***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: The objective of this study was to develop a prospect ively applicable method for classifying comorbid conditions which might alter the risk of mortality for use in longitudinal studies . A weighted index that takes into account the number and the seriousness of comorbid disease was developed in a cohort of 559 medical patients . The 1-yr mortality rates for the different scores were : " 0 " , 12 % ( 181 ) ; " 1 - 2 " , 26 % ( 225 ) ; " 3 - 4 " , 52 % ( 71 ) ; and " greater than or equal to 5 " , 85 % ( 82 ) . The index was tested for its ability to predict risk of death from comorbid disease in the second cohort of 685 patients during a 10-yr follow-up . The percent of patients who died of comorbid disease for the different scores were : " 0 " , 8 % ( 588 ) ; " 1 " , 25 % ( 54 ) ; " 2 " , 48 % ( 25 ) ; " greater than or equal to 3 " , 59 % ( 18 ) . With each increased level of the comorbidity index , there were stepwise increases in the cumulative mortality attributable to comorbid disease ( log rank chi 2 = 165 ; p less than 0.0001 ) . In this longer follow-up , age was also a predictor of mortality ( p less than 0.001 ) . The new index performed similarly to a previous system devised by Kaplan and Feinstein . The method of classifying comorbidity provides a simple , readily applicable and valid method of estimating risk of death from comorbid disease for use in longitudinal studies . Further work in larger population s is still required to refine the approach because the number of patients with any given condition in this study was relatively small UNLABELLED In order to evaluate the activity and toxicity of a three-drug combination of vindesine , ifosfamide and cisplatin ( VIP ) for inoperable non-small-cell lung cancer ( NSCLC ) , we conducted a r and omized trial comparing VIP with a two-drug combination of cisplatin and vindesine ( VP ) .  Between September 1987 and March 1992 , a total of 132 patients with stage III or IV NSCLC were r and omly allocated to either VIP or VP . The VIP regimen consisted of vindesine ( VDS 3 mg/m(2 ) on days 1 and 8) , ifosfamide ( IFX 1300 mg/m(2 ) on days 1 - 5 ) , and cisplatin ( CDDP 20 mg/m(2 ) on days 1 - 5 ) . The VP regimen consisted of VDS and CDDP with the same dose and schedule as the VIP regimen . Both regimens were repeated every 4 weeks . Objective response rates were 49.3 % ( 95 % confidence interval : 95%CI , 43.1 - 55.4 % ) in the VIP arm and 44.6 % ( 95%CI , 38.4 - 50.2 % ) in the VP arm ; the difference was not significant ( P=0.5390 ) . Median response duration , median survival time , and two-year survival rates were 26.5 weeks , 49.6 weeks , and 14.9 % in the VIP arm and 28.7 weeks , 37.1 weeks , and 12.3 % in the VP arm , respectively . There were also no significant differences between these two treatment arms . In comparison with the VP regimen , however , a survival advantage of the VIP regimen could be confirmed when the data were evaluated with Cox 's multivariate analysis ( P=0.0131 ) . In both arms , the principal toxicity was myelosuppression , which was significantly more frequent in the VIP arm , although generally well tolerated . CONCLUSION This study suggested the survival advantage of the VIP regimen over the VP regimen for treatment of patients with advanced NSCLC BACKGROUND AND PURPOSE Tumor hypoxia and anemia have been linked to poor overall survival and local control in carcinomas of both the uterine cervix and the head and neck for patients undergoing radiotherapy .  Little is known about the effect of these factors on the outcome of NSCLC patients with locally advanced disease undergoing chemoradiation therapy .  MATERIAL S AND METHODS To examine the impact of anemia in stage III NSCLC patients undergoing combined modality therapy  , we review ed our data base from three sequential trials of concurrent weekly paclitaxel + /- carboplatin and radiation therapy .  