***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: A structured question naire consisting of two parts was used to evaluate the impact of ovarian cancer and its management on quality of life in 28 patients with advanced disease . The first part rated their perceptions of behavioral disruption and emotional distress in five life areas , i.e. , activity , daily living , health , support , and outlook as set out by the interviewer-rated Spitzer question naire " Quality of Life Index of Cancer Patients . " The second part rated their response in the domain of sexual activity . Data were collected prospect ively at three monthly intervals during the 2-year descriptive study . In 12 patients ovarian cancer persisted despite surgery and chemotherapy result ing in the demise of 8 women within 2 years . During the first year of study these patients described a similar deterioration in quality of life as those who had a complete response to treatment . However , after 1 year , patients with persistent disease rated their quality of life much lower . Diagnosis of persistent disease after conventional treatment proved more stressful than the diagnosis of the primary disease . Treatment of ovarian cancer will produce behavioral disruption and emotional distress , with lasting affects seen even in patients with complete response 2 years after commencing therapy Background Women with platinum-resistant ovarian cancer are a heterogeneous group whose median overall survival is 12 months . We hypothesized that their quality of life ( QoL ) scores would be prognostic . Patients and methods Data from AURELIA ( n = 326 ) , a r and omized trial of chemotherapy with or without bevacizumab  , were used to identify baseline QoL domains [ EORTC ( European Organisation for Research and Treatment of Cancer ) QLQ-C30 and OV28 ] that were significantly associated with overall survival in multivariable Cox regression analyses . Patients were classified as having good , medium , or poor risk . Cutpoints were vali date d in an independent data set , CARTAXHY ( n = 136 ) . Multivariable analyses of significant QoL domains on survival were adjusted for clinicopathological prognostic factors . The additional QoL information was assessed using C statistic . Results In AURELIA , all domains , except cognitive function , predicted overall survival in univariable analyses . Physical function ( P < 0.001 ) and abdominal/gastrointestinal symptom ( P < 0.001 ) scores remained significant in multivariable models . In high ( score < 67 ) , medium ( 67 - 93 ) , and low ( > 93 ) risk categories for physical function , median overall survival was 11.0 , 14.7 , and 19.3 months , respectively ( P < 0.001 ) . In CARTAXHY , median overall survival was 7.9 , 16.2 , and 23.9 months ( P < 0.001 ) , respectively . For high- ( > 44 ) , medium- ( 13 - 44 ) , and low- ( < 13 ) risk categories for abdominal/gastrointestinal symptoms , median overall survival was 11.9 , 14.3 , and 19.7 months in AURELIA ( P < 0.001 ) and 10.5 , 19.6 , and 24.1 months in CARTAXHY ( P = 0.02 ) . Physical function ( P = 0.02 ) and abdominal/gastrointestinal symptoms ( P = 0.03 ) remained independent prognostic factors after adjustment for clinicopathological factors . The C statistic of the full model was 0.71 . For QoL factors alone , patient factors alone and disease factors alone , the C statistics were 0.61 , 0.61 , and 0.67 respectively . Conclusions Physical function and abdominal/gastrointestinal symptom scores improved predictions of overall survival over clinicopathological factors alone in platinum-resistant ovarian cancer . This additional prognostic information could improve trial stratification , patient-doctor communication about prognosis , and clinical decision-making . Clinical trial registration NCT00976911 PURPOSE Although patient-reported cancer symptoms and quality -of-life issues ( SQLIs ) have been promoted as essential to a comprehensive assessment , efficient and efficacious methods have not been widely tested in clinical setting s. The purpose of this trial was to determine the effect of the Electronic Self-Report Assessment -Cancer ( ESRA-C ) on the likelihood of SQLIs discussed between clinicians and patients with cancer in ambulatory clinic visits . Secondary objectives included comparison of visit duration between groups and usefulness of the ESRA-C as reported by clinicians . PATIENTS AND METHODS This r and omized controlled trial was conducted in 660 patients with various cancer diagnoses and stages at two institutions of a comprehensive cancer center .  