***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: Purpose Deterioration of anorectal function after long-course preoperative chemoradiotherapy combined with surgery for rectal cancer is poorly defined . We conducted a prospect i ve study to evaluate the acute and long term effects of preoperative chemoradiotherapy on anorectal function and quality of life of the patients . Methods There were 26 patients in surgery group and 31 patients in preoperative chemoradiotherapy group .  Anorectal function and quality of life of the patients were assessed by anorectal manometry , incontinence score , quality of life question naire . Results Significant lower resting pressures in both groups and lower maximal squeeze pressures in the preoperative chemoradiotherapy group were observed after postsurgical evaluations compared with the paired pretreatment ones . In the surgery group , both the Wexner continence score , FIQL score , and the rectoscopy score were comparable before and after surgery , whereas significant worsening in the Wexner score was observed in the preoperative chemoradiotherapy group postoperatively ( P < 0.01 ) . Significant reduction in anal canal resting pressures and squeeze pressures , Wexner score , and FIQL score were observed immediately after the completion of preoperative chemoradiotherapy . Significant lower maximal squeeze pressures and worsening of the Wexner scores were observed in the preoperative chemoradiotherapy group compared to the surgery group during the postoperative assessment s ( P < 0.05 and P < 0.01 , respectively ) . Conclusions Both total mesorectal excision and preoperative chemoradiotherapy may adversely affect the anorectal function . Careful selection of the patients who will benefit from neoadjuvant therapy and identifying the patients with a high risk of developing functional problems may help to improve functional outcomes for the treatment of rectal cancer The aim of this study was to assess symptoms and health-related quality of life ( HRQL ) during (neo)adjuvant radiotherapy for rectal cancer . Patients receiving pelvic radiotherapy 50 Gy for rectal cancer , were studied prospect ively ( n=42 ) . The European Organization for Research and Treatment of Cancer ( EORTC ) question naires quality of life-core 30 QLQ-C30 and QLQ-CR38 and a 5-day symptom diary were completed at the start and end of radiotherapy and 4 - 6 weeks later . At the end of radiotherapy , mean scores of diarrhoea , fatigue and appetite loss had significantly increased ( P<0.01 ) compared with pretreatment scores , but this was not observed for scores for nausea or pain . At the end of radiotherapy , diarrhoea , fatigue , appetite loss , physical function , social function and global quality of life ( QL ) were significantly worse than the population -based norms . 64 % of the patients reported an increase in fatigue and 52 % an increase in diarrhoea during radiotherapy . HRQL scores had returned to pre-treatment levels 4 - 6 weeks after radiotherapy . Thus , diarrhoea , fatigue and appetite loss increased transiently during pelvic radiotherapy Abstract Objective : To compare chemotherapy given at home with outpatient treatment in terms of  colorectal cancer patients ' safety , compliance , use of health services , quality of life , and satisfaction with treatment . Design : R and omised controlled trial . Setting : Large teaching hospital . Participants : 87 patients receiving adjuvant or palliative chemotherapy for colorectal cancer . Interventions : Treatment with fluorouracil ( with or without folinic acid or levamisole ) at outpatient clinic or at home . Main outcome measures : Treatment toxicity ; patients ' compliance with treatment , quality of life , satisfaction with care , and use of health re sources . Results : 42 patients were treated at outpatient clinic and 45 at home . The two groups were balanced in terms of age , sex , site of cancer , and disease stage . Treatment related toxicity was similar in the two groups ( difference 7 % ( 95 % confidence interval −12 % to 26 % ) ) , but there were more voluntary withdrawals from treatment in the outpatient group than in the home group ( 14 % v 2 % , difference 12 % ( 1 % to 24 % ) ) . There were no differences between groups in terms of quality of life scores during and after treatment . Levels of patient satisfaction were higher in the home treatment group , specifically with regard to information received and nursing care . There were no significant differences in use of health services . Conclusions : Home chemotherapy seemed an acceptable and safe alternative to hospital treatment for patients with colorectal cancer that may improve compliance and satisfaction with treatment . What is already known