115 pts from 17 institutions were enrolled from 4/94 to 5/97 . In this series , hemoglobin values were collected before treatment and weekly during radiotherapy . We correlated baseline Hb and Hb changes during chemoradiation treatment with overall survival . RESULTS Although pretreatment anemia was common ( 30 % Hb = 110 - 130 g/l , 16 % Hb < 110 g/l ) , log-rank analyses of presenting Hb , average Hb and minimum Hb during treatment were not statistically significantly predictive of survival . However in a Cox model , declining hemoglobin during chemoradiation had a statistically significant impact on survival . CONCLUSIONS These analyses reveal that a decline in hemoglobin during chemoradiation for stage III NSCLC has a statistically significant correlation with overall survival . Strategies maximizing hemoglobin during combined modality therapy need further exploration in well-planned r and omized trials PURPOSE Evidence is emerging about the strong predictive relationship between  self-rated health ( SRH )  and survival , although there is little evidence on palliative population s where an accurate prediction of survival is valuable . Thus , the relative importance of SRH in predicting the survival of ambulatory patients with advanced cancer was examined . SRH was compared to clinical assessment s of performance status , as well as to  quality -of-life measures .  PATIENTS AND METHODS By use of a prospect i ve cohort design , 181 patients ( 76 % response rate ) with advanced cancer were recruited into the study , resurveyed at 18 weeks , and observed to record deaths . RESULTS The average age of patients was 62 years ( SD = 12 ) . The median survival time was 10 months . SRH was the strongest predictor of survival from baseline . Also , a Cox regression comparing changes in SRH over time yielded hazard ratios suggesting the relative risk ( RR ) of dying was greater for fair ratings at 18 weeks ( approximately 3 times ) compared with consistent good or better ratings ; the RR was even greater ( 4.2 and 6.2 times ) for poor ratings , especially when ratings were poor at baseline and 18 weeks ( 31 times ) . Improvement in SRH over time yielded the lowest RR . CONCLUSION SRH is valid , reliable , and responsive to change as a predictor of survival of advanced cancer . These qualities suggest that SRH should be considered as an additional tool by oncologists to assess patients . Similarly , health managers could use SRH as an indicator of disease severity in palliative care case mix . Finally , SRH could provide a key to help us underst and the human side of disease and its relationship with medicine A statistical analysis was performed on the patient data collected from two compassionate-use programmes using oxaliplatin ( Eloxatin ® ) + 5-fluorouracil ( 5-FU ) ± folinic acid ( FA ) , to identify predictive factors for oxaliplatin-based salvage treatment in patients with 5-FU-resistant advanced colorectal cancer ( ACRC ) . 481 5-FU-resistant ACRC patients , most with performance status ≤ 2 , ≥ 3 involved sites , and ≥ 2 prior lines of chemotherapy , received oxaliplatin + 5-FU ± FA . Prognostic factors associated with overall response rate ( ORR ) , time to progression ( TTP ) and overall survival ( OS ) were identified using univariate and multivariate logistic and /or Cox proportional hazards analyses . The ORR was 16 % ( 95 % CI : 13–20 ) , the median TTP was 4.2 months ( 95 % CI : 3.4–4.6 ) , and the median OS was 9.6 months ( 95 % CI : 8.6–10.6 ) . The multivariate analysis indicated poor ( ≥ 2 WHO ) performance status ( PS ) , a large number of prior chemotherapy regimens ( ≥ 3 ) , a low baseline haemoglobin level ( < 10 g/dl ) , and a triweekly ( vs biweekly ) treatment administration schedule as significantly associated ( P < 0.05 ) with a lower ORR . Sex ( male ) , number of organs involved ( ≥3 ) and alkaline phosphatase ( AP ) level ( ≥ 2 × the upper limit of normal ) were associated ( P < 0.05 ) with shorter TTP . Poor PS , a large number of organs involved , and elevated AP were independently and significantly correlated with shorter OS . Our analysis identified a relationship between efficacy results of oxaliplatin + 5-FU ± FA treatment in 5-FU-resistant ACRC patients and baseline prognostic factors related to PS , extent of disease and number of prior regimens . © 2001 Cancer Research Campaign PURPOSE To assess long-term survival and prognostic indicators of survival in patients with advanced urothelial cancer treated with gemcitabine and cisplatin .  MATERIAL S AND METHODS Survival data from three previously published phase II trials of gemcitabine/cisplatin were up date d. Baseline hemoglobin , performance status , and presence of visceral metastases , which are known prognostic factors with other regimens , were examined . Survival curves were constructed by the Kaplan-Meier method and significance assessed using the log-rank statistic . Cox 's Proportional Hazards Model was used to construct univariate and multivariate survival models . RESULTS AND CONCLUSIONS Overall median survival of 121 included patients was 13.2 ( 11.0 to 14.9 ) months and estimated 4 year survival was 13 + /- 6 % . In a univariate analysis , the presence of visceral metastases and a hemoglobin < 12.5 mg/dl had significant adverse prognostic implication s ( P < 0.001 and P = 0.02 , respectively ) . Performance status was not a significant predictor of survival , perhaps due to the fact that only 14 % of patients had a performance status of 2 . In a multivariate analysis , only the absence of visceral metastases retained its prognostic importance with an estimated 24 % 4-year survival in such patients . These results lend further evidence for the clinical benefit of this regimen in advanced transitional cell cancer There are few reports on factors that determine survival in advanced gastrointestinal cancer with weight loss . In these patients ( n = 91 , median weight loss 16.6 % ) , we prospect ively examined the importance of metastatic spread , anthropometry , blood parameters , Karnofsky performance status , appetite , and the acute-phase response as predictors of survival . Survival was calculated from date of assessment to the most recent clinic attendance ( ≥30 mo ) or until death . On multivariate analysis , metastatic spread ( p < 0.05 ) , Karnofsky performance status ( p < 0.01 ) , and C-reactive protein concentration ( p < 0.001 ) had independent prognostic value . In locally advanced disease ( n = 64 ) , Karnofsky performance status and C-reactive protein concentration remained significant . There was a significantly lower survival in patients with an acute-phase response ( median 136 days ) than in patients with no response ( median 466 days ; p < 0.01 ) . Performance status and the acute-phase response are associated , independent of weight loss , with survival duration in advanced gastrointestinal cancer patients Accuracy in the assessment of performance status by oncologists has not been well evaluated . We investigated possible discrepancies in the assessment of performance status among patients , nurses , and oncologists , and evaluated the prognostic importance of each assessment . Two hundred and six in patients with inoperable , advanced non-small cell lung cancer were investigated prospect ively .  Weighted Kappa statistics for inter-observer agreement were 0.53 between oncologists and patients and 0.63 between oncologists and nurses . There was a significant difference among the assessment s by the three groups ( P < 0.001 ) . Oncologists gave the healthiest performance status assessment , nurses an intermediate assessment , and patients the poorest . When included separately in the Cox model , the assessment by each group was significantly correlated with survival . However , the assessment by the patients themselves failed to distinguish survival of patients with performance status 1 and 2 . Among the three models including patient- , nurse- , and oncologist-assessed PS , that including oncologist-assessed PS best fitted to the observed survival data . These results showed that the assessment by the patients themselves is different from those by the nurses and the oncologists and provided additional support for the use of the assessment by oncologists in clinical oncology . © 2001 Cancer Research Campaign Abstract Objective : To describe doctors ' prognostic accuracy in terminally ill patients and to evaluate the determinants of that accuracy . Design : Prospect i ve cohort study Setting : Five outpatient hospice programmes in Chicago Participants : 343 doctors provided survival estimates for 468 terminally ill patients at the time of hospice referral Main outcome measures : Patients ' estimated and actual survival . Results : Median survival was 24 days . Only 20 % ( 92/468 ) of predictions were accurate ( within 33 % of actual survival ) ; 63 % ( 295/468 ) were over 
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Co-morbidity was consistently associated with shorter survival .
Age and gender were not consistently associated with survival duration , except in lung cancer where females survived longer .
Tumour-related factors associated with shorter survival included primary tumour ( lung ) , metastatic site ( liver , brain and visceral ) and disease extent .
Symptoms associated with shorter survival included those of the anorexia – cachexia syndrome , dyspnoea , pain and impaired physical well being .
Performance status was strongly associated with survival in most studies .
Laboratory tests associated with shorter survival included anaemia , thrombocytopenia , hypoalbuminaemia and elevated serum levels of both alkaline phosphatase and lactate dehydrogenase .
Conclusion Prognostic factors in patients with advanced cancer can be conceptualised as attributes of the host , tumour , treatment and interactions between the three reflected in symptoms , quality of life performance status and laboratory tests