***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 
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    Input: Goal of the workAnemia is a common side effect of chemotherapy . Limited information exists about its incidence and risk factors . The objective of this study was to evaluate the incidence of anemia and risk factors for anemia occurrence in patients with early breast cancer who received adjuvant chemotherapy .  Material s and methods We evaluated risk factors for anemia in pre- and post/perimenopausal patients with lymph node-positive early breast cancer treated with adjuvant chemotherapy in two r and omized trials . All patients received four cycles of doxorubicin and cyclophosphamide ( AC ) followed by three cycles of cyclophosphamide , methotrexate , fluorouracil ( CMF ) . Anemia incidence was related to baseline risk factors . Multivariable analysis used logistic and Cox regression . Main results Among the 2,215 available patients , anemia was recorded in 11 % during adjuvant chemotherapy .  Grade 2 and 3 anemia occurred in 4 and 1 % of patients , respectively . Pretreatment hemoglobin and white blood cells ( WBC ) were significant predictors of anemia . Adjusted odds ratios ( logistic regression ) comparing highest versus lowest quartiles were 0.18 ( P < 0.0001 ) for hemoglobin and 0.52 ( P = 0.0045 ) for WBC . Age , surgery type , platelets , body mass index , and length of time from surgery to chemotherapy were not significant predictors . Cox regression results looking at time to anemia were similar . Conclusions Moderate or severe anemia is rare among patients treated with AC followed by CMF . Low baseline hemoglobin and WBC are associated with a higher risk of anemia BACKGROUND Carboplatin dosing for gynecologic malignancies is traditionally based on the Jelliffe formula that lacks dose adjustment for weight . Obese women may therefore receive a sub-therapeutic carboplatin dose . This study assessed the association between BMI and outcome for ovarian cancer patients treated with carboplatin-based chemotherapy .  METHODS An analysis of patients treated with carboplatin and paclitaxel on Gynecologic Oncology Group ( GOG ) protocol 158 was performed . The dose of carboplatin for each patient was based on an area under the curve of 7.5 and a glomerular filtration rate ( GFR ) derived from the Jelliffe formula which is derived from age and serum creatinine . Patients were stratified based on body mass index ( BMI ) . RESULTS A total of 387 patients were included in the analysis . The patients were stratified into three groups : normal weight ( BMI < 25.0 , 50 % ) , overweight ( BMI 25 - 29.9 , 32 % ) and obese ( BMI > or = 30.0 , 18 % ) . Compared to pretreatment values , the obese patients had a lower relative decrease in their platelet counts ( -25 % for BMI > or = 30 vs. -61 % for BMI < 25 ) ( p = 0.01 ) . Similar trends were noted for relative changes in hemoglobin ( p = 0.006 ) and hematocrit ( p = 0.002 ) . Dose reductions were required in 34 % of normal weight compared to 21 % of the obese women ( p = 0.004 ) . There was a trend toward increased risk for disease progression in women with a BMI > or = 30 ( RR : 1.25 , 95 % CI : 0.93 - 1.69 , p = 0.14 ) . CONCLUSION Obese ovarian cancer patients treated with carboplatin experience substantially less toxicity than normal weight women . The lower toxicity suggests that obese patients may be receiving a subst and ard drug dose Two hundred and eleven patients with node-positive stage II and III breast cancer were treated with eight cycles of adjuvant chemotherapy comprising cyclophosphamide , doxorubicin and oral ftorafur ( CAFt ) , with and without tamoxifen .  