***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: We evaluated 4 different health‐related quality of life ( HRQL ) measures prospect ively to determine their ability to detect change over time : the Health Utilities Index Mark 2 and Mark 3 , the Pediatric Quality of Life Inventory ( PedsQL ) 4.0 Generic Core and Cancer Module , the EuroQol EQ‐5D visual analogue scale ( EuroQol ) , and the Lansky Play‐Performance Scale This paper compares  parent- and  self-report  health-related quality of life ( HRQL ) in children aged 2 - 16 years with brain tumours , one , six and twelve months after diagnosis with matched normal controls .  HRQL was assessed using the PedsQL generic core scales .  37 tumour patients and 42 controls were included in analysis of parent-report  , and 27 patients and 31 controls in self-report HRQL . Parent-report scores were significantly lower in patients than controls for all PedsQL scores at all time points ( max p=0.002 ) . Differences in self-report PedsQL between patients and controls were variable . The relationship between self- and parent-report in patients and controls was inconsistent ; varied over time ; and did not consistently correlate with parental depressive symptoms , suggesting parents and their children do not regard HRQL in a similar way . Prospect i ve , longitudinal assessment of HRQL is important , but should be supplemented with other outcome measures such as health status and behaviour in this population AIMS To evaluate the relationship between parent- and child-report Health-Related Quality of Life ( HRQL ) and demographic , tumour and family variables in children with a brain tumour in the first year after diagnosis and to identify determinants of HRQL at 12 months . PROCEDURE Longitudinal prospect i ve study : Semi-structured interviews took place approximately 1 , 6 and 12 months after diagnosis . HRQL was measured using the self- and parent-report PedsQL 4.0 Total Scale Score . Tumour and treatment variables considered included tumour site and grade , hydrocephalus at diagnosis , chemotherapy and radiotherapy . Family variables included measures of family function , family support and family stress , the primary carer 's coping strategies and symptoms of depression and anxiety . Univariate analyses were used at all three time points , and to identify potential early predictors of HRQL at 1 year . Regression analysis was then used to identify the most important determinants of HRQL at 1 year . RESULTS Thirty-five patients completed the 12-month interviews . There were consistent significant negative correlations between concurrent family impact of illness and parent and self-report HRQL , and positive correlations between concurrent family support and parent-report HRQL . Treatment with radio- or chemotherapy correlated with child-report HRQL only at some time points . Multivariate analysis showed infratentorial tumour site , and poor HRQL at 1 month best predicted poor self- and parent-report HRQL at 12 months . CONCLUSION Children with infratentorial tumours and poor HRQL early after diagnosis tend to have poor HRQL at 1 year . While family factors are important modulators of concurrent HRQL , they do not appear important in predicting HRQL OBJECTIVES Infratentorial tumour site and health-related quality of life ( HRQL ) 1 month after diagnosis have been shown to predict HRQL 1 year after diagnosis in children with brain tumours . This study aim ed to identify additional early child-related determinants of parent- and child-report  HRQL . METHODS Longitudinal prospect i ve study . Semi-structured interviews took place approximately 1 and 12 months after diagnosis . HRQL was measured using the self- and parent-report Pediatric Quality of Life Scales ( PedsQL 4.0 ) Total Scale Score and Health Utilities Index Mark 3 ( HUI3 ) multi-attribute utility function . Child variables included performance and verbal IQ , general memory , selective attention executive function , behaviour problems , adaptive behaviour , symptoms of depression and anxiety and event related anxiety . Univariate analyses were used to identify potential early predictors of HRQL . Regression analysis was then used to identify the most important determinants of HRQL at 1 year . RESULTS Thirty-five patients completed the 12-month interviews . Multivariate analysis showed infratentorial tumour site remained an important determinant of HRQL 1 year after diagnosis . Infratentorial tumour site and selective attention at 1 month generally best predicted poor self- and parent-report HRQL at 12 months . Adaptive behaviour and performance IQ may be important . CONCLUSION Selective attention and infratentorial tumour site are most important in predicting both parent- and self-report HRQL at 1 year after diagnosis . Larger prospect i ve studies are needed to confirm these findings . Cognitive remediation or/ and pharmacological