Patient-reported SQLIs  were automatically displayed on a graphical summary and provided to the clinical team before an on-treatment visit ( n = 327 ) ; in the control group , no summary was provided ( n = 333 ) . SQLIs were scored for level of severity or distress . One on-treatment clinic visit was audio recorded for each participant and then scored for discussion of each SQLI . We hypothesized that problematic SQLIs would be discussed more often when the intervention was delivered to the clinicians . RESULTS The likelihood of SQLIs being discussed differed by r and omized group and depended on whether an SQLI was first reported as problematic ( P = .032 ) . Clinic visits were similar with regard to duration between groups , and clinicians reported the summary as useful . CONCLUSION The ESRA-C is the first electronic self-report application to increase discussion of SQLIs in a US r and omized clinical trial Main purpose The objective of this study was to determine the relationship between clinician- grade d symptoms based on the common toxicity criteria ( CTC ) and patient-reported quality of life ( QoL ) . We hypothesized that toxicity symptoms that are objective or observable would have a higher correlation with QoL than subjective data . Material and methods A retrospective analyses of data from three closed r and omized chemotherapy trials was performed . A total of 2,110 patients with ovarian cancer ( stage IIB – IV ) who had complete toxicity and QoL data at cycles 3 and 6 were included .  Toxicities were grade d according to the National Cancer Institute Common Toxicity Criteria . Quality of life was assessed every other cycle by using the European Organization for Research and Treatment of Cancer Quality of Life Question naire ( EORTC QLQ-C30).Main results Correlations between CTC grading and the QLQ-C30 functioning scales were weak ( < 0.30 ) ; correlation coefficients between CTC ratings and the QLQ-C30 symptom scales including nausea , vomiting , constipation , pain , and dyspnea ranged from 0.32 to 0.49 except for constipation ( 0.55 ) . On a symptom level exact agreement between clinician and patient reporting ranged from 54.2 % ( pain ) to 80.8 % ( emesis/vomiting ) . When symptom grading differed , patients reported greater severity for pain , constipation , and dyspnea , whereas clinicians grade d emesis/vomiting and nausea as more severe than the grading by patients . Conclusion Patient experience is not routinely captured by CTC toxicity scales . Therefore , clinicians should not entirely rely on the CTC grading but consider patient-reported outcomes as well PURPOSE There is growing interest to enhance symptom monitoring during routine cancer care using patient-reported outcomes , but evidence of impact on clinical outcomes is limited . METHODS We r and omly assigned patients receiving routine outpatient chemotherapy for advanced solid tumors at Memorial Sloan Kettering Cancer Center to report 12 common symptoms via tablet computers or to receive usual care consisting of symptom monitoring at the discretion of clinicians . Those with home computers received weekly e-mail prompts to report between visits . Treating physicians received symptom printouts at visits , and nurses received e-mail alerts when participants reported severe or worsening symptoms . The primary outcome was change in health-related quality of life ( HRQL ) at 6 months compared with baseline , measured by the EuroQol EQ-5D Index . Secondary endpoints included emergency room ( ER ) visits , hospitalizations , and survival . RESULTS Among 766 patients allocated , HRQL improved among more participants in the intervention group than usual care ( 34 % v 18 % ) and worsened among fewer ( 38 % v 53 % ; P < .001 ) . Overall , mean HRQL declined by less in the intervention group than usual care ( 1.4- v 7.1-point drop ; P < .001 ) . Patients receiving intervention were less frequently admitted to the ER ( 34 % v 41 % ; P = .02 ) or hospitalized ( 45 % v 49 % ; P = .08 ) and remained on chemotherapy longer ( mean , 8.2 v 6.3 months ; P = .002 ) . Although 75 % of the intervention group was alive at 1 year , 69 % with usual care survived the year ( P = .05 ) , with differences also seen in quality -adjusted survival ( mean of 8.7 v. 8.0 months ; P = .004 ) . Benefits were greater for participants lacking prior computer experience . Most patients receiving intervention ( 63 % ) reported severe symptoms during the study . Nurses frequently initiated clinical actions in response to e-mail alerts . CONCLUSION Clinical benefits were associated with symptom self-reporting during