***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: Abstract Background : Patients receiving chemotherapy for cancer often develop anemia , which can contribute to increased morbidity and reduced quality of life ( QOL ) . Chemotherapy-induced anemia can be successfully treated using recombinant human erythropoietin ( rHuEPO ) . Aim of the study : To demonstrate the effectiveness of once-weekly ( QW ) rHuEPO dosing to effect improved hemoglobin levels , decreased transfusion use , and improved functional outcomes and QOL in pediatric leukemic patients ( ALL ) receiving maintenance chemotherapy . Patient and methods : This was a prospect i ve r and omized , single-center , open-label , 12-week case-control study of epoetin alfa in pediatric patients with acute lymphoblastic leukemia ( ALL ) in remission receiving maintenance chemotherapy . Sixty patients were r and omly assigned to receive either epoetin alfa ( rHuEPO group = 30 cases , 17 males and 13 females , age ; 6.8 ± 2.33 years ) , or no epoetin alfa ( control group = 30 cases , 16 males and 14 females , age ; 6.76 ± 2.28 years ) . Both groups were matched as regard age , sex , baseline Hb concentration , remission state , chemotherapy regimen , numbers and amount of blood transfusion , and leukemia state ( both were low and st and ard risk ) . Epoetin alfa was administered at a dose of 450 IU/kg , once weekly , subcutaneously ( s.c . ) for 12 consecutive weeks . Endpoints were changes in hematologic and QOL parameters . Results : Among the 30 patients evaluable for hematologic response , the mean increase in Hb from baseline to time of final evaluation was 3.08 ± 1.48 g/dl ( p < 0.001 ) . An increase in Hb of ≧ 2 g/dl , in the absence of blood transfusion , occurred in 70 % of patients ( 21 of 30 patients ) who were on the study for ≧ 30 days . The overall response rate ( Hb increase ≧ 2 g/dl or Hb ≧ 12 g/dl in the absence of blood transfusion ) was 90 % ( 27 of 30 patients ) . In 30 patients who were evaluable for QOL assessment , epoetin-α therapy was found to significantly ( p < 0.001 ) improve mean cancer linear analog scale ( CLAS ) scores for energy level , ability to perform daily activity , and overall QOL from baseline to the time of final evaluation . QW epoetin-α was found to be well tolerated . Conclusion : Treatment with QW epoetin-α was found to increase Hb levels , decrease transfusion requirement , and improve functional status and QOL in anemic patients with ALL in maintenance receiving chemotherapy . The once-weekly schedule is convenient , safe , and may reduce the burden on patients , parents , and their caregivers by reducing the number of visits to the clinic Using a multi-attribute approach , we and others have reported on the comprehensive health status of survivors of cancer in childhood , after completion of therapy . However , there is a dearth of information about health status and associated health-related quality of life ( HRQL ) in children and adults with cancer , during the treatment process ; a deficit which this study was intended to redress . All children ( n=18 ) receiving ' maintenance ' chemotherapy for acute lymphoblastic leukemia ( ALL ) at a single institution were assessed prospect ively through a single cycle of therapy . Patients , family members and health care professionals used global ratings , the health utilities index mark 2 ( HUI2 ) and mark 3 ( HUI3 ) classification systems , and detailed descriptions of temporary states of health , to provide independent assessment s of health status at weekly intervals . Utility scores were derived for each comprehensive health state and for single attribute levels of the HUI2 system , and for the temporary health state descriptions . The classification of the subjects into the most appropriate temporary health states was challenging even for older children and some of the parents . The HUI instruments were used much more easily and produced highly comparable information . The most frequently affected attributes were pain , emotion and mobility/ambulation ; in that order . The global ( p=0.005 ) and specific morbidity burdens were , as predicted , greatest in the middle of the cycle of chemotherapy , reflecting the toxicity of steroid use . HUI2 global utility scores demonstrated moderate responsiveness with an intra-class correlation coefficient of 0.43 . Cyclical administration of therapy , in particular corticosteroids , produces important changes in health status and HRQL in children with ALL . The HUI are valid and responsive systems for quantifying the burden of morbidity during the treatment of cancer in childhood . These are sensitive tools which can be used in a wide array of other