***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: Objective Although recent studies have improved underst and ing of quality of life ( QOL ) outcomes of breast conserving surgery , few have used longitudinal data for more than two time points , and few have examined predictors of QOL over two years . Additionally , the longitudinal data analyses in such studies rarely apply the appropriate statistical methodology to control for censoring and inter-correlations arising from repeated measures obtained from the same patient pool . This study evaluated an internet-based system for measuring longitudinal changes in QOL and developed a cloud-based system for managing patients after breast conserving surgery . Methods This prospect i ve study analyzed 657 breast cancer patients treated at three tertiary academic hospitals . Related hospital personnel such as surgeons and other healthcare professionals were also interviewed to determine the requirements for an effective cloud-based system for surveying QOL in breast cancer patients . All patients completed the SF-36 , Quality of Life Question naire ( QLQ-C30 ) and its supplementary breast cancer measure ( QLQ-BR23 ) at baseline , 6 months , 1 year , and 2 years postoperatively . The 95 % confidence intervals for differences in responsiveness estimates were derived by bootstrap estimation . Scores derived by these instruments were interpreted by generalized estimating equation before and after surgery . Results All breast cancer surgery patients had significantly improved QLQ-C30 and QLQ-BR23 subscale scores throughout the 2-year follow-up period ( p<0.05 ) . During the study period , QOL generally had a negative association with advanced age , high Charlson comorbidity index score , tumor stage III or IV , previous chemotherapy , and long post-operative LOS . Conversely , QOL was positively associated with previous radiotherapy and hormone therapy . Additionally , patients with high scores for preoperative QOL tended to have high scores for QLQ-C30 , QLQ-BR23 and SF-36 subscales . Based on the results of usability testing , the five constructs were rated on a Likert scale from 1–7 as follows : system usefulness ( 5.6±1.8 ) , ease of use ( 5.6±1.5 ) , information quality ( 5.4±1.4 ) , interface quality ( 5.5±1.4 ) , and overall satisfaction ( 5.5±1.6 ) . Conclusions The current trend in clinical medicine is applying therapies and interventions that improve QOL . Therefore , a potentially vast amount of internet-based QOL data is available for use in defining patient population s that may benefit from therapeutic intervention . Additionally , before undergoing breast conserving surgery , patients should be advised that their postoperative QOL depends not only on the success of the surgery , but also on their preoperative functional status CONTEXT Breast cancer patients often experience multiple symptoms and substantial discomfort . Some symptoms may occur simultaneously and throughout the duration of chemotherapy treatment . OBJECTIVES The aim of this study was to investigate symptom severity and symptom cluster trajectories during chemotherapy in out patients with breast cancer in Taiwan . METHODS This prospect i ve , longitudinal , repeated measures study administered a st and ardized question naire ( M. D. And erson Symptom Inventory Taiwan version ) to 103 breast cancer patients during each day of the third 21-day cycle of chemotherapy . Latent class growth analysis was performed to examine symptom cluster trajectories . RESULTS Three symptom clusters were identified within the first 14 days of the 21-day chemotherapy cycle : the neurocognition cluster ( pain , shortness of breath , vomiting , memory problems , and numbness/tingling ) with a trajectory of Y = 2.09 - 0.11 ( days ) , the emotion-nausea cluster ( nausea , disturbed sleep , distress/upset , drowsiness , and sadness ) with a trajectory ofY = 3.57 - 0.20 ( days ) , and the fatigue-anorexia cluster ( fatigue , lack of appetite , and dry mouth ) with a trajectory of Y = 4.22 - 0.21 ( days ) . The " fatigue-anorexia cluster " and " emotion-nausea cluster " peaked at moderate levels on chemotherapy days 3 - 5 , and then gradually decreased to mild levels within the first 14 days of the 21-day chemotherapy cycle . CONCLUSION Distinct symptom clusters were observed during the third cycle of chemotherapy . Systematic and ongoing evaluation of symptom cluster trajectories during cancer treatment is essential . Healthcare providers can use these findings to enhance communication with their breast cancer patients and to prioritize symptoms that require attention and intervention Abstract Purpose Multimodal therapies affect the quality of life ( QoL ) of patients with primary breast cancer ( PBC ) . The objectives of this prospect i ve study were to explore the changes in QoL from diagnosis to conclusion