***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: This study examined the effect of an integrated yoga programme on chemotherapy-related nausea and emesis in early operable breast cancer out patients . Sixty-two subjects were r and omly allocated to receive yoga ( n = 28 ) or supportive therapy intervention ( n = 34 ) during the course of their chemotherapy . Both groups had similar socio-demographic and medical characteristics . Intervention consisted of both supervised and home practice of yoga sessions lasting for 60 min daily , while the control group received supportive therapy and coping preparation during their hospital visits over a complete course of chemotherapy . The primary outcome measure was the Morrow Assessment of Nausea and Emesis ( MANE ) assessed after the fourth cycle of chemotherapy . Secondary outcomes included measures for anxiety , depression , quality of life , distressful symptoms and treatment-related toxicity assessed before and during the course of chemotherapy . Following yoga , there was a significant decrease in post-chemotherapy-induced nausea frequency ( P = 0.01 ) and nausea intensity ( P = 0.01 ) , and intensity of anticipatory nausea ( P = 0.01 ) and anticipatory vomiting ( P = 0.05 ) as compared with the control group . There was a significant positive correlation between MANE scores and anxiety , depression and distressful symptoms . In conclusion , the results suggest a possible use for stress reduction interventions such as yoga in complementing conventional antiemetics to manage chemotherapy-related nausea and emesis BACKGROUND During the last decade , survival rates for breast cancer have increased as a result of earlier detection and increased use of adjuvant therapy . Limited data exist on the psychosocial aspects of the transitional period between the end of primary treatment and survivorship . We investigated the baseline psychosocial status of women enrolled in a r and omized trial testing two psychosocial interventions for women at the end of primary treatment . METHODS Participants , identified within 1 month after surgery ( registration ) , provided demographic information and limited measures of quality of life . They were followed until they finished primary treatment ( enrollment ) , at which time they completed a mailed baseline survey that included st and ardized measures of quality of life ( including st and ardized scales of physical and emotional functioning ) , mood , symptoms , and sexual functioning .  A total of 558 patients ( mean age = 56.9 years ) were enrolled in the study between July 1 , 1999 , and June 30 , 2002 . Health outcomes were examined according to treatment received : mastectomy with and without chemotherapy , and lumpectomy with and without chemotherapy . All statistical tests were two-sided . RESULTS Among all treatment groups , patients who had a mastectomy had the poorest physical functioning at registration ( P<.001 ) and at enrollment ( P=.05 ) . At enrollment , mood and emotional functioning were similar among all patients , with no differences by type of treatment received . At enrollment , symptoms , including muscle stiffness , breast sensitivity , aches and pains , tendency to take naps , and difficulty concentrating , were common among patients in all groups and were statistically significantly associated with poor physical functioning and emotional well-being . Sexual functioning was worse for women who received chemotherapy than for those who did not , regardless of type of surgery ( P<.001 ) . CONCLUSIONS At the end of primary treatment for breast cancer , women in all treatment groups report good emotional functioning but report decreased physical functioning , particularly among women who have a mastectomy or receive chemotherapy . Clinical interventions to address common symptoms associated with treatment should be considered to improve physical and emotional functioning at the end of primary treatment for breast cancer To compare the effectiveness of individual support , group rehabilitation and a combination of the two in improving health-related quality of life ( HRQOL ) and psychological well-being in cancer patients during 24 months after diagnosis , as compared with st and ard care ( SC ) . Furthermore , to compare the study sample and a r and om sample of the Swedish population with regard to HRQOL . A total of 481 consecutive patients , newly diagnosed with cancer , were r and omly assigned to one of the four alternatives . Data on HRQOL and psychological well-being were collected at baseline and after 3 , 6 , 12 and 24 months . The interventions did not improve HRQOL or psychological well-being , as compared with SC . At 3 months , the study sample reported an HRQOL comparable with the normal population . Many cancer patients are able to manage their cancer-related concerns with the support available from SC . However , it