All patients had undergone radical surgery , and 148 patients were treated with post-operative radiotherapy in two r and omized studies . The impact of haematological toxicity of CAFt on distant disease-free ( DDFS ) and overall survival ( OS ) was recorded . Dose intensity of all given cycles ( DI ) , dose intensity of the two initial cycles ( DI2 ) and total dose ( TD ) were calculated separately for all chemotherapy drugs and were correlated with DDFS and OS . Patients with a lower leucocyte nadir during the chemotherapy had significantly better DDFS and OS ( P = 0.01 and 0.04 respectively ) . Dose intensity of the two first cycles also correlated significantly with DDFS ( P = 0.05 ) in univariate but not in multivariate analysis , while the leucocyte nadir retained its prognostic value . These results indicate that the leucocyte nadir during the adjuvant chemotherapy is a biological marker of chemotherapy efficacy ; this presents the possibility of establishing an optimal dose intensity for each patient . The initial dose intensity of adjuvant chemotherapy also seems to be important in assuring the optimal effect of adjuvant chemotherapy Myelosuppression , particularly febrile neutropenia ( FN ) , are serious dose‐limiting toxicities that occur frequently during the first cycle of chemotherapy . Identifying patients most at risk of developing FN might help physicians to target prophylactic treatment with colony‐stimulating factor ( CSF ) , in order to decrease the incidence , or duration , of myelosuppression and facilitate delivery of chemotherapy as planned . We present a risk model for FN occurrence in the first cycle of chemotherapy , based on a subgroup of 240 patients with non‐Hodgkin lymphoma ( NHL ) enroled in our European prospect i ve observational study . Eligible patients had an International Prognostic Index of 0–3 , and were scheduled to receive a new myelosuppressive chemotherapy regimen with at least four cycles . Clinical ly relevant factors significantly associated with cycle 1 FN were older age , increasing planned cyclophosphamide dose , a history of previous chemotherapy , a history of recent infection , and low baseline albumin ( < 35 g/l ) . Prophylactic CSF use and higher weight were associated with a significant protective effect . The model had high sensitivity ( 81 % ) and specificity ( 80 % ) . Our model , together with treatment guidelines , may rationalise the clinical decision of whether to support patients with CSF primary prophylaxis based on their risk factor profile . Further validation is required Background : Obesity has been shown to be an indicator of poor prognosis for patients with primary breast cancer ( BC ) regardless of the use of adjuvant systemic therapy . Patients and methods : This is a retrospective analysis of 2,887 node-positive BC patients enrolled in the BIG 02 - 98 adjuvant study , a r and omised phase III trial whose primary objective was to evaluate disease-free survival ( DFS ) by adding docetaxel to doxorubicin-based chemotherapy . In the current analysis , the effect of body mass index ( BMI ) on DFS and overall survival ( OS ) was assessed .  BMI was obtained before the first cycle of chemotherapy . Obesity was defined as a BMI ≥ 30 kg/m² . Results : In total , 547 ( 19 % ) patients were obese at baseline , while 2,340 ( 81 % ) patients were non-obese . Estimated 5-year OS was 87.5 % for non-obese and 82.9 % for obese patients ( HR 1.34 ; P = 0.013 ) . Estimated 5-years DFS was 75.9 % for non-obese and 70.0 % for obese patients ( HR 1.20 ; P = 0.041 ) . In a multivariate model , obesity remained an independent prognostic factor for OS and DFS . Conclusions : In this study , obesity was associated with poorer outcome in node-positive BC patients . Given the increasing prevalence of obesity worldwide , more research on improving the treatment of obese BC patients is needed OBJECTIVES To evaluate the association between body mass index ( BMI ) and outcomes in women with advanced or recurrent endometrial cancer treated with doxorubicin/cisplatin .  METHODS Data from patients treated on five Gynecologic Oncology Group trials were retrospectively review ed . BMI was categorized as normal ( < 25 ) , overweight ( > or = 25 to < 30 ) , obese ( > or = 30 to < 40 ) , and morbidly obese ( > or = 40 ) . BMI was analyzed for associations with demographics , clinical characteristics , toxicity , progression-free survival ( PFS ) , and overall survival ( OS ) . RESULTS Among 949 patients , 533 ( 56 % ) had recurrent disease , 227 ( 23.9 % ) had Stage IV disease , and 189 ( 19.9 % ) had Stage III disease .  