circumstances to quantify changes in health status Background Glucocorticoids are important in the treatment of childhood acute lymphoblastic leukaemia ( ALL ) . However , cyclic administration of high dose glucocorticoids may cause rapid and substantial changes in quality of life ( QoL ) . The maintenance phase of the Dutch ALL-9 protocol consisted of alternating two weeks on and five weeks off dexamethasone ( 6 mg/m2/day ) . The present study was performed to assess the effect of dexamethasone on QoL during treatment for ALL according to this protocol . Methods In a multicentre prospect i ve cohort study , QoL was assessed halfway ( T1 ) and at the end of the two-year treatment ( T2 ) . A generic ( Child Health Question naire ) and disease specific ( PedsQL ™ cancer version ) QoL question naire were used to assess QoL in two periods : on and off dexamethasone , respectively . Results 41 children ( 56 % males ) were evaluated , mean age at diagnosis was 5.6 years .  The CHQ physical and psychosocial summary scores were significantly lower than population norms . At T1 and T2 , overall QoL showed no significant change . However , regarding specific domains ( pain , cognitive functioning , emotion/behaviour and physical functioning ) QoL decreased over time . QoL was significantly more impaired during periods on dexamethasone . Conclusion Dexamethasone was associated with decreased QoL. At the end of treatment , reported QoL during dexamethasone deteriorated even more on certain scales ( pain , cognitive functioning , emotion/behaviour and physical functioning ) . Knowledge of the specific aspects of QoL is essential to improve counselling and coping in paediatric oncology . Adverse effects of specific drugs on QoL should be taken into account when design ing treatment protocol Background The quality of life of children with leukemia is reduced by fear and anxiety of parents after diagnosis , lack of information about the disease , treatments , and care of the child . This study aims to evaluate the effect of educating parents of leukemic children on the patients ’ quality of life . Methods In this interventional study , sixty parents of ALL children who met inclusion criteria were selected using simple r and om sampling method , and assigned to the experimental and control groups . The study tool included a valid and reliable question naire ( TNO-AZL ) , that was filled in through interview by parents before and two months after the intervention for both groups . The first part of the question naire included demographic items and the second part ( 7 dimensions , each with 8 sections ) contained questions related to the quality of life . The scores could range between 56 and 280 and a higher score represented a better quality of life . The intervention included three one-hour classes composed of lecture and question -answer sessions which were held for groups of 4 - 6 participants , accompanied by a booklet . Results Before the intervention , the quality of life score in the experimental and control groups was 180.83±14.43 and 174.28±20.72 , respectively ; after the intervention , these figures changed to 226.9±11.76 and 174.41±20.42 respectively . Paired sample s T-test proved a significant increase in the quality of life in the experimental group . Conclusion Parent education successfully increased the quality of life of leukemic children ; therefore , parental consultation sessions and educational programs are recommended BACKGROUND This study investigates the effect of using patient reported outcomes ( PROs ) about health-related quality of life ( HRQOL ) in clinical practice on the type and amount of psychosocial topics discussed during a paediatric oncology consultation . PROCEDURE Children ( N = 193 ) with cancer participated in a sequential cohort intervention study , with a control ( no PRO was used ) and intervention group ( a PRO was used ) . For each child three consecutive consultations with the paediatric oncologist were audio recorded in order to assess the discussed psychosocial topics . One third of the audio recordings were qualitatively analysed . RESULTS The type of the discussed psychosocial topics in the control and intervention group did not differ from each other . However , the discussion of psychosocial topics increased in the intervention group compared to the control group . In both groups , topics within the social domain occurred most frequently and topics regarding the emotional domain had the lowest incidence . CONCLUSIONS PROs do not change the psychosocial content of communication . Paediatric oncologists already address psychosocial issues during the consultation , regardless of the use of a PRO . However , with a PRO