of adjuvant therapy and to identify predictive factors of QoL. Methods Before surgery ( t1 ) , before onset of adjuvant treatment ( t2 ) and after completion of adjuvant chemo- or radiotherapy ( t3 ) , patients with PBC ( n = 759 ) completed the European Organization for Research and Treatment of Cancer Quality of Life Core Question naire , Charlson Comorbidity Index , Patient Health Question naire and Perceived Involvement in Care Scales . Predictors of the course of global QoL were estimated using multinomial logistic regression . Effect estimates are odds ratios ( OR ) and their 95 % confidence intervals ( CIs ) . Results Global QoL improved between t1 and t3 , while physical functioning , emotional functioning and fatigue deteriorated . QoL before surgery was more often poor in patients < 60 years ( OR 2.2 , 95 % CI 1.5–3.1 ) and in those with comorbid mental illnesses ( OR 8.6 , CI 5.4–13.7 ) . Forty-seven percentage reported good global QoL both at t1 and at t3 . QoL improved in 28 % , worsened in 10 % and remained poor in 15 % . Compared to patients with consistently good global QoL , a course of improving QoL was more often seen in patients who had received a mastectomy and in those with intense fear of treatment before surgery . A course of decreasing QoL was more often found in patients who were treated with chemotherapy . QoL stayed poor in patients with chemotherapy , mastectomy and intense fear . There was no evidence that radiotherapy , progressive disease or perceived involvement impact the course of QoL. Conclusions Younger age and comorbid mental illnesses are associated with poor QoL pre-therapeutically . QoL is more likely to stay or become poor in patients who receive chemotherapy BACKGROUND Breast conservative therapy ( BCT ) is a st and ard treatment option in early operable breast cancers ( OBC ) and a select group of large or locally advanced tumors . The present study deals with prospect i ve evaluation of quality of life ( QOL ) score in consecutive patients treated with BCT employing adjuvant RT treated with either a cobalt machine or a linear accelerator ( LA ) . MATERIAL AND METHODS Patients of carcinoma breast who underwent BCT were taken into the study . Patients with larger breasts ( inter-field separation > 18 - 20 cm ) were treated on LA and those with smaller breasts were treated on cobalt machine . All patients received a uniform RT dose ( 45 - 50 Gy/25#/5 weeks ) to whole breast followed by tumor bed boost with suitable energy electrons . Prospect i ve evaluation of QOL was done using EORTC QLQ C30 and breast cancer-specific EORTC QLQ BR23 . QOL evaluation was done at pre-RT , at half completion of RT treatment ( at 20 - 23 fractions ) and at completion of RT . RESULTS Pre-RT evaluation GQOL scores in patients treated with cobalt and LA were 71.6 and 71.7 , respectively ( P = 0.8 ) . QLQ C30 functional and symptom domain scores were also similar in the groups . At RT completion , Global quality of life ( GQOL ) scores were 67.7 in patients treated with cobalt as compared to 77.7 in patients treated with LA ( P = 0.75 ) . Physical function domain scores in cobalt and LA patients were 70.8 and 80.3 , respectively ( P = 0.26 ) . Fatigue score was higher in patients treated with cobalt ( 39.1 versus 29.7 ; P = 0.9 ) . However , there was no difference in other functional and symptom domains . There was no significant change in any of the EORTC QLQ C30 domains at RT completion as compared to the pre-RT scores . CONCLUSION There is no significant difference in QOL domains between appropriately selected patients treated with cobalt and LA . There are no significant changes in QOL domain scores at RT conclusion as compared to pre-RT baseline in patients treated with cobalt or LA source . A cobalt machine may be effectively used to deliver adjuvant RT in appropriately selected BCT patients especially in developing countries with limited re sources Many breast cancer survivors have coexistent chronic diseases or comorbidities at the time of their cancer diagnosis . The purpose of the study was to evaluate the association of comorbidities on breast cancer survivors ’  quality of life . A prospect i ve design was used to recruit 140 women before cancer surgery , 134 women completed the study . Comorbidities were assessed using self-report and verified by medical record review and the Charlson Comorbidity Index ( CCI ) before and 12-month after cancer surgery . Quality of life was evaluated using  Short-Form Health Survey ( SF-36 v2 ) . Descriptive statistics , chi-square tests , t-tests , Fisher ’s exact test , and correlations were performed for data analysis . A total of 28 comorbidities were identified . Among the 134 patients , 73.8 % had at least one of the comorbidities , 54.7 % had 2–4 , and only 7.4 % had 5–8 . Comorbidities did not change at 12 months after surgery . Numbers of comorbidities by patients ’ self-report and weighted categorization of comorbidities by CCI had a similar negative correlation with overall quality of life scores as well as domains of general health , physical functioning , bodily pain , and vitality . Comorbidities , specifically hypertension , arthritis , and diabetes , were associated with poorer quality of life in multiple domains among breast cancer survivors . Future research should consider the combined influence of comorbidity and cancer on patients ’ quality of life AIM The aim was to assess the health-related quality of life ( HRQOL ) and its temporal variation at first visit and subsequent visits among breast cancer patients . DESIGN AND SETTING The prospect i ve study was carried out in Outpatient Department of Radiation Oncology , University Teaching and Tertiary Referral Hospital . MATERIAL AND METHODS After clearance from the ethical committee and EORTC group , 81 surgically treated female breast cancer patients referred to the Outpatient Department of Radiation Oncology for chemoradiation and hormonal therapy  were included in the study after informed written consent , irrespective of the age and stage of disease . The patients were interviewed as per the EORTC QLQ-C30 Question naire module at four levels at the first visit and at subsequent follow-up visits at 6 , 12 , and 24 months , respectively , and are still on follow-up . STATISTICAL ANALYSIS The data collected were expressed as mean/raw score ( RS ) , st and ard deviation ( SD ) , and percent mean/scale score expressed on the linear transformation scale , derived as per the calculations and equations of the EORTC QLQ-C30 Scoring Manual . Intragroup comparison ( IGC ) was done at four levels/visits , a , b , c and d. A P-value of < 0.05 was considered significant . RESULTS The mean age at presentation was 46.6 ± 10.2 years . The study showed that the physical functioning , role functioning , cognitive functioning , emotional functioning , social functioning , global health status , and symptomatology showed statistically significant improvement over time ( P < 0.001 ) . CONCLUSION The survivors of female breast cancer over the long-term follow-up showed significant improvement and coping mechanisms involved in a majority of HRQOL parameters Purpose This study aim ed to evaluate the prevalence and the effects of unmet needs on quality of life ( QOL ) among recurrent breast cancer survivors . Methods Completed question naires were collected from 52 women with recurrent breast cancer . Clinical and socio-demographic characteristics were review ed , and the Supportive Care Needs Survey , Functional Assessment of Cancer Therapy-Breast Cancer Instrument , and Beck Depression Inventory ( BDI ) were administered . The frequency of unmet needs and the mean differences by patient characteristics and BDI scores were analyzed . The predictive value of unmet needs on QOL , controlling for socio-demographic variables and then for clinical variables , was analyzed in hierarchical regression models . Results The most common unmet needs belonged to the health system and information domain . The depressive group had greater unmet needs in the psychological domain ( p<0.001 ) , physical and daily living domain ( p=0.001 ) , and health and information domain ( p=0.002 ) . Patients with lower education attainment and those with lower performance status had greater unmet needs in the psychological needs ( p=0.002 ) and in the physical and daily living needs domain ( p=0.002 ) , respectively . Unmet needs in the psychological domain ( p=0.008 ) , physical and daily living domain ( p=0.022 ) , and sexuality domain ( p=0.040 ) strongly predicted QOL of women with recurrent breast cancer . Conclusion Unmet needs were strong predictors for QOL among recurrent breast cancer patients . This suggests that QOL of women with recurrent breast cancer is possibly more affected by unmet needs than by patient 's socio-demographic or clinical characteristics . Intervention strategies could be developed based on the identified needs of women with recurrent breast cancer in order to improve their QOL . Further longitud 
    Output:
    
Patients with comorbidities , treated with chemotherapy , with less social support and with more unmet needs have poorer HRQL .
HRQL improves over time .
Discordant results in studies were found in the association of age , marital status , household income , type of surgery , radiotherapy and hormone therapy and unmet sexuality needs with poor global health status or overall well-being .
Conclusions In Asia , patients with breast cancer , in particular those with other comorbidities and those treated with chemotherapy , with less social support and with more unmet needs , have poorer HRQL .
Appropriate social support and meeting the needs of patients may improve patients ’ HRQL