***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: UNLABELLED Information on treatment outcome outside clinical trials is sparse . This is the first study that relates surgical and medical quality of care in daily practice with outcome . BACKGROUND In a previous study we showed , that the quality of chemotherapy as described by a guideline and given in daily practice to premenopausal primary breast cancer patients was suboptimal with only 68 % and 53 % of the patients receiving chemotherapy with a dose intensity ( DI ) and relative dose intensity ( RDI ) of > or = 85 % , respectively . Many invalid reasons for delay and dose reductions were identified . PATIENTS AND METHODS Premenopausal node-positive primary breast cancer patients treated from 1988 to 1992 were traced using two national registries . Relevant data were collected from their records . The following treatment-related variables were correlated with prognosis : type of surgery , number of investigated lymph nodes , radiotherapy , chemotherapy , interval between surgery and start of chemotherapy , DI , duration , delays and dose adjustments of chemotherapy and hospital size . RESULTS Twenty-four of the 254 traced patients did not receive any chemotherapy , 230 received the recommended schedule of cyclophosphamide ( C ) , methotrexate ( M ) and 5-fluorouracil ( F ) . The median time of follow-up was 6.7 ( range 0.9 - 10.2 ) years . The 5-year disease-free survival ( DFS ) and overall survival ( OS ) was 61 % and 77 % , respectively . In an univariate analysis DI < 65 % correlated with a worse DFS and OS ( p=0.05 and p=0.03 , respectively ) . The use of chemotherapy correlated with a better DFS ( p=0.03 ) than no use . In a multivariate analysis DI between 65 and 85 % result ed in a better DFS ( p=0.02 ) than DI > or = 85 % and DI < 65 % . CONCLUSION The prognosis of the breast cancer patients in this population was comparable with the results of r and omised trials using adjuvant CMF . The only treatment related variable of value for prognosis was DI . Unexpectedly DI between 65 % and 85 % result ed in the best prognosis in this population . The relevance of this observation remains unclear and warrants further investigation PURPOSE To investigate the effects of the Interactive Breast Cancer CDROM as a decision aid for breast cancer patients with a choice between breast conserving therapy ( BCT ) and mastectomy ( MT ) .  PATIENTS AND METHODS Consecutive patients with stage I and II breast cancer were enrolled . A quasi-experimental , longitudinal , and pretest/posttest design was used . Follow-up was scheduled 3 and 9 months after discharge from the hospital . Control patients ( n = 88 ) received st and ard care ( oral information and brochures ) . The CDROM was provided to patients in the experimental condition ( n = 92 ) as a supplement to st and ard procedures . Outcome variables were treatment decision , satisfaction , and quality of life ( QoL ) . RESULTS No effect on treatment decision was found . CDROM patients expressed more general satisfaction with information at 3 and 9 months ( 95 % confidence interval for the difference ( d ) between the means ( d : 4.1 to 12.5 and 5.7 to 14.2 respectively ) . CDROM patients were also more satisfied with their treatment decision at 3 and at 9 months ( d : 0.1 to 0.4 ; 0.2 to 0.5 ) . Moreover , at 9 months , CDROM patients were more satisfied with breast cancer-specific information ( d : 0.9 to 16.5 ) , the decision-making process ( d : 0.1 to 0.4 ) , and communication ( d : 0.2 to 11.0 ) . At 3 and 9 months , a positive effect was found on general health ( d : 0.2 to 14.5 and 0.3 to 15.0 ) . Moreover , at 9 months , CDROM patients reported better physical functioning ( d : 5.1 to 19.8 ) , less pain ( d : -17.9 to -4.5 ) , and fewer arm symptoms ( d : -14.1 to -0.5 ) . CONCLUSION The Interactive Breast Cancer CDROM improved decision making in patients with early-stage breast cancer with a choice between BCT and MT , as evaluated in terms of patients ' satisfaction and BACKGROUND AND PURPOSE The International Breast Cancer Study Group ( IBCSG ) has developed and approach for assessing the impact of adjuvant therapy on quality of life ( QL ) within the framework of international , multilingual clinical trials . The major steps are summarized . Conceptual , method ological and practical issues are discussed with reference to results of two trials closed to accrual ( IBCSG VI , VII ) and one subsequent ongoing trial ( IBCSG IX ) . PATIENTS AND METHODS QL was assessed in pre- and post-menopausal patients with operable breast cancer . Various  single-item linear analogue self- assessment ( LASA ) scales  were used as indicators of components of QL , including global indicators of well-being , functioning and health perception , and specific indicators of symptoms of disease and treatment . In trials VI and VII , QL was assessed at baseline , during adjuvant treatment and follow-up , and at recurrence . Based on this experience , the QL form was revised for subsequent trials and further investigated in a sub sample of patients r and omized into trial IX . RESULTS In trials VI and VII , the QL indicators were responsive to the impact of biomedical factors at baseline , various adjuvant treatments , changes over the first 18 months , and recurrence . In trial IX , the revised QL form was well accepted by patients and staff . Completing this form did not exceed five minutes . QL differences between on and off cytotoxic treatment strengthen the cl aim that these measures are responsive . Correlations and logistic regression analyses show the expected relationship among the various global and specific indicators . CONCLUSION Results from two trials closed to accrual and an ongoing trial confirm the feasibility , validity and clinical relevance of the IBCSG approach for study ing the impact of adjuvant breast cancer therapy on QL in international clinical trials 
    Output:
    
Most quality indicators evaluated processes of care .