***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 Although health-related quality of life ( HRQL ) is increasingly assessed in r and omized controlled trials ( RCTs ) , HRQL findings are not always incorporated into clinical decision making . We examined the current perspectives of oncologists on the use of HRQL findings from RCTs , and variation of these perspectives between countries and specialties . Methods A cross-sectional  e-survey  of oncologist members of the NCIC Clinical Trials Group , the United Kingdom National Cancer Research Institute Clinical Studies Groups , and the Australia/New Zeal and cancer clinical trials network was conducted . Respondents reported their perceptions of the usefulness of RCT HRQL outcomes for informing practice , their use of HRQL findings in practice , barriers/facilitators to this use , and preferences for HRQL data presentation in RCT publications . Chi-square tests compared responses between countries and specialties . Results A total of 396 oncologists participated ( estimated response rate : 30 % ) . The most frequently reported specialties were medical ( 46 % ) and radiation ( 37 % ) oncology . HRQL findings from RCTs were reported as useful ( 73 % ) , but were infrequently used to guide clinical decisions with patients . Perceived barriers were lack of time ( 67 % ) and underst and ing ( 57 % ) , and concerns about generalizability of results ( 68 % ) . Identified facilitators included joint publication of HRQL/ clinical outcomes ( 96 % ) and summary of clinical implication s of HRQL findings in RCT publications ( 76 % ) . Use of HRQL findings , perceived barriers/facilitators , and presentation preferences did not differ by country or specialty . Conclusions Oncologists support HRQL findings from RCTs , but perceive important barriers to their use in clinical decision making , regardless of country or specialty . Combined , clear reporting of HRQL/ clinical data may facilitate their clinical application Background : Limited data describe patient-reported outcomes ( PROs ) of localised oesophageal cancer treated with definitive chemoradiotherapy(CRT ) . The phase 2/3 SCOPE-1 trial assessed the effectiveness of CRT±cetuximab . The trial for the first time provided an opportunity to describe PROs from a multi-centre group of patients treated with CRT  that are presented here . Methods : Patients undergoing CRT±cetuximab within the SCOPE-1 trial ( 258 patients from 36 UK centres ) completed generic- , disease- and treatment-specific health-related quality of life  ( HRQL ) question naires ( EORTC QLQ-C30 , QLQ-OES18 , Dermatology Life- Quality Index ( DLQI ) ) at baseline and at 7 , 13 , 24 , 52 and 104 weeks . Mean EORTC functional scale scores ( > 15 point change significant ) , DLQI scores ( > 4 point change significant ) and proportions of patients ( > 15 % significant ) with ‘ minimal ’ or ‘ severe ’ symptoms are presented . Results : Question naire response rates were good . At baseline , EORTC functional scores were high ( > 75 % ) and few symptoms were reported except for severe problems with fatigue , insomnia and eating-related symptoms ( e.g. , appetite loss , dysphagia , dry mouth ) in both groups(>15 % ) . Functional aspects of health deteriorated and symptoms increased with treatment and by week 13 global quality of life , physical , role and social function significantly deteriorated and more problems with fatigue , dyspnoea , appetite loss and trouble with taste were reported . Recovery occurred by 6 months ( except severe fatigue and insomnia in > 15 % of patients ) and maintained at follow-up with no differences between groups . Conclusions :  CRT for localised oesophageal cancer has a significant detrimental impact on many aspects of HRQL ; however , recovery is achieved by 6 months and maintained with the exception of persisting problems with severe fatigue and insomnia . The data suggest that the HRQL recovery after definitive CRT is quicker , and there is little lasting deficit compared with treatment including surgery . These data need to be compared with HRQL data from studies evaluating treatments including surgery for oesophageal cancer Results for health-related quality of life ( HRQoL ) from clinical trials are increasingly used for clinical decision making as well as comparative eff ectiveness , health policy , and reimbursement decisions . Research suggests that HRQoL information can be used to establish treatment preferences because patients value HRQoL data and can interpret HRQoL fi ndings accurately . Trials that incorporate HRQoL as an outcome should therefore be design ed , analysed , and reported well . We did a systematic review of the literature and identifi ed 18 publications with guidelines or st and ards for reporting of HRQoL in r and omised controlled trials , which draw attention to the need for good quality in both trial design and reporting . With regard to trial design , examples of key quality criteria include : the need to use reliable and valid HRQoL measures that are appropriate for the population of interest and that include core outcomes agreed by clinicians , research ers , and patients ; timing of HRQoL assessment that is relevant to clinical interpretation of results ; minimisation of missing data ( since data are often not missing r and omly , but instead could be linked to other clinical outcomes of interest , with those most unwell not providing data ) ; and use of prespecifi ed statistical analyses to avoid multiple statistical testing and selective reporting of results . Given these and other requirements for quality st and ards in clinical trial design , many authors have recommended st and ards for HRQoL reporting so that readers of trial reports can ascertain whether quality st and ards have been reached . Such st and ard criteria have included , for example , the provision of a clear rationale for the domains of HRQoL assessment ( eg , specifi c symptoms such as pain , or functions such as activity levels ) and the corresponding choice of HRQoL instrument , with cited evidence of the instrument ’s validity and a statement about the timing of HRQoL assessment s used in the trial . Trials should report baseline compliance and the extent of subsequent missing data , since reports that omit details about the amount