intervention , particularly aim ed at children with infratentorial tumours may improve attention and subsequently HRQL and both merit further investigation This study provided a differential comparison of the efficacy of st and ardized instruction in hypnosis or active cognitive strategy for provision of relief from procedurally induced pain and anxiety . Subjects were instructed to self-direct in the use of strategies during medical procedures . Twenty pediatric oncology patients participated in the study . They were not informed that hypnosis was one of the strategies . Subjects were screened for hypnotizability and r and omly assigned to treatments . Demographic data were collected . Pre- strategy training observations were made during a Bone Marrow Aspiration or Lumbar Puncture ( BMA/LP ) using visual analog scales , the McGill Pain Question naire , State-Trait Anxiety Inventory , pulse and temperature readings , and interview . Following strategy training , data were collected during a second BMA/LP using the same measures as employed pre-intervention . Results indicated that both strategies were effective in providing pain reduction . Neither technique provided for anxiety reduction . Hypnotizability scale scores failed to correlate with degree of pain reduction Background : Objectives were to describe the reliability and validity of a new paediatric-specific mucositis scale , the Children ’s International Mucositis Evaluation Scale ( ChIMES ) . Methods : In a multi-centre prospect i ve study , children aged 0 to ⩽18 years were eligible if they were receiving any of the following : myeloablative stem cell transplantation ( SCT ) , ⩾60 mg m−2 course−1 doxorubicin or ⩾12 g m−2 methotrexate .  Multiple measures of mucositis were included along with ChIMES . Respondents were parent proxy report for children aged < 12 years , and child self-report for children aged 12–18 years and 8 to < 12 years .  Mucositis diaries were completed at baseline and on Days 7–17 following chemotherapy/conditioning . On Day 14 , the respondent reported presence of mucositis and change since the previous day . Results : The 185 respondents included parents ( N=98 ) , children aged 12–18 years ( N=66 ) and children aged 8 to < 12 years ( N=21 ) . Test – retest reliability was excellent for ChIMES Total Score and ChIMES Percentage Score with r>0.8 for all respondent types . Criteria for construct validation were met across all measures . ChIMES also demonstrated responsiveness with significant differences between baseline and Day 14 . Conclusion : ChIMES is a paediatric-specific measure of mucositis with favourable psychometric properties . It exhibits reliability , construct validity and responsiveness . ChIMES should be incorporated into clinical trials of mucositis prevention and treatment in paediatric cancer and SCT BACKGROUND Adolescents with cancer experience many troubling symptoms , including sleep disruptions that can affect mood and quality of life .  Massage is a safe and popular intervention that has demonstrated efficacy in pediatric and adult patients with cancer . This study aim ed to assess the feasibility of conducting a massage intervention to help with sleep in hospitalized adolescent oncology patients . PROCEDURE Adolescents ages 12 - 21 with cancer who were expected to be hospitalized for at least four consecutive nights were recruited from the inpatient unit at Children 's National Health System and r and omized to either massage intervention or a waitlist control . Patients in the intervention group received one massage per night , for two or three nights . Sleep was measured with actigraphy and patient and proxy reported instruments were used to measure fatigue , mood , and anxiety . RESULTS The majority ( 78 % ) of patients approached for the study consented , and almost all patients in the intervention group ( 94 % ) received at least one massage , 69 % received two , and rates of completion of instruments among adolescents were high demonstrating feasibility . There were trends toward increased night time and overall sleep in the intervention group compared with st and ard of care , but no differences between groups in the patient reported outcome measures . Participant and parent feedback on the intervention was positive and was the impetus for starting a clinical massage service at the hospital . CONCLUSIONS Massage for hospitalized adolescents with cancer is feasible , well received , and can potentially improve patients ' sleep . A r and omized multicenter efficacy study is warranted BACKGROUND Children with cancer identify fatigue as a pervasive symptom , which increases during the corticosteroid pulse in acute lymphoblastic leukemia ( ALL ) maintenance . The FitBit is a fitness tracker that downloads activity measurements to the Internet in real time . In this feasibility study , we explored if children who received daily FitBit coaching