***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: PURPOSE To investigate the benefit of chemotherapy in patients with symptomatic hormone-resistant prostate cancer using relevant end points of palliation in a r and omized controlled trial . PATIENTS AND METHODS We r and omized 161 hormone-refractory patients with pain to receive mitoxantrone plus prednisone or prednisone alone ( 10 mg daily ) . Nonresponding patients on prednisone  could receive mitoxantrone subsequently . The primary end point was a palliative response defined as a 2-point decrease in pain as assessed by a 6-point pain scale completed by patients ( or complete loss of pain if initially 1 + ) without an increase in analgesic medication and maintained for two consecutive evaluations at least 3 weeks apart . Secondary end points were a decrease of > or = 50 % in use of analgesic medication without an increase in pain , duration of response , and survival . Health-related quality of life was evaluated with a series of linear analog self- assessment scales ( LASA and the Prostate Cancer-Specific Quality -of-Life Instrument [ PROSQOLI ] ) , the core question naire of the European Organization for Research and Treatment of Cancer ( EORTC ) , and a disease-specific module . RESULTS Palliative response was observed in 23 of 80 patients ( 29 % ; 95 % confidence interval , 19 % to 40 % ) who received mitoxantrone plus prednisone , and in 10 of 81 patients ( 12 % ; 95 % confidence interval , 6 % to 22 % ) who received prednisone alone ( P = .01 ) . An additional seven patients in each group reduced analgesic medication > or = 50 % without an increase in pain . The duration of palliation was longer in patients who received chemotherapy ( median , 43 and 18 weeks ; P < .0001 , log-rank ) . Eleven of 50 patients r and omized to prednisone treatment responded after addition of mitoxantrone . There was no difference in overall survival . Treatment was well tolerated , except for five episodes of possible cardiac toxicity in 130 patients who received mitoxantrone . Most responding patients had an improvement in quality -of-life scales and a decrease in serum prostate-specific antigen ( PSA ) level . CONCLUSION Chemotherapy with mitoxantrone and prednisone provides palliation for some patients with symptomatic hormone-resistant prostate cancer PURPOSE We observed that quality -of-life ( QL ) scores , collected to evaluate treatment in a r and omized trial in advanced breast cancer , predicted survival duration . This report explores the prognostic associations between QL and survival in more detail . PATIENTS AND METHODS In a r and omized clinical trial comparing intermittent and continuous therapy policies for patients with advanced breast cancer ,  QL  was measured by linear analog self- assessment ( LASA ) and the Quality -of-Life Index ( QLI ) .  Baseline scores and subsequent changes were included in statistical models of survival duration , with and without other prognostic factors . RESULTS Physician assessment of QLI and patient LASA scores for physical well-being ( PWB ) , mood , nausea and vomiting , appetite , and overall QL ( but not pain ) at the commencement of treatment were significant predictors of subsequent survival . Scores for PWB and QLI were independent of other prognostic factors . Changes in scores were also prognostically important . Both baseline and change in scores for PWB , mood , pain , and QLI after the first three treatment cycles , but before an arbitrary 180-day time point , were significantly predictive of survival beyond that time . Both QLI and PWB were prognostically independent of tumor response . Although QL improvement was correlated with tumor response , continuous therapy yielded significantly better QL scores , even in nonresponders . CONCLUSION These findings support the validity of the simple QL measures used in the trial . They are compatible with the simple explanation that patients perceive disease progression before it is clinical ly evident , but also with a causal relationship between QL and survival duration PURPOSE Implantable intrathecal drug delivery systems ( IDDSs ) have been used to manage refractory cancer pain , but there are no r and omized clinical trial ( RCT ) data comparing them with comprehensive medical management ( CMM ) . PATIENTS AND METHODS We enrolled 202 patients on an RCT of CMM versus IDDS plus CMM . Entry criteria included unrelieved pain ( visual analog scale [ VAS ] pain scores > /= 5 on a 0 to 10 scale ) . Clinical success was defined as > /= 20 % reduction in VAS scores , or equal scores with > /= 20 % reduction in toxicity . The main outcome measure was pain control combined with change of toxicity , as measured by the National Cancer Institute Common Toxicity Criteria , 4 weeks after r and omization . RESULTS Sixty of 71 IDDS patients ( 84.5 % ) achieved clinical success compared with 51 of 72 CMM patients ( 70.8 % , P = .05 ) . IDDS patients more often achieved > /= 20 % reduction in both pain VAS and toxicity ( 57.7 % [ 41 of 71 ] v 37.5 % [ 27 of 72 ] , P = .02 ) . The mean CMM VAS score fell from 7.