***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: BACKGROUND The aim of the study was to analyse the toxicity and health related quality of life ( HRQoL ) of breast cancer patients treated with FAC ( 5-fluorouracil , doxorubicin , cyclophosphamide ) and TAC ( docetaxel , doxorubicin , cyclophosphamide ) with and without primary prophylactic G-CSF ( PPG ) .  PATIENTS AND METHODS This was a phase III study to compare FAC and TAC as adjuvant treatment of high-risk node-negative breast cancer patients . After the entry of the first 237 patients , the protocol was amended to include PPG in the TAC arm due to the high incidence of febrile neutropenia . A total of 1047 evaluable patients from 49 centres in Spain , two in Pol and and four in Germany were included in the trial .  Side-effects and the scores of the EORTC QLQ-C30 and QLQ BR-23 question naires were compared in the three groups ( FAC , TAC pre-amendment and TAC post-amendment ) . RESULTS The addition of PPG to TAC significantly reduced the incidence of neutropenic fever , grade 2 - 4 anaemia , asthenia , anorexia , nail disorders , stomatitis , myalgia and dysgeusia . Patient QoL decreased during chemotherapy , more with TAC than FAC , but returned to baseline values afterwards . The addition of PPG to TAC significantly reduced the percentage of patients with clinical ly relevant Global Health Status deterioration ( 10 or more points over baseline value ) at the end of chemotherapy ( 64 % versus 46 % , P<0.03 ) . CONCLUSIONS The addition of PPG significantly reduces the incidence of neutropenic fever associated with TAC chemotherapy as well as that of some TAC-induced haematological and extrahaematological side-effects . The HRQoL of patients treated with TAC is worse than that of those treated with FAC but improves with the addition of PPG , particularly in the final part of chemotherapy treatment 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 Quality of life ( QOL ) assessment s of women entering a UK r and omised trial of adjuvant radiotherapy ( START ) were investigated to estimate the independent effects on QOL of age , time since surgery , type of breast surgery , chemotherapy and endocrine therapy .  QOL was evaluated using the EORTC general cancer QOL scale ( EORTC QLQ-C30 ) , breast cancer module ( BR23 ) , the Body Image Scale ( BIS ) and the Hospital Anxiety and Depression Scale ( HADS ) . Independent effects of age and clinical factors were tested using multiple regression analysis . A total of 2208 ( mean age 56.9 years , range 26 - 87 ) consented to the QOL study prior to radiotherapy ; 17.1 % had undergone mastectomy ( Mx ) and the remainder had undergone a wide local excision ( WLE ) . 33.3 % had received adjuvant chemotherapy ( CT ) and 56.7 % were taking endocrine therapy ( ET ) . Age had significant effects on QOL with older and younger subgroups predicting poorer QOL for different domains . CT affected most QOL domains and result ed in worse body image , sexual functioning , breast and arm symptoms ( < 0.001 ) . Mx was associated with greater body image concerns ( p<0.001 ) , and WLE with more arm symptoms ( p=0.01 ) . There were no effects of  ET  on QOL .  Women < 50 years ( proxy pre-menopausal ) had worse QOL in respect of anxiety , body image and breast symptoms but age and clinical factors had no effect on depression . Overall , QOL and mental health were favourable for most women about to start RT , but younger age and receiving CT were significant risk factors for poorer QOL , and so patients in these subgroups warrant further monitoring . Surgery had a limited impact and ET had no effect on QOL OBJECTIVE To evaluate a single cycle of adjuvant chemotherapy compared with longer duration chemotherapy for premenopausal women or chemoendocrine therapy for postmenopausal women with operable breast cancer using a quality -of-life-oriented end point , Q-TWiST ( quality -adjusted analysis of TWiST : Time Without Symptoms and Toxicity ) . DESIGN Multicenter r and omized clinical trial -- International Breast Cancer Study Group ( IBCSG : formerly Ludwig Group ) Trial V. SETTING IBCSG participating centers in Sweden , Switzerl and , Australia , Yugoslavia , Spain , New Zeal and , Italy , Germany , and South Africa . PATIENTS Data were available for 1229 eligible patients with node-positive breast cancer who were r and omized to receive one of three adjuvant treatments after at least a total mastectomy and axillary clearance . INTERVENTIONS Patients received either a single cycle of perioperative chemotherapy consisting of cyclophosphamide , methotrexate , fluorouracil , and leucovorin ; or six cycles ( 6 months ) of a conventionally timed chemotherapy consisting of cyclophosphamide , methotrexate , fluorouracil , and prednisone for premenopausal women or this combination plus tamoxifen for postmenopausal women ; or both perioperative and conventionally timed chemotherapy for a 7-month course of adjuvant therapy . RESULTS At 5 years of median follow-up , patients who received the longer duration therapies had an improved 5-year disease-free survival percentage ( 53 % compared with 36 % ; P less than 0.001 ) and 5-year overall survival percentage ( 73 % compared with 63 % ; P = 0.001 ) compared with those who received the single perioperative cycle alone . By 3.5 years , the greater burden of toxic effects associated with the longer duration treatments was balanced by their superior control of disease . Within 5 years of follow-up , even after subtracting time with adjuvant treatment toxicity , patients gained an average of 2.2 months of Q-TWiST if treated with the longer duration therapies compared with the single cycle ( P = 0.03 ) . The gain for premenopausal patients was 2.8 months ( P = 0.05 ) , whereas the gain for postmenopausal women was 1.5 months ( P greater than 0.2 ) . CONCLUSIONS Six or seven months of adjuvant chemotherapy or chemoendocrine therapy improve both the quantity and quality of life for patients with node-positive breast cancer compared with a single short course of perioperative combination chemotherapy BACKGROUND Quality of life has increasingly become an important issue in breast cancer treatment . One of the impetuses for sentinel lymph node biopsy or selective axillary lymph node dissection ( ALND ) is the assumed decreased incidence of lymphedema