of missing data , or report substantial missing data , should be interpreted with caution . Type 1 statistical errors , result ing from multiple statistical testing , can be addressed by the requirement that trial protocol s prespecify the principal HRQoL postulated outcomes , and their respective timepoints for analysis and reporting in the fi nal trial publication . Finally , reporting of HRQoL data in a comprehensible , clinical ly applicable format , and in the context of other trial outcomes might better promote the use of HRQoL data in practice . Despite these existing recommendations , a systematic review of 794 r and omised trials undertaken between 2002 and 2008 that reported HRQoL outcomes across a range of medical conditions showed that only 56 % of trials provided a rationale for the selected outcome measure , 50 % provided an HRQoL hypothesis , 28 % provided information about missing data , and 36 % did not discuss the HRQoL fi ndings in the context of the other trial outcomes . The review noted that when HRQoL data 8 Ezzati M , Kammen DM . Indoor air pollution from biomass combustion and acute respiratory infections in Kenya : an exposure-response study . Lancet 2001 ; 358 : 619–24 . 9 Naeher LP , Smith KR , Leaderer BP , Mage D , Grajeda R. Indoor and outdoor PM2.5 and CO in high and low-density Guatemalan villages . J Expo Anal Environ Epidemiol 2000 ; 10 : 544–51 . 10 Barraza-Villarreal A , Sunyer J , Hern and ez-Cadena L , et al. Air pollution , airway infl ammation , and lung function in a cohort study of Mexico City schoolchildren . Environ Health Perspect 2008 ; 116 : 832–38 . 11 Moshammer H , Hoek G , Luttmann-Gibson H , et al.  Parental smoking and lung function in children : an international study . Am J Respir Crit Care Med 2006 ; 173 : 1255–63 . 12 Miller RL , Daswani M , Lendor C. Prenatal exposure to air pollution and respiratory outcomes in children . In : Jeorgenson NA , ed . Passive smoking and health research . New York : Nova Science Publishers , 2007 : 283–96 BACKGROUND  Patient reported outcomes  ( PROs ) have gained a prominent place in clinical research . Previous estimates suggest that PRO measures are used in 14 % of clinical trials . Online registries , such as Clinical Trials.gov , may be useful in evaluating extent of PRO use . PURPOSE To estimate the proportion of clinical trials using at least one PRO measure  and to examine associations between trial characteristics and use of PRO measures . METHODS A copy of the Clinical Trials.gov data base was made , containing all data from November 2007 to December 2013 . Content was search ed for use of PRO measures . Multivariable logistic regression was used to investigate possible associations between trial-level characteristics and use of PRO measures . RESULTS Of 96,736 registered trials , 26,337 ( 27 % ) were identified as using one or more  PRO measures . Among oncology trials , 29 % ( 3947/13,584 ) were identified as using a PRO measure , compared to 27 % ( 22,390/83,152 ) of non-oncology trials . A greater proportion of trials using PRO measures were more likely to be sponsored by university/ research organizations ( 29 % ) or the US government ( 33 % ) , compared to industry ( 22 % ) ; Phase III ( 35 % ) ; non-r and omized ( 32 % ) ; and evaluating devices ( 30 % ) , procedures ( 31 % ) or behaviors ( 50 % ) , compared to drugs ( 24 % ) . Fewer were FDA -regulated ( 23 % ) . CONCLUSIONS Evidence suggests that between 2007 and 2013 , there has been an increase in the number of trials that use a  PRO measure  , particularly in oncology trials . With initiatives such as the Patient-Focused Drug Development and FDA PRO Guidance , the trend in the use of PRO measures in clinical research will likely increase further Abstract Background Patient-reported outcomes ( PROs ) are captured within cancer trials to help future patients and their clinicians make more informed treatment decisions . However , variability in st and ards of PRO trial design and reporting threaten the validity of these endpoints for application in clinical practice . Methods We systematic ally investigated a cohort of r and omized controlled cancer trials that included a primary or secondary PRO . For each trial , an evaluation of protocol and reporting quality was undertaken using st and ard checklists . General patterns of reporting where also explored . Results Protocol s ( 101 source d , 44.3 % ) included a mean ( SD ) of 10 ( 4 ) of 33 ( range = 2–19 ) PRO protocol checklist items . Recommended items frequently omitted included the rationale and objectives underpinning PRO collection and approaches to minimize/address missing PRO data . Of 160 trials with published results , 61 ( 38.1 % , 95 % confidence interval = 30.6 % to 45.7 % ) failed to include their PRO findings in any publication ( mean 6.43-year follow-up ) ; these trials included 49 568 participants . Although two-thirds of included trials published PRO findings , reporting st and ards were often inadequate according to international guidelines ( mean [ SD ] inclusion of 3 [ 3 ] of 14 [ range = 0–11 ] ) CONSORT PRO Extension checklist items ) . More than one-half of trials publishing PRO results in a secondary publication ( 12 of 22 , 54.5 % ) took 4 or more years to do so following trial closure , with eight ( 36.4 % ) taking 5–8 years and one trial publishing after 14 years . Conclusions PRO protocol content is frequently inadequate , and nonreporting of PRO findings is widespread , meaning patient-important information may not be available to benefit patients , clinicians , and regulators . Even where PRO data are published , there is often considerable delay and reporting quality is suboptimal . This study presents key recommendations to enhance the likelihood of successful delivery of PROs in the future 
    Output:
    
The included publications identified several barriers and facilitators around PRO trial design , conduct , analysis and report that can hinder or promote the impact of PRO trial data .
Conclusions PRO trial data may potentially lead to a range of benefits for patients and society , which can be measured through appropriate impact metrics .
However , in practice there is relatively limited evidence demonstrating directly attributable and indirect real world PRO-related research impact .