***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: Intensification of treatment for acute myeloid leukemia ( AML ) in adult patients result ed in a substantial improvement in long-term prognosis . Therefore , the assessment of quality of life ( QL ) of patients undergoing treatment is of growing interest . This study was design ed to evaluate QL in patients with AML treated according to the protocol of the German AML-Cooperative Group ( Münster , Germany ) . The EORTC QLQ-C 30 question naire was used to analyze QL throughout therapy , evaluating defined specific parameters at 12 different time-points . Sixty-one patients were recruited within the first 30 months of the study . Those 28 patients who have completed the course of inpatient treatment ( n = 28 ) are evaluated for changes in the conceptually distinct QL domains : Physical Functioning ( P < 0.001 ) , role functioning ( P = 0.001 ) , Emotional Functioning ( P < 0.001 ) and social functioning ( P = 0.007 ) improve significantly from beginning of chemotherapy to the end of inpatient treatment . Individual assessment of Global Health Status and Subjective QL improves significantly over the same time ( P < 0.001 ) . at the end of inpatient treatment patients suffer significantly less from fatigue , nausea/emesis , loss of appetite and sleep disturbance ( P < 0.001 ) . although most patients with aml eventually relapse , the evaluation of ql in patients undergoing treatment shows that subjective benefit outweights the adverse effects of antileukemic therapy Fatigue is a major complaint among advanced cancer patients . Several instruments are available for measuring fatigue . The EORTC QLQ-C30 is one of the most frequently used health-related quality of life ( HRQOL ) instruments , and it includes a three-item fatigue subscale . Limited knowledge exists about the validity , performance and sensitivity of EORTC QLQ-C30 fatigue scale as compared with a fatigue-specific instrument . The aim of the present study was to vali date the EORTC QLQ-C30 fatigue scale ( FA ) against the Fatigue Question naire ( FQ ) . The FQ is frequently used and was developed to measure fatigue in both cancer and noncancer population s. The FQ measures physical ( PF , seven items ) and mental fatigue ( MF , four items ) . The study population included two different cohorts : A ) patients with advanced metastatic cancer included in a prospect i ve r and omized study of palliative radiotherapy ( n = 238 ) ; B ) patients with leukaemia and malignant lymphoma curatively treated with stem-cell transplantation and high-dose chemotherapy ( n = 128 ) . The analysis demonstrated that the FA correlated higher with the PF scale ( r = 0.67–0.75 ) as compared with the MF scale ( r = 0.49–0.61 ) . The item – scale correlations between FA items and the PF scale were consistently higher than between FA items and the MF scale . A factor analysis including all the items within the FA and the FQ identified two factors . All FA items loaded on a PF factor ( 0.70–0.85 ) . A floor/ ceiling effect , indicating a high number of respondents with lowest , respectively , highest scores was observed more frequently in the FA as compared with the FQ . The PF discriminated better between diagnostic groups with different levels of fatigue than the FA did . In conclusion , the EORTC QLQ-C30 fatigue scale is measuring physical fatigue . A floor/ ceiling effect seems to appear for the EORTC QLQ-C30 fatigue scale . The validity of the EORTC QLQ-C30 fatigue scale is to be question ed for use in palliative care patients . In studies with fatigue as a defined end point , a domain-specific instrument should , therefore , be added When a r and omized trial ( NMSG 4/90 ) comparing treatment with melphalan/prednisone to melphalan/prednisone + interferon α‐2b in newly diagnosed multiple myeloma was inititated in 1990 , a quality ‐of‐life assessment was integrated into the study . We used the question naire ( QLQ‐C30 ) developed by the European Organization of Research and Treatment of Cancer ( EORTC ) Study Group on Quality of Life . The QLQ‐C30 incorporates five functional scales , three symptom scales , a global health and quality ‐of‐life scale and some single symptom measures . The question naire was completed prior to treatment and after 1 , 6 , 12 , 24 , 36 and 48 months . 524 ( 90.2 % ) of 581 patients enrolled in the NMSG 4/90 completed the first question naire , and 484 ( 83.3 % ) completed all question naires given to them . All but one of the scales met the minimum criteria of reliability ( Cronbach ’s alpha ≥0.70 ) . Validity was shown by ( 1 ) the ability of the scales to discriminate clearly between patients differing in clinical status as defined by pre‐treatment W.H.O. performance index and Durie & Salmon stage , and ( 2 ) the sensitivity to changes in objective disease status ( response and relapse ) . This is the first report of the measurement of health‐related quality of life in a prospect i ve clinical trial in multiple myeloma . The results demonstrate that the QLQ‐C30 is a reliable and valid instrument for the measurement of quality of life in these patients . The data will be used for a cost – utility analysis of the results of the NMSG 4/90 trial 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 Patients who undergo hematopoietic SCT ( HSCT ) often experience physical and psychological problems , even long after treatment has been completed . This study was performed to evaluate the effects of a 12-week outpatient physical exercise ( PE ) program , incorporating aerobic and strength exercises , as compared with a usual care control condition on patients ’ physical performance and psychosocial well-being . Patients who had completed HSCT up to 6 months earlier were r and omly assigned to a supervised PE program  ( n=64 ) or a usual care control group  ( n=67 ) . Primary outcomes were quantified physical performance and self-reported physical functioning . Secondary outcomes were body composition measurement , quantified walking activity and patient-reported outcomes ( physical activity , fatigue and health-related quality of life ) . Assessment s were at baseline , immediately after program completion and at 3-month follow-up . Significant intervention effects were observed at both posttreatment and follow-up on physical performance measures . No other outcomes yielded statistically significant group differences . PE should be considered in the management of HSCT recipients to improve physical performance after discharge from the hospital . Further research is needed to determine how the program can be enhanced so that improved physical performance also translates into improved physical and psychosocial functioning in daily life Few studies have evaluated long-term health-related quality of life ( HRQL ) in patients during auto-SCT .  