available they address these issues more systematic ally and more often Background Most studies on health-related quality of life ( HRQOL ) in children with cancer focussed on survivors . Only few studies have evaluated patients during ongoing oncological treatment . The aim of this study was a prospect i ve assessment of HRQOL in children during the first year after diagnosis of cancer and an examination of demographic , medical , and parental predictors of HRQOL . Methods Fifty-two patients ( mean age : 10.9 years ) were assessed 6 weeks and 1 year after diagnosis with the  TNO-AZL Question naire for Children 's Health-Related Quality of Life . Parents completed the Brief Symptom Inventory . Results Compared to a community sample , patients reported more physical complaints , reduced motor functioning and autonomy , and impaired positive emotional functioning 6 weeks after diagnosis . HRQOL significantly improved over the year . However , at 1 year , patients still showed reduced motor and emotional functioning . At 6 weeks , children with leukemia were most affected . At 1 year , patients with brain tumors complained about more physical symptoms than the other groups . Intensity of treatment and presence of medical complications mainly influenced HRQOL at 6 weeks but less at 1 year . Parental psychopathology was associated with better cognitive functioning in the child . Conclusion This prospect i ve study found several domains of HRQOL to be compromised 6 weeks and 1 year after the diagnosis of cancer . Although HRQOL significantly increased over the year , there were important differences between diagnostic groups . The findings highlight the importance of repeated evaluation of HRQOL in children undergoing cancer treatment and consideration of specific differences between diagnostic groups The objective of the study was to assess acute neurotoxicity associated with triple intrathecal therapy (TIT)±high-dose methotrexate ( HD MTX ) in children with acute lymphoblastic leukemia ( ALL ) . 1395 children were enrolled on FRALLE 93 protocol from 1993 to 1999 . Lower-risk group ( LR , n=182 ) were r and omized to weekly low-dose MTX at 25 mg/m2/week ( LD MTX , n=81 ) or HD MTX at 1.5 g/m2/2 weeks × 6 ( n=77 ) . Intermediate-risk group ( IR , n=672 ) were r and omized to LD MTX ( n=290 ) or HD MTX at 8 g/m2/2 weeks × 4 ( n=316 ) . Higher-risk group ( HR , n=541 ) prednisone-responder patients  received LD MTX and cranial radiotherapy . HR group steroid resistant cases were grafted ( autologous or allogenic ) . TIT ( MTX , cytarabine and methylprednisolone ) was given every 2 weeks during 16–18 weeks and every 3 months during maintenance therapy in LR and IR patients . 52 patients ( 3.7 % ) developed neurotoxicity . Isolated seizures : n=15 ( 1.1 % ) , peripheral and spinal neuropathy : n=17 ( 1.2 % ) and encephalopathy : n=20 ( 1.4 % ) . Age > 10 years was significantly associated with neurotoxicity ( P=0.01 ) and use of HD MTX is associated with encephalopathy ( P=0.03 ) . Sequels are reported respectively in 60 and 33 % of spinal neuropathy and encephalopathy cases . Current strategies tailoring risk of neurological sequels has to be defined St and ard risk acute lymphoblastic leukemia ( SR-ALL ) has high cure rates , but requires 2 - 3 years of therapy . We aim ed to ( i ) prospect ively evaluate health-related quality of life ( HRQOL ) during and after SR-ALL therapy , and ( ii ) identify associated predictors . Parents of 160 SR-ALL patients enrolled on Children 's Oncology Group ( COG ) therapeutic trial AALL0331 at 31 sites completed the  Pediatric Quality of Life Inventory ( PedsQL ) 4.0 Generic Core Scales ( physical , emotional and social functioning ) and Family Assessment Device-General Functioning ( FAD-GF ) at 1 , 6 and 12 months after diagnosis , and 3 months post-therapy . Mean PedsQL scores in physical , emotional and social functioning were impaired 1 month after diagnosis but steadily improved . Three months post-therapy , impaired physical and social functioning was observed in 27.8 and 25.8 % of patients , respectively . In repeated- measures analysis , problematic family functioning predicted emotional ( OR = 1.85 , 95 % CI 1. 
    Output:
    
Overall HRQL was significantly reduced on treatment .
Despite HRQL improvements over time , longitudinal studies reported a proportion of children continued to experience reduced HRQL after treatment completion .
We found inconsistent associations between clinical /demographic factors and HRQL outcomes .
Tentative evidence emerged for worse HRQL being associated with intensive phases of chemotherapy , corticosteroid therapy , experiencing greater toxicity , older age , and female sex .