Mean BMI was 29.8 ; 29.6 % , 27.0 % , 33.2 % and 10.2 % of patients , respectively , were categorized as normal , overweight , obese , and morbidly obese . The mean BMI was significantly different when compared by age group ( p<0.001 ) , stage ( p=0.047 ) , histologic type ( p=0.024 ) , and tumor grade ( p=0.014 ) . Older patients and those with clear cell , poorly differentiated tumors , or stage IV disease had a lower BMI . No significant associations between PFS and BMI were detected . Increasing BMI was significantly associated with an increased risk of death in Stage III/IV ( HR=1.86 , 95 % CI 1.16 - 2.99 for BMI > or = 40 vs. BMI < 25 ) but not recurrent patients . Higher BMI patients had less Grade 3/4 toxicities than normal patients ( p<0.001 ) but this difference disappeared for obese patients receiving > or = 95 % of the calculated dose . CONCLUSIONS BMI was not predictive of PFS in this endometrial cancer population although morbidly obese patients had decreased OS in primary Stage III/IV patients . Toxicities decreased with increasing BMI , perhaps secondary to capped dosing Background Chemotherapy-induced neutropenia ( CIN ) places patients at risk of life-threatening infections . While reduction of chemotherapy dose or delay of the subsequent treatment cycle and , consequently , reduction of relative dose intensity ( RDI ) may limit myelotoxicity , these actions can also impact adversely on treatment outcome and should be avoided in adjuvant setting s. Patients and methods Based on data from 444 breast cancer patients in the INC-EU Prospect i ve Observational European Neutropenia Study , we have evaluated patient-specific and treatment-specific factors that impact on the incidence of grade 4 CIN ( absolute neutrophil count < 0.5 × 109/L ) , either during the first or in any cycle of (neo)adjuvant chemotherapy , across a range of regimens and doses . Results Using multivariate logistic regression analysis , risk factors for grade 4 CIN were identified as older age , lower weight , higher planned dose intensity of doxorubicin , epirubicin , or docetaxel , higher number of planned cycles , vascular comorbidity , lower baseline white blood cell count , and higher baseline bilirubin . Use of colony-stimulating factor  before a neutropenic event occurred , dose delays , and dose reductions were protective against grade 4 CIN . Conclusions By identifying risk factors for grade 4 CIN , CSF prophylaxis may be appropriately targeted to prevent low RDI in patients treated with curative intent Obesity is a risk factor for the development of colon carcinoma . The influence of body mass index ( BMI ) on long‐term outcomes and treatment‐related toxicity in patients with colon carcinoma has not been well characterized BACKGROUND Although several studies have established a link between obesity and colon cancer risk , little is known about the effect of obesity on outcomes after diagnosis . We investigated the association of  body mass index ( BMI )  with outcomes after colon cancer in patients from cooperative group clinical trials . METHODS The study cohort consisted of 4288 patients with Dukes B and C colon cancer who were accrued from July 1989 to February 1994 to National Surgical Adjuvant Breast and Bowel Project r and omized trials .  Risk of recurrence , second primary cancer , and mortality ( overall and by likely cause ) were evaluated in relation to BMI at diagnosis using statistical modeling . Median follow-up time was 11.2 years . All statistical tests were two-sided . RESULTS Very obese patients ( BMI > or = 35 kg/m2 ) had greater risk of a colon cancer event ( recurrence or secondary primary tumor ; hazard ratio [ HR ] = 1.38 , 95 % confidence interval [ CI ] = 1.10 to 1.73 ) than normal weight patients ( BMI = 18.5 - 24.9 kg/m2 ) . Mortality was greater for very obese ( HR = 1.28 , 95 % CI = 1.04 to 1.57 ) and underweight ( BMI < 18.5 kg/m2 ) ( HR = 1.49 , 95 % CI = 1.17 to 1.91 ) than for normal weight patients . The increased risk of mortality for underweight patients was dominated by non-colon cancer deaths ( HR of such deaths compared with normal weight patients = 2.23 , 95 % CI = 1.50 to 3.31 ) , whereas for the very obese , deaths likely due to colon cancer were increased ( HR = 
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As a conclusion , we observed that obese patients tolerate chemotherapy  better than lean patients .
However , this may be confounded by poorly specified dose capping practice s and the use of hematopoietic growth factors .