***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 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 BACKGROUND Given the more comorbidities with a decline in physiologic reserve , it can be challenging to make appropriate treatment decisions in the elderly . PATIENTS AND METHODS Here , we prospect ively evaluated and compared the health-related quality of life ( HRQOL ) of patients aged ≥ 65 with aged < 65 who were treated with a postoperative chemotherapy for completely resected stage Ib , II or IIIa non-small-cell lung cancer ( NSCLC ) . Either four cycles of paclitaxel (Taxol)-carboplatin ( PC ) or vinorelbine-cisplatin ( NP ) was used . The HRQOL was assessed with EORTC QLQ-C30 and EORTC QLQ-LC13 . RESULTS Between October 2008 and October 2011 , a total of 139 patients ( aged < 65 , n = 73 ; ≥ 65 , n = 66 ) were enrolled , and 127 ( 91.4 % ) completed the question naire . Overall , the quality of life ( QOL ) in elderly patients did not significantly deteriorate with adjuvant chemotherapy and the time trend of QOL in elderly patients was similar to that of younger patients . Although the elderly suffered from increased treatment-related adverse events involving sore mouth , peripheral neuropathy and alopecia compared with the baseline , the same time trends were also observed in younger group . The mean dose intensities ( MDIs )  for PC and NP regimen were not significantly different between the two age groups . CONCLUSIONS Postoperative chemotherapy did not substantially reduce HRQOL in elderly NSCLC patients , and HRQOL during and after adjuvant chemotherapy did not significantly differ by age Background Quality of life ( QoL ) is now established as an important outcome for evaluating the impact of disease , and for assessing the efficacy of treatments . However , individuals change with time and the basis on which they make a QoL judgement may also change , a phenomenon increasingly referred to as response shift . Here , the individual may change his or her internal st and ards , values , and /or conceptualization on the target construct as a result of external factors such as a treatment or a change in health status . This has important implication s for assessing the effects of treatments as a change in QoL may reflect a response shift , a treatment effect , or a complex combination of both . In this study , we used an individualised quality of life ( IQoL ) measure , the SEIQoL  , together with a then-test to determine whether response shift would influence the measurement of treatment efficacy in edentulous patients . Methods Data are reported here for the first phase of a r and omised controlled clinical trial design ed to assess the impact , on IQoL , of implant supported dentures compared with high quality conventional dentures .  IQoL was measured using the  SEIQoL-DW  in 117 patients ( mean age 64.8 ; 32 % male ) at baseline ( T1 ) and 3 months ( T2 ) after receiving high quality conventional dentures . The work was carried out in dental teaching hospitals in Dublin and Belfast . Results Unadjusted SEIQoL index scores revealed no significant impact of treatment at three months ( baseline : 75.0 ; 3 months : 73.2 , p = .33 , n.s . ) . However , the then-test at 3 months revealed that patients retrospectively rated their baseline IQoL as significantly lower ( P < .001 ) than they had rated it at the time ( then-test baseline : 69.2 ) . Comparison of the 3 month scores with this readjusted baseline indicated a significant treatment effect ( then-test baseline : 69.2 ; 3 months : 73.2 , p = 0.016 ) . 81 % of patients nominated at least one different IQoL domain at 3 months . Conclusion The positive impact of denture treatment for edentulous patients on IQoL was seen only when response shifts were taken into consideration . The nature of the response shifts was highly complex but the data indicated a degree of re-conceptualisation and reprioritisation . Assessment of the impact of treatments using patient-generated reports must take account of the adaptive nature of patients Introduction There are few studies on the effect on quality of life ( QL ) of cancer-related illness and treatment in elderly patients . The aim of this work was to evaluate prospect ively QL in a sample of elderly patients with stages I – III breast cancer who started radiotherapy treatment and compare their QL with that of a sample of younger patients . Material s and methods Forty-eight patients , ≥ 65 years of age completed the European Organization for Research and Treatment of Cancer ( EORTC ) QL question naires QLQ-C30 and QLQ-BR23 , and the Interview for Deterioration in Daily Living Activities in Dementia  ( IDDD )  daily activities scale three times throughout treatment and follow-up periods . Clinical and demographic data were also recorded . Fifty patients ages 40–64 years with the same disease stage and treatment modality had previously completed the QL question naires . QL scores , changes in them among the three assessment s , differences between groups based on clinical factors , and differences between the two sample s were calculated . Results QL scoring was good and stable ( > 70/100 points ) in most areas , in line with clinical data . Light and moderate limitations occurred in global QL and some emotional , sexual , and treatment-related areas . Moderate decreases ( 10–20 ) appeared in some toxicity-related areas , which recovered during the follow-up period . Breast-conservation and sentinel-node patients presented higher scores in emotional areas . There were few QL differences among age-based sample s. Conclusions QL and clinical data indicate radiotherapy was well tolerated . Age should not be the only factor evaluated when deciding upon treatment for breast cancer patients Objectives The optimal treatment for elderly patients ( age > 70 years ) with glioblastoma ( GBM ) remains controversial . We conducted a prospect i ve trial in 43 consecutive elderly patients with GBM treated with hypofractionated radiotherapy ( RT ) followed by adjuvant temozolomide . Patients and methods Forty-three patients 70 years of age or older with a newly diagnosed GBM and a Karnofsky performance status ( KPS ) ≥ 60 were treated with hypofractionated RT ( 6 fractions of 5 Gy each for a total of 30 Gy over 2 weeks ) followed by up to 12 cycles of