is reasonable to assume that the findings suffer from a lack of data from especially vulnerable patients and a possible Hawthorne effect . It can not be concluded that cancer patients have no need for additional psychosocial interventions . Future projects should include screening and target interventions for those at risk for significant and prolonged psychological distress Our purpose was to evaluate the late physical and psychosocial difficulties of premenpausal patients treated for a localized breast cancer and to weigh the impact of chemotherapy on long-term quality of life . Two self-administered question naires , the EORTC core QLQ-C30 and the breast module ( BR23 ) were mailed to 179 premenopausal node-negative women continuously disease-free , previously enrolled in a trial testing the efficacy of adjuvant CMF chemotherapy ( Espié et al , 1997 ) . The core question naire evaluates the physical , role , emotional , cognitive and social functioning and global health status . The breast module includes four functional scales : body image , sexual functioning , sexual enjoyment and future perspective . It also includes symptom scales such as arm or breast symptoms . Some specific professional and social states were added . 119 ( 68 % ) patients ( mean age 54 years , range 30–69 ) participated . Mean follow-up time since diagnosis was 9.6 years ( 4–16 ) . 68 % had conservative and 32 % radical surgery ( with reconstructive surgery in 50 % ) . CMF was given to 77 ( 65 % ) patients . Irradiation was administered in 75 % of patients irrespective of adjuvant therapy . QLQ-C30 scale scores were similar in patients who had or had not received chemotherapy .  Disturbance in body image , sex life and breast symptoms did not differ between patients who had or had not received adjuvant CMF . No major socioprofessional difficulties were reported except problems in borrowing from banks not related to past chemotherapy . With long follow-up , most premenopausal women treated for a localized breast cancer cope with the disease and its treatments . Adjuvant CMF chemotherapy does not appear to impair quality of life nor social and professional life in these patients . © 2000 Cancer Research PURPOSE Chemotherapy for non-small-cell lung cancer ( NSCLC ) remains controversial . We describe the two largest reported , r and omized , parallel trials design ed to determine whether the addition of chemotherapy influences duration and quality of life in localized , unresectable ( mitomycin , ifosfamide ,  cisplatin [MIC]1 trial ) and extensive ( MIC2 trial ) disease . PATIENTS AND METHODS Ambulatory patients with NSCLC , aged 75 years or younger , with localized disease , were r and omized in MIC1 to receive up to four cycles of chemotherapy ( CT : mitomycin 6 mg/m(2 ) , ifosfamide 3 g/m(2 ) , and cisplatin 50 mg/m(2 ) ) every 21 days , followed by radical radiotherapy ( CT + RT ) or radiotherapy ( RT ) alone . Extensive-stage patients were r and omized in MIC2 to identical chemotherapy plus palliative care ( CT + PC ) or palliative care ( PC ) alone . Short-term change in quality of life ( QOL ) was assessed in a subgroup of patients . Data from the two trials were combined to allow multivariate and stratified survival analyses . RESULTS Seven hundred ninety-seven eligible patients were r and omized , 446 in MIC1 and 351 in MIC2 . MIC CT improved survival in both trials ( significantly in MIC2 ) . The median survival time in MIC1 was 11.7 months ( CT + RT ) versus 9.7 months ( RT alone ) ( P = .14 ) ; whereas in MIC2 , median survival time was 6.7 months ( CT + PC ) compared with 4 . 8 months ( PC alone ) ( P = .03 ) . QOL , assessed in 134 patients from start of trial to week 6 , showed improvement with chemotherapy and deterioration with st and ard treatment . In the combined analysis of 797 r and omized patients , the positive effect of MIC on survival was significant overall ( P = .01 ) and after adjusting for prognostic factors ( P = .01 ) . CONCLUSION MIC chemotherapy prolongs survival in unresectable NSCLC without compromising QOL Goals of workThe aims of this secondary analysis were to determine the prevalence of nutrition impact symptoms in medical oncology patients at 1 , 6 , and 12 months after commencement of chemotherapy  and to investigate the relationship of these symptoms to quality of life ( QoL ) and performance status . Material s and methods A prospect i ve longitudinal survey was conducted in 219 medical oncology patients who had commenced chemotherapy in the past month . The Rotterdam Symptom Assessment  scale assessed the number and distress level of symptoms . The association between symptoms and global QoL and performance status as measured by the Life Satisfaction Scale was investigated . Main results Symptom prevalence as determined by the proportion of patients experiencing at least one nutrition impact symptom was 79 % and 