This prospect i ve study examined HRQL in 96 eligible patients before , during and up to 3 years after auto-SCT .  The aim of the study was to make a comprehensive assessment of the frequency and severity of different symptoms in patients undergoing auto-SCT .  The European Organization for Treatment and Research of Cancer Quality of Life Question naire ( EORTC QLQ C-30 ) was administered 13 times . The second week during treatment was the period when patients had the lowest HRQL regarding both total quality of life and function and symptom scales . The patients recovered quickly and just two months after transplantation the baseline values were restored . Three years after transplantation most of the items in the question naire had stabilized , except role function and dyspnea , which had improved . There were significant differences between multiple myeloma ( MM ) and lymphoma patients ’ physical function , quality of life , fatigue and pain during week 2 . At the 3-year follow-up , lymphoma patients indicated a better HRQL than MM patients . The quick recovery of patients after transplantation suggests that treatment is well tolerated ; however , the supportive care could be improved at week 2 , especially for the lymphoma patients Objective Long-term health-related quality of life ( HRQoL ) was determined for patients admitted to the haematology ward who needed intensive care treatment ( H-IC+ ) and compared with those who did not ( H-IC− ) as well as with that for patients admitted to the general ICU ( nH-IC+ ) . Methods A cross-sectional study was carried out median 18 months after admission by employing the short form-36 , checklist for individual strength , cognitive failure question naire and hospital anxiety and depression scale . Results 27 ( 79 % ) of the 34 H-IC+ patients approached , and 93 ( 85 % ) of the 109 H-IC− patients approached replied . Data were adjusted for relevant covariates and matched with those of 149 patients in the general ICU . Apart from the lower role-physical functioning score for H-IC+ ( P = 0.04 ) no other differences were found between H-IC+ and H-IC−. Groups H-IC+ and nH-IC+ evaluated their HRQoL on SF-36 similarly , except for the lower aggregated physical component summary ( PCS ) for H-IC+ ( P<0.0001 ) . After adjusting for PCS , no significant differences in CIS , CFQ and HADS were observed between the groups . Conclusions Eighteen months after admission , patients treated for haematological malignancies reported similar HRQoL , whether or not they had received intensive care treatment , but reported a lower PCS than those of patients in the general ICU . Hence , there is no reason to assume that admission to the ICU has a negative impact on long-term HRQoL , so this should not affect the decision whether or not to transfer patients with haematological malignancies to the ICU Allogeneic  haematopoietic stem cell transplantation ( HSCT )  is an increasingly widespread therapy method . It is associated with many socio-psychological and physical risks . Forty-four subjects , who were clinical ly monitored at the Bolzano BMT Centre including a follow-up period of at least 3 months , completed the question naire Functional Assessment of  Chronic Illness Therapy-Bone Marrow Transplantation ( version 4 ) . Semi-structured , problem-oriented interviews were conducted with seven r and omly selected subjects , the results of which were subjected to a summarising content analysis according to Mayring . The results from the quantitative and qualitative parts were compared based on triangulation . In the r and om sample , 22.7 % stated that they were highly satisfied with their current quality of life ( QOL ) . Throughout all dimensions of the question naire , women showed lower scores than men . The results revealed a positive correlation between the post-HSCT period and QOL ( r(s)=0.338 , P=0.025 ) , especially regarding the social/family ( r(s)=0.411 , P=0.006 ) and emotional well-being ( r(s)=0.306 , P=0.043 ) . The interviews primarily revealed dependence and inability to work . The support received from family , friends and hospital staff and the shift in priorities because of the transplantation were perceived as positive . The comparison mainly leads to corresponding results of the quantitative and qualitative parts of the study . Patient self-rating using question naires and interviews plays a direct and relevant role in the assessment of the QOL after allogeneic HSCT AIM The aim of this study was to compare the effect of two methods of rehabilitation after stem cell transplantation on health and quality of life . BACKGROUND Stem cell transplantation is routinely used in the treatment of haematological malignancy . However , it is an intensive treatment often associated with deterioration in wellbeing and the need for prolonged recovery . METHODS During a 14-month data collection period ( August 2005 to October 2006 ) , patients who had had a stem cell transplant ( n = 58 ) were r and omly allocated to either a healthcare professional-led rehabilitation programme or a self-managed rehabilitation programme . The primary outcome measure , physical functioning as measured by the 36-item Short Form Health Survey , was recorded at baseline and 6 months after r and omization . Secondary health and quality of life measures included the seven other dimensions of the 36-item Short Form Health Survey , General Health Question naire , Graham and Longman Quality of Life Scale and a Shuttle Walk Test . FINDINGS There was no difference in change in Short Form 36 physical function 
    Output:
    
None of the instruments review ed appeared to have been developed for use in clinical practice and specifically for patients with HM , except MyPOS .
Furthermore , measurement properties were established , largely , in clinical trial scenarios .