adjuvant temozolomide ( 150–200 mg/m2 for 5 days during each 28 day cycle ) . The HRQOL was assessed with the EORTC Quality of Life Question naire C30 . The primary endpoint was overall survival ( OS ) . Secondary endpoints included progression free survival ( PFS ) , toxicity and quality of life . Results The median OS was 9.3 months and the median PFS was 6.3 months . The 6 and 12 month survival rates were 86 % and 35 % , respectively . The 6 and 12 month PFS rates were 55 % and 12 % , respectively . In multivariate analysis KPS was the only significant independent predictive factor of survival ( P = 0.008 ) . Neurological deterioration occurred during or after RT in 16 % of patients and was resolved in most cases with the use of steroids . Grade 3–4 hematologic toxicity occurred in 28 % of patients during the adjuvant chemotherapy treatment with temozolomide . The treatment had no negative effect on HRQOL , however , fatigue ( P = 0.02 ) and constipation ( P = 0.01 ) scales worsened over time . Conclusions Hypofractionated RT followed by temozolomide may provide survival benefit maintaining a good quality of life in elderly patients with GBM . It may represent a reasonable therapeutic approach especially in patients with less favourably prognostic factors BACKGROUND Evidence on adjuvant chemotherapy in older women with breast cancer is poor . We tested whether weekly docetaxel is more effective than st and ard chemotherapy . PATIENTS AND METHODS We carried out a multicenter , r and omized phase III study . Women aged 65 - 79 , operated for breast cancer , with average to high risk of recurrence , were allocated 1 : 1 to CMF ( cyclophosphamide 600 mg/m² , methotrexate 40 mg/m² , fluorouracil 600 mg/m² , days 1 , 8) or docetaxel ( 35 mg/m(2 ) days 1 , 8 , 15 ) every 4 weeks , for four or six cycles according to hormone receptor status . Primary end point was disease-free survival ( DFS ) . A geriatric assessment was carried out . Quality of life ( QoL ) was assessed with EORTC C-30 and BR-23 question naires . RESULTS From July 2003 to April 2011 , 302 patients were r and omized and 299 ( 152 allocated CMF and 147 docetaxel ) were eligible . After 70-month median follow-up , 109 DFS events were observed . Unadjusted hazard ratio ( HR ) of DFS  for docetaxel versus CMF was 1.21 [ 95 % confidence interval ( CI ) 0.83 - 1.76 , P = 0.32 ] ; DFS estimate at 5 years was 0.69 with CMF and 0.65 with docetaxel  . HR of death was 1.34 ( 95 % CI 0.80 - 2.22 , P = 0.26 ) . There was no interaction between treatment arms and geriatric scales measuring patients ' ability or comorbidities . Hematological toxicity , mucositis and nausea were worse with CMF ; allergy , fatigue , hair loss , onychopathy , dysgeusia , diarrhea , abdominal pain , neuropathy , cardiac and skin toxicity were worse with docetaxel . One death was attributed to CMF and two to docetaxel . Increasing age , impairment in instrumental daily living activities , number of comorbidities and docetaxel treatment were independently associated with severe nonhematological toxicity . QoL was worse with docetaxel  for nausea-vomiting , appetite loss , diarrhea , body image , future perspective , treatment side-effects and hair loss items . CONCLUSIONS Weekly docetaxel is not more effective than st and ard CMF as adjuvant treatment of older women with breast cancer and worsens QoL and toxicity . CLINICAL TRIALSGOV NCT00331097 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND This study was conducted to analyze the feasibility of adjuvant capecitabine therapy using a tailored-dose escalation strategy in elderly patients with colon cancer ( CC ) . METHODS CC patients ( ≥ 70 years of age ) who received adjuvant capecitabine were enrolled . The starting dosage of capecitabine was 2000 mg/m(2)/day ( days 1 - 14 , every 3 weeks ) . On the second cycle , the dosage was escalated to 2500 mg/m(2)/day if the patient tolerated the first cycle . Dose intensity ( DI ) , toxicity , and the change in quality of life ( QoL ) were evaluated . RESULTS Of 82 patients enrolled , 67 completed eight cycles . Dose escalation to 2500 mg/m(2)/day was possible in 56 patients , and this dosage was maintained in 24 patients until the completion of chemotherapy ( eight cycles ) . Forty-one patients completed therapy with a DI ≥ 1333 mg/m(2)/day [ relative dose intensity ( RDI ) ≥ 80 % ] . Toxic effects were tolerable and the QoL was not compromised during treatment . Creatinine clearance < 50 ml/min and Charlson-Age comorbidity index ≥ 8 were related to a reduced capecitabine dosage ( RDI < 80 % ) . CONCLUSIONS A tailored-dose escalation strategy was feasible in elderly CC patients receiving adjuvant capecitabine chemotherapy .  Decreased renal function and an increased number of comorbidities were independently predictive of reduced administration of the capecitabine dose Mastectomy and breast-conserving treatment have proven equally effective in terms of survival in early breast cancer , but studies continue to provide evidence that patients undergoing breast-conserving procedures  have a better quality of life ( QOL ) . Age is not considered to be a contraindication for breast-conserving treatment , but retrospective studies have indicated that elderly patients are less likely to be treated conservatively . In the present study , survival , QOL and treatment preference have been investigated in a multicentre , r and omised clinical trial of elderly patients with early breast cancer undergoing mastectomy or tumour excision plus tamoxifen . Eligible patients were aged 70 years or more and had histologically- or cytologically-confirmed operable breast cancer . A QOL question naire consisting of 36 items 
    Output:
    
For most elderly patients with breast cancer , the non-significant negative change in the QoL was transient .
A significant increase in the QoL during the course of temozolomide in elderly patients with glioblastoma but a decreasing trend in QoL after radiotherapy was shown .
This review also shows a uniform trend of stable or improved QoL during adjuvant therapy and at follow-up evaluations across the studies with prostate , colon or cervical cancer population .
This review suggests that adjuvant chemotherapy and radiotherapy may not have detrimental effects on QoL in most elderly patients with solid tumours