72 % at 1 and 6 months after starting chemotherapy . Even at 12 months , symptom prevalence was 46 % . The most common symptoms included dry mouth , nausea , and constipation with the most distressing symptoms reported as dry mouth , diarrhea , and stomach pain . A higher number of symptoms was associated with lower QoL ( T1 : r = −0.35 , n = 217 , P < 0.05 ; T2 : r = −0.406 , n = 194 , P < 0.001 ; T3 : r = −0.353 , n = 157 , P < 0.001 ) . Patients experiencing more symptoms were more likely to have lower performance status at T2 and T3 ( T2 : n = 189 , P = 0.019 ; T3 : n = 143 , P = 0.003 ) . Conclusion Nutrition impact symptoms were commonly experienced , even 12 months following commencement of chemotherapy , and were associated with poorer QoL and performance status . This highlights the importance of early identification and management of nutrition impact symptoms with adequate follow-up in order to provide optimal care for people with cancer Goals The aim of the study was to determine the feasibility and validity of a newly developed patient-based instrument — the  Patient Neurotoxicity Question naire (PNQ)—for grading chemotherapy-induced peripheral neuropathy ( CIPN ) . Patients and methods We prospect ively collected data from 300 female patients who were treated with taxane chemotherapy for primary breast cancer as part of a national multicenter phase III r and omized trial ( N-SAS BC 02 ) . We evaluated patient compliance with the PNQ and several validation parameters , including concordance between CIPN grade s noted by physicians ( National Cancer Institute Common Toxicity Criteria ) and patients ( PNQ ) , and the concurrent validity and responsiveness of the PNQ versus the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity ( FACT/GOG-Ntx ) utilizing data at pre-treatment and before three , five , and seven treatment cycles . Main results The question naire completion rate was > 90 % at all assessment s. Evaluation by physicians always result ed in lower neuropathy assessment scores compared with those reported directly by patients ( weighted kappa coefficients , 0.02–0.06 ) . Both PNQ sensory and motor scores were significantly correlated with the FACT/GOG-Ntx ( r = 0.66 and 0.51 , respectively ) . In the repeated measures analysis of variance model , PNQ grade s increased considerably as treatment continued , indicating progressively worsening CIPN over time . Conclusions The PNQ has an applicable degree of feasibility and validity , useful for the diagnosis of CIPN as well as for clinical treatment decision-making , where the development of CIPN is a potential treatment-limiting consideration . Physicians underreport and underestimate the severity of CIPN symptoms compared with patients , thereby supporting the importance of assessing patient-reported outcomes using the PNQ PURPOSE Despite the recognition of fatigue as a common and distressing symptom during cancer treatment , there are few evidence -based interventions available to manage such fatigue . The purpose of this multi-institutional pilot study was to explore the effects of a home-based moderate walking exercise intervention on fatigue , physical functioning , emotional distress , and quality of life ( QOL ) during breast cancer treatment . DESCRIPTION OF STUDY Fifty-two women were recruited from five university hospital outpatient departments for this pilot study with an experimental design . Subjects were r and omly assigned to the walking program or to usual care during adjuvant chemotherapy or radiation therapy for breast cancer . Symptoms , physical functioning , and QOL were measured at baseline , midtreatment , and at the end of treatment . RESULTS Women who exercised at least 90 minutes per week on 3 or more days reported significantly less fatigue and emotional distress as well as higher functional ability and QOL than women who were less active during treatment . CLINICAL IMPLICATION S A home-based walking exercise program is a potentially effective , low-cost , and safe intervention to manage fatigue and to improve QOL during adjuvant chemotherapy or radiation therapy for breast cancer . This health-promoting self-care 
    Output:
    
Regarding the number of items , the QOL-BC instrument has the most number of items .
All identified QoL instruments have content validity done .
In this review , there was one article on development of new QoL instrument , the New India QoL tool , which has comprehensive validity examinations - the least number of items that may be useful in the clinical setting but need further psychometric testing in different setting s or language s. The QLI-CV instrument has had comprehensive intra- and inter- method validation on different language s , different cultural setting s and various types of cancer .
However , the instrument may not be feasible because the method to calculate the QoL score is not straightforward