for 2 weeks before a maintenance steroid pulse  had an increase in steps per day and determined the relationship between steps per day prepulse and fatigue postpulse . PROCEDURE Seventeen children in ALL maintenance , aged 6 - 15 , wore the FitBit for 3 days to establish a baseline . A tailored weekly step goal was then set with the child and parent . Daily emails with feedback and FitBit screenshots were sent over the 2-week intervention . Self-report of fatigue was measured at baseline , after 2 weeks ( i.e. before the steroid pulse ) , and after 5 days of steroids . RESULTS There was a trend toward increased steps per day from weeks 1 - 2 ( P = 0.079 ) ; fatigue was low and did not increase during the corticosteroid pulse . A significant correlation ( r = -0.66 , P = 0.005 ) was found between the steps per day during week 2 and fatigue after the steroid pulse with higher steps associated with lower fatigue . CONCLUSIONS The intervention was feasible in this small sample . The average steps each time period ( week 1 , week 2 , and during steroids ) was over 10,000 , demonstrating that children with ALL can be active during treatment . Physical activity may be protective of fatigue during a corticosteroid pulse Measurement of pediatric cancer patients ' health‐related quality of life ( HRQL ) in phase III r and omized , controlled clinical trials is being recognized increasingly as an essential component in evaluating the comprehensive health outcomes of modern anti‐neoplastic treatment protocol s. Use of a brief core measure of HRQL plus disease‐specific symptom modules is a way to assess specific HRQL outcomes with a minimum of subject burden . Demonstrating a measure 's feasibility , reliability and validity also represents children 's ability to provide reliable and valid responses to HRQL questions . The Pediatric Cancer Quality of Life Inventory ( PCQL ) Modular Approach consists of a 15‐item core measure of HRQL and 2 specific symptom modules : pain and nausea . To vali date a patient‐report form and a parent‐report form , the PCQL was administered to 291 pediatric cancer patients and to their parents . Feasibility and range of measurement , as well as patient – parent concordance , were assessed . Internal consistency reliability was assessed via Cronbach 's alpha . Validity was determined by the known‐groups approach and by correlating PCQL scores with days missed from school . Patients had minimal missing data , and the range of measurement for the items was good . Patient – parent concordance was large but not perfect . For both patient and parent forms , internal consistency reliability of the PCQL core scale ( 0.83 and 0.86 , respectively ) was strong . The internal consistency reliabilities of the 2 symptom modules for both patient and parent forms were in the acceptable range for group comparisons . Regarding clinical validity , the core scale and the 2 symptom modules distinguished between patients on and off treatment for both patient and parent reports . Further , both patient and parent reports correlated with days of missed school in the past 6 and 12 months . The PCQL Modular Approach has demonstrated acceptable internal consistency reliability and clinical validity for both patient‐report and parent‐report forms . By implication , children are capable of providing reliable and valid responses to these HRQL questions . Int . J. Cancer Suppl . 12:71–76 , 1999 . © 1999 Wiley‐Liss , Few studies have attempted to describe the experience of symptoms in young children with cancer . This is due , in part , to the lack of vali date d symptom assessment scales for this patient population . The objective of this study was to evaluate the reliability and validity of a revised Memorial Symptom Assessment Scale ( MSAS ) in patients aged 7 - 12 as an instrument for the assessment of symptoms in young children with cancer . The MSAS ( 7 - 12 ) was administered to 149 children ( in patients and out patients ) who were undergoing treatment at either the Royal Marsden NHS Trust , London , United Kingdom or The Children 's Hospital at Westmead , Sydney , Australia . Validity was evaluated by comparison with the medical record , parental report , and concurrent assessment on visual analogue scales for selected symptoms . The data provide evidence of the reliability and validity of MSAS ( 7 - 12 ) and demonstrate that children with cancer as young as 7 years can report clinical ly relevant and consistent information about their symptom experience . Young children with cancer experience multiple symptoms . Approximately one-third had experienced lethargy and /or pain and /or insomnia during the 48 hours prior to the completion of MSAS ( 7 - 12 ) . The completion 
    Output:
    
Enhancing the child ’s voice in pediatric oncology research studies allows us to better underst and the impact of cancer and its treatment on the lives of children