***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: Patient‐reported outcomes ( PROs ) are increasingly used in clinical setting s. Prior research suggests that PROs collected at baseline may be associated with cancer survival , but most of those studies were conducted in patients with breast or lung cancer . The objective of this study was to determine the correlation between prospect ively collected PROs and cancer‐specific outcomes in patients with early stage colorectal cancer INTRODUCTION Performance status ( PS ) is an established prognostic factor in patients with advanced cancer and is usually scored by the treating physician . The EORTC QLQ-C30 question naire as reported by cancer patients is a vali date d tool to assess quality of life ( QoL ) . Subjectivity plays a role in both assessment s , and data on a direct comparison are scarce . METHODS We compared the prognostic value for overall survival ( OS ) of the WHO PS to the baseline physical function scale of the EORTC QLQ-C30 ( QLQ-C30 PF ) in a prospect i ve r and omised phase 3 trial in advanced colorectal cancer ( ACC ) , the CAIRO study . Patients were divided into two groups based on the baseline QLQ-C30 PF . QLQ-C30 PF was considered ' good ' if the score was more than 66.7 % and ' poor ' if 66.7 % or less . Results were vali date d in a subsequent phase 3 study in ACC , the CAIRO2 study . RESULTS The median OS for patients with a ' good ' QLQ-C30 PF and a ' poor ' PF in patients with WHO PS 0 was 20.3 months ( n = 300 ) and 10.4 months ( n = 44 ) , in patients with WHO PS 1 16.8 months ( n = 125 ) and 10.1 months ( n = 63 ) , and in patients with WHO PS 2 16.2 months ( n = 11 ) and 9.9 months ( n = 12 ) , respectively . In a Cox regression model which included other prognostic factors , ' good ' versus ' poor ' QLQ-C30 PF was significantly prognostic for OS ( 0.57 95 % confidence interval : 0.46 - 0.72 ) , but not WHO PS . These results were confirmed in the CAIRO2 study . CONCLUSIONS We demonstrate in ACC patients that  PF , as assessed by patients using the EORTC QLQ-C30 , is superior in terms of prognostic value to WHO PS as scored by physicians . Our data support to include the results of baseline EORTC QLQ-C30 PF instead of WHO PS as a stratification parameter in oncology trials Background Care of patients with locally recurrent rectal cancer ( LRRC ) requires careful patient selection . While curative resection offers survival benefits , significant trade-offs exist for the patient . Knowledge of patient-reported outcomes will help inform treatment decisions . Methods Quality of life ( QOL ) and pain were prospect ively assessed in 105 patients treated for LRRC at a single institution , using the vali date d Functional Assessment of Cancer Therapy-Colorectal  ( FACT-C ) and  Brief Pain Inventory ( BPI ) question naires . In 54 patients enrolled and followed from diagnosis of LRRC , relationship between pretreatment pain , QOL , and overall survival ( OS ) were examined . Results Patients underwent curative surgical resection ( C , 59 % ) , noncurative surgery ( NC , 12 % ) or nonsurgical treatment ( NS , 28 % ) . Median OS was 7.1 , 1.4 , and 1.9 years , respectively ( C versus NC : p < 0.001 ; C versus NS : p = 0.006 ; NC versus NS : p = 0.261 ) . Physical well-being QOL differed over time ( p = 0.042 ) , with greatest difference between C and NC surgery patients ( p = 0.049 ) . The remaining QOL domain scores and pain scores demonstrated no significant time or treatment effect . For the 54 patients assessed from diagnosis , median OS was independently predicted by treatment group ( C , NC , NS : 4.3 , 1.7 , versus 2.4 years ; p < 0.001 ) and pretreatment pain intensity ( score ≤ 4 versus > 4 : 3.8 versus 2.0 years ; p = 0.001 ) . Conclusion Curative surgery offered prolonged survival , but significant pain exists among long-term survivors and should be a focus of survivorship care . Noncurative surgery did not offer apparent advantages over nonsurgical palliation . Patient ’s pretreatment pain has prognostic value , and should be assessed , treated , and considered in treatment decisions Selecting the most appropriate end points for clinical trials is important to assess the value of new treatment strategies . Well-established end points for clinical research exist in oncology but may not be as relevant to the older cancer population because of competing risks of death and potentially increased impact of therapy on global functioning and quality of life . This article discusses specific clinical end points and their advantages and disadvantages for older individuals . R and omized or single-arm phase II trials can provide insight into the range of efficacy and toxicity in older population s but ideally need to be confirmed in phase III trials , which are unfortunately often hindered by the severe heterogeneity of the older cancer population , difficulties with selection bias depending on inclusion criteria , physician perception , and barriers in willingness to participate . All clinical trials in oncology should be without an upper age limit to allow entry of eligible older adults . In setting s where so-called st and ard therapy is not feasible , specific trials for older patients with cancer might be required , integrating meaningful measures of outcome . Not all questions can be answered in r and omized clinical trials , and large observational cohort studies or registries within the community setting should be established ( preferably in parallel to r and omized trials ) so that treatment patterns across different setting s can be compared with impact on outcome . Obligatory integration of a comparable form of geriatric assessment is recommended in future studies , and regulatory organizations such as the European Medicines Agency and US Food and Drug Administration should require adequate collection of data on efficacy and toxicity of new drugs in fit and frail elderly sub population 
    Output:
    
Physical and psychological functioning , pain , fatigue and appetite loss had prognostic significance above and beyond clinical predictors in CRC .
Routine monitoring of these PROs may allow earlier detection and amelioration of problems , which may improve quality of life and perhaps extend survival .