be statistically significant at a P value of < /= .05 ( three fewer than expected by chance ) . Two were in the hypothesized direction of effect , and two were in the opposite direction . All arose from measurements 1 year after diagnosis , which were most susceptible to confounding by treatment . There was no evidence of consistency of associations across outcomes or question naires . These results are in keeping with chance as the explanation for our statistically significant findings . CONCLUSION HRQOL and psychosocial status at diagnosis and 1 year later are not associated with medical outcome in women with early-stage BC PURPOSE We observed that quality -of-life ( QL ) scores , collected to evaluate treatment in a r and omized trial in advanced breast cancer , predicted survival duration . This report explores the prognostic associations between QL and survival in more detail . PATIENTS AND METHODS In a r and omized clinical trial comparing intermittent and continuous therapy policies for patients with advanced breast cancer ,  QL  was measured by linear analog self- assessment ( LASA ) and the Quality -of-Life Index ( QLI ) .  Baseline scores and subsequent changes were included in statistical models of survival duration , with and without other prognostic factors . RESULTS Physician assessment of QLI and patient LASA scores for physical well-being ( PWB ) , mood , nausea and vomiting , appetite , and overall QL ( but not pain ) at the commencement of treatment were significant predictors of subsequent survival . Scores for PWB and QLI were independent of other prognostic factors . Changes in scores were also prognostically important . Both baseline and change in scores for PWB , mood , pain , and QLI after the first three treatment cycles , but before an arbitrary 180-day time point , were significantly predictive of survival beyond that time . Both QLI and PWB were prognostically independent of tumor response . Although QL improvement was correlated with tumor response , continuous therapy yielded significantly better QL scores , even in nonresponders . CONCLUSION These findings support the validity of the simple QL measures used in the trial . They are compatible with the simple explanation that patients perceive disease progression before it is clinical ly evident , but also with a causal relationship between QL and survival duration Background This paper describes the ethnic and socioeconomic correlates of functioning in a cohort of long-term nonrecurring breast cancer survivors . Methods Participants ( n = 804 ) in this study were women from the Health , Eating , Activity , and Lifestyle ( HEAL ) Study , a population -based , multicenter , multiethnic , prospect i ve study of women newly diagnosed with in situ or Stages I to IIIA breast cancer . Measurements occurred at three timepoints following diagnosis . Outcomes included st and ardized measures of functioning ( MOS SF-36 ) . Results Overall , these long-term survivors reported values on two physical function subscales of the SF-36 slightly lower than population norms . Black women reported statistically significantly lower physical functioning ( PF ) scores ( P = 0.01 ) , compared with White and Hispanic women , but higher mental health ( MH ) scores ( P < 0.01 ) compared with White and Hispanic women . In the final adjusted model , race was significantly related to PF , with Black participants and participants in the “ Other ” ethnic category reporting poorer functioning compared to the White referent group ( P < 0.01 , 0.05 ) . Not working outside the home , being retired or disabled and being unemployed ( on leave , looking for work ) were associated with poorer PF compared to currently working ( both P < 0.01 ) . Conclusion These data indicate that race/ethnicity influences psychosocial functioning in breast cancer survivors and can be used to identify need for targeted interventions to improve functioning Aim The aims of our study were to assess quality of life ( QoL ) as a prognostic factor of overall survival ( OS ) and to determine whether QoL data improved three prognostic classifications among French patients with advanced hepatocellular carcinoma ( HCC ) . Methods We pooled two r and omized clinical trials conducted by the Fédération Francophone de Cancérologie Digestive in a palliative setting . In each trial  QoL was assessed at baseline using the Spitzer QoL Index ( 0–10 ) . Three prognostic classifications were calculated : Okuda ,  Cancer of the Liver Italian Program ( CLIP ) , and  Barcelona Clinic Liver Cancer group ( BCLC ) scores . To explore whether the scores could be improved by including QoL , univariate Cox analyses of all potential baseline predictors were performed . A final multivariate Cox model was constructed including only significant multivariate baseline variables likely to result in improvement of each scoring system . In order to retain the best prognostic variable to add for each score , we compared Akaike information criterion , likelihood ratio , and 
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With few exceptions , the findings showed that quality of life data or some aspects of quality of life measures were significant independent predictors of survival duration .
Global quality of life , functioning domains and symptom scores - such as appetite loss , fatigue and pain - were the most important indicators , individually or in combination , for predicting survival times in cancer patients after adjusting for one or more demographic and known clinical prognostic factors .
Conclusion This review provides evidence for a positive relationship between quality of life data or some quality of life measures and the survival duration of cancer patients .
Pre-treatment ( baseline ) quality of life data appeared to provide the most reliable information for helping clinicians to establish prognostic criteria for treating their cancer patients .
This strategy is likely to yield more accurate and specific quality of life-related prognostic variables for specific cancers