compared with st and ard ALND . This is based on the assumption that ALND is associated with a clinical ly significant incidence of lymphedema and that this lymphedema decreases the quality of life of these patients . However , few data exist on this issue . This study attempts to define the incidence and effect on quality of life of postoperative lymphedema in breast cancer patients . METHODS To determine the incidence of postoperative lymphedema , the Breast Cancer Registry at Henry Ford Hospital was accessed to obtain information on all patients who underwent ALND in the management of breast cancer over a 7-year period . The registry is a prospect ively gathered data base to include the development of various complications , such as lymphedema . To determine the effects of lymphedema on quality of life , 101 consecutive , unselected patients who underwent breast surgery were asked to complete the SF-36 , a generic quality of life instrument . The SF-36 measures eight domains of quality of life . Patients were then divided into three groups : ( 1 )  breast surgery without ALND ( -ALND ) , ( 2 )  breast surgery with ALND but no lymphedema ( -LE ) , and ( 3 ) breast surgery with ALND and lymphedema ( + LE ) . RESULTS In all , 827 patients with ALND were identified in the registry . Of these , 8.3 % developed clinical ly apparent lymphedema . Patients in -ALND and -LE groups had similar scores in all domains of the SF-36 . However , patients in the + LE group had significantly lower scores in the domains of role-emotional and bodily pain . A significantly higher percentage of patients in the + LE group had scores below one st and ard deviation compared with national norms in the domains of bodily pain ( P = 0.005 ) , mental health ( P = 0.01 ) , and general health ( P = 0.04 ) . CONCLUSIONS Although postoperative lymphedema occurs in a minority of patients , when it does occur it can produce demonstrable diminutions in quality of life . Therefore , efforts to reduce the incidence of lymphedema , such as sentinel lymph node biopsy or selective ALND , would benefit breast cancer patients PURPOSE The r and omized study aim ed to determine the efficacy of psychological intervention consisting of relaxation and guided imagery to reduce anxiety and depression in gynecologic and breast cancer patients undergoing brachytherapy during hospitalization . METHODS AND MATERIAL S Sixty-six patients programmed to receive brachytherapy in two hospitals in Barcelona ( Spain ) were included in this study . The patients were r and omly allocated to either the study group ( n=32 ) or the control group ( n=34 ) . Patients in both groups received training regarding brachytherapy , but only study group patients received training in relaxation and guided imagery . After collection of sociodemographic data , all patients were given a set of question naires on anxiety and depression : the Hospital Anxiety and Depression Scale ( HADS ) , and on quality of life : Cuestionario de Calidad de Vida QL-CA-AFex ( CCV ) , prior to , during and after brachytherapy . RESULTS The study group demonstrated a statistically significant reduction in anxiety ( p=0.008 ) , depression ( p=0.03 ) and body discomfort ( p=0.04 ) compared with the control group . CONCLUSIONS The use of relaxation techniques and guided imagery is effective in reducing the levels of anxiety , depression and body discomfort in patients who must remain isolated while undergoing brachytherapy . This simple and inexpensive intervention enhances the psychological wellness in patients undergoing brachytherapy . State : This study has passed Ethical Committee review PURPOSE / OBJECTIVES To describe the side-effects burden experienced over time by 53 women who were receiving treatment for breast cancer and to describe the association of side-effects burden with psychological adjustment and life quality . DESIGN Data were drawn from the Self-Help Intervention Project ( SHIP ) , an intervention study design ed to test the effectiveness of nursing interventions for women receiving treatment for breast cancer . SETTING Subjects were interviewed in their homes or treatment locations three times over a period of four to five months . SAMPLE 53 women r and omly assigned to the control group of the SHIP . METHODS The research ers collected data after treatment was initiated , six to eight weeks later , and three months after that . MAIN RESEARCH VARIABLES Side-effects burden , psychological adjustment , and life quality . FINDINGS Fatigue was the most problematic side effect over time . Other problematic side effects included sore arm(s ) , difficulty sleeping , hair loss , and skin irritation . Significant associations were evident for psychological adjustment with symptom extension and number of side effects at Time 2 and Time 3 . Depression burden and anxiety burden were associated significantly with psychological adjustment at all three times . Overall life quality and present life quality was associated negatively with symptom extension and number of side effects at all three times . Fatigue burden was associated negatively with life quality at Time 2 and Time 3 with depression burden and anxiety burden negatively associated with life quality at all three times . CONCLUSIONS Over time , evidence showed that negative feelings , in particular depression burden and anxiety burden , persist . Depression burden and anxiety burden each were negatively associated with overall and present life quality at all three times . IMPLICATION S FOR NURSING PRACTICE A need exists for clinical ly individualized nursing interventions that will reduce the side effects burden of women receiving treatment for breast cancer . Interventions can do much 
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Few differences were detected by type of chemotherapy , with the single exception of worse results among younger women treated with radiotherapy .
In the short term , better results were reported for all HRQL components by women undergoing conservative rather than radical surgery .
Presence of lymphedema was associated with worse HRQL .
Psychosocial disorder and level of depression and anxiety , regardless of treatment or disease stage , worsened HRQL .
One study found that breast cancer patients scored worse than did healthy women on almost all SF-12 scales .