cancer care BACKGROUND Serum CA125 concentration often rises several months before clinical or symptomatic relapse in women with ovarian cancer . In the MRC OV05/EORTC 55955 collaborative trial , we aim ed to establish the benefits of early treatment on the basis of increased CA125 concentrations compared with delayed treatment on the basis of clinical recurrence . METHODS Women with ovarian cancer in complete remission after first-line platinum-based chemotherapy and a normal CA125 concentration were registered for this r and omised controlled trial . Clinical examination and CA125 measurement were done every 3 months . Patients and investigators were masked to CA125 results , which were monitored by coordinating centres . If CA125 concentration exceeded twice the upper limit of normal , patients were r and omly assigned ( 1:1 ) by minimisation to early or delayed chemotherapy . Patients and clinical sites were informed of allocation to early treatment , and treatment was started as soon as possible within 28 days of the increased CA125 measurement . Patients assigned to delayed treatment continued masked CA125 measurements , with treatment commencing at clinical or symptomatic relapse . All patients were treated according to st and ard local practice . The primary outcome was overall survival . Analysis was by intention to treat . This study is registered , IS RCT N87786644 . FINDINGS 1442 patients were registered for the trial , of whom 529 were r and omly assigned to treatment groups and were included in our analysis ( 265 early , 264 delayed ) . With a median follow-up of 56·9 months ( IQR 37·4 - 81·8 ) from r and omisation and 370 deaths ( 186 early , 184 delayed ) , there was no evidence of a difference in overall survival between early and delayed treatment ( HR 0·98 , 95 % CI 0·80 - 1·20 , p=0·85 ) . Median survival from r and omisation was 25·7 months ( 95 % CI 23·0 - 27·9 ) for patients on early treatment and 27·1 months ( 22·8 - 30·9 ) for those on delayed treatment . INTERPRETATION Our findings showed no evidence of a survival benefit with early treatment of relapse on the basis of a raised CA125 concentration alone , and therefore the value of routine measurement of CA125 in the follow-up of patients with ovarian cancer who attain a complete response after first-line treatment is not proven . FUNDING UK Medical Research Council and the European Organisation for Research and Treatment of Cancer OBJECTIVES To document levels of and changes in physical activity before and after ovarian cancer diagnosis and explore associations with psychosocial outcomes . METHODS Of 1207 eligible Australian Ovarian Cancer Study ( AOCS ) participants , 798 participated in an additional prospect i ve Quality of Life ( QoL ) Study which measured anxiety , depression and QoL at 3 - 6 monthly intervals for 2 years beginning 3 - 48 months after diagnosis . AOCS asked about physical activity before diagnosis and 530 women also completed a one-off lifestyle question naire 7 - 64 months after diagnosis which assessed activity during their first and , if relevant , second-to-third and fourth-to-sixth years following diagnosis . Analysis of variance was used to relate physical activity to psychosocial outcomes . RESULTS Almost 40 % of women decreased their physical activity in the first year after diagnosis . Approximately 25 % still had lower levels after 2 - 3 and 4+years . Recent physical activity level was inversely associated with depression and positively associated with QoL ( P<0.05 ) . Also , women who maintained or increased their physical activity after diagnosis had better mean depression and QoL scores than women who decreased physical activity or remained inactive ( P<0.05 ) . Among women who received chemotherapy shortly prior to completing the lifestyle question naire , high versus low or medium physical activity was associated with significantly lower mean depression scores during both periods of treatment and non-treatment ( P<0.05 ) . CONCLUSIONS Many women did not regain their pre-morbid physical activity levels several years after ovarian cancer diagnosis . Low physical activity may simply be a consequence of poor well-being but , alternatively , physical activity may improve psychosocial health of this group The objective of this study was to determine current practice with regards to follow- 
    Output:
    
ConclusionS tudies have shown that PROMs can identify otherwise undetected symptoms .
Using PROMs proactively during the consultation has been shown to improve symptom management for patients with some other types of cancer .