on this topic Home chemotherapy programmes have been proposed as an alternative to hospital treatment However , they are more costly , and there is little evidence on their impact on outcomes such as compliance , quality of life , or use of other health services What this study adds Home chemotherapy was not associated with an increased use of health services such as primary care or emergency departments Home chemotherapy had no effect on patients ' quality of life but increased their compliance with treatment and satisfaction , particularly with regard to nursing care Home chemotherapy seems an acceptable and safe alternative to outpatient treatment that may improve compliance with CONTEXT Laparoscopic-assisted colectomy ( LAC ) has emerged as the preferred minimally invasive surgical strategy for diseases of the colon . The safety and efficacy of LAC for colon cancer are unknown , and the nature and magnitude of any quality -of-life ( QOL ) benefit result ing from LAC for colon cancer is also unknown . OBJECTIVE To compare short-term QOL outcomes after LAC vs open colectomy for colon cancer . DESIGN , SETTING , AND PARTICIPANTS Multicenter , r and omized controlled trial ( Clinical Outcomes of Surgical Therapy [ COST ] ) . Between September 1994 and February 1999 , 37 of 48 centers provided data for the QOL component of the trial for 449 consecutive patients with clinical ly resectable colon cancer . MAIN OUTCOME MEASURES Scores on the Symptoms Distress Scale ( SDS ) , Quality of Life Index , and a single-item global rating scale at 2 days , 2 weeks , and 2 months postoperative ; duration of postoperative in-hospital analgesic use ; and length of stay . RESULTS Of 449 patients , 428 provided QOL data . In an intention-to-treat analysis comparing SDS pain intensity , SDS summary , QOL Index summary , and global rating scale scores at each time point , the only statistically significant difference observed between groups was the global rating scale score for 2 weeks postsurgery . The mean ( median ) global rating scale scores for 2 weeks postsurgery were 76.9 ( 80 ) for LAC vs 74.4 ( 75 ) for open colectomy ( P = .009 ) . While in the hospital , patients assigned to LAC required fewer days of both parenteral analgesics compared with patients assigned to open colectomy ( mean [ median ] , 3.2 [ 3 ] vs 4.0 [ 4 ] days ; P<.001 ) and oral analgesics ( mean [ median ] , 1.9 [ 1 ] vs 2.2 [ 2 ] days ; P = .03 ) . CONCLUSION Only minimal short-term QOL benefits were found with LAC for colon cancer compared with st and ard open colectomy . Until ongoing trials establish that LAC is as effective as open colectomy in preventing recurrence and death from colon cancer , this procedure should not be offered to patients with colon cancer Objective To examine the prevalence of outcome reporting bias — the selection for publication of a subset of the original recorded outcome variables on the basis of the results — and its impact on Cochrane review s. Design A nine point classification system for missing outcome data in r and omised trials was developed and applied to the trials assessed in a large , unselected cohort of Cochrane systematic review s. Research ers who conducted the trials were contacted and the reason sought for the non-reporting of data . A sensitivity analysis was undertaken to assess the impact of outcome reporting bias on review s that included a single meta- analysis of the review primary outcome . Results More than half ( 157/283 ( 55 % ) ) the review s did not include full data for the review primary outcome of interest from all eligible trials . The median amount of review outcome data missing for any reason was 10 % , whereas 50 % or more of the potential data were missing in 70 ( 25 % ) review s. It was clear from the publications for 155 ( 6 % ) of the 2486 assessable trials that the research ers had measured and analysed the review primary outcome but did not report or only partially reported the results . For reports that did not mention the review primary outcome , our classification regarding the presence of outcome reporting bias was shown to have a sensitivity of 88 % ( 95 % CI 65 % to 100 % ) and specificity of 80 % ( 95 % CI 69 % to 90 % ) on the basis of responses from 62 trialists . A third of Cochrane review s ( 96/283 ( 34 % ) ) contained at least one trial with high suspicion of outcome reporting bias for the review primary outcome . In a sensitivity analysis undertaken for 81 review s with a single meta- analysis of the primary outcome of interest , the treatment effect estimate was reduced by 20 % or more in 19 ( 23 % ) . Of the 42 meta-analyses with a statistically significant result only , eight ( 19 % ) became non-significant after adjustment for outcome reporting bias and 11 ( 26 % ) would have overestimated the treatment effect by 20 % or more . Conclusions Outcome reporting bias is an under-recognised problem that affects the conclusions in a substantial proportion of Cochrane review s. Individuals conducting systematic review s need to address explicitly the issue of missing outcome data for their review to be considered a reliable source of evidence . Extra care is required during data extraction , review ers should identify when a trial reports that an outcome was measured but no results were reported or events observed , and contact with trialists should be encouraged Objective : We aim ed to test the hypothesis that warming and humidification of insufflation CO2 would lead to reduced  postoperative pain  and improved recovery by reducing peritoneal inflammation in laparoscopic colonic surgery . Summary Background Data : Warming and humidification of insufflation gas is thought be beneficial in laparoscopic surgery , but evidence in prolonged laparoscopic procedures is lacking . Methods : We used a multicenter , double-blinded , r and omized controlled design . The Study Group received warmed ( 37 ° C ) , humidified ( 98 % RH ) insufflation carbon dioxide , and the Control Group received st and ard gas ( 19 ° C , 0 % RH ) . Anesthesia and analgesia were st and ardized . Intraoperative oesophageal temperature was measured at 15 minutes intervals . At the conclusion of surgery , the primary surgeon was asked to rate camera fogging on a Likert scale . Postoperative opiate usage was determined using Morphine Equivalent Daily Dose ( MEDD ) , and pain was measured using visual analogue scores . Peritoneal and plasma cytokine concentrations were measured at 20 hours postoperatively . Postoperative recovery was measured using defined discharge and complication criteria , and the Surgical Recovery Score . Results : Eighty-two patients were r and omized , with 41 in each arm . Groups were well matched at baseline . Intraoperative core temperature was similar in both groups . Median camera fogging score was significantly worse in the Study group ( 4 vs. 2 , P = 0.040 ) . There were marginal differences in pain scores , but no significant differences were detected in MEDD usage , cytokine concentrations , or any recovery parameters measured . Conclusion : Warming and humidification of insufflation CO2 does not attenuate the early inflammatory cytokine response , and confers no clinical ly significant benefit in laparoscopic colonic surgery Background R and omized controlled trials ( RCTs ) have reported improved or unchanged three-year survival following  laparoscopic colon resection ( LCR ) for colon cancer compared with that following open resection ( OCR ) . The aim of this study was to determine health-related quality of life ( HRQL ) in patients r and omized to laparoscopic or open resection for colon cancer . Methods In total , 285 patients ( 130 LCR , 155 OCR ) from seven Swedish centers were included .  HRQL was assessed preoperatively and at 2 , 4 , and 12 weeks postoperatively with the EQ-5D and EORTC QLQ-C30 instruments . Results The LCR patients did significantly better on the social function component of the EORTC QLQ-C30 at two and four weeks and on the role function component at two weeks . Conclusion Laparoscopic resection for colon cancer improved quality of life during the first postoperative month Some studies indicate that age at the time of surgery has a general effect on outcomes . The impact of age on the quality of life ( QOL ) of patients with rectal cancer , however , has not been investigated . The present study was conducted to address this issue . Over a 5-year period the European Organization for Research and Treatment of Cancer (EORTC)-QLQ-C-30 and a tumor-specific module were prospect ively administered to patients before surgery , at discharge , and at 3 , 6 , 12 , and 24 months postoperatively . Comparisons were made between age groups . A total of 519 patients participated in the study . QOL data were available for 253 patients . Significant differences were observed only between patients aged 69 years and younger ( ≤69 years ) ( 169/253 ) and those aged 70 years and older ( ≥70 years ) ( 85/253 ) . Physical and role functioning was better for patients ≤69 years ; patients ≥70 years suffered from increased pain and fatigue . Younger patients had more difficulty with sexual enjoyment , and over time sexual strain was worse for patients aged ≥70 years during the early postoperative period but improved , whereas patients aged ≤69 years had increasing levels of strain 
    Output:
    
There is major heterogeneity of PRO measurement and a wide variation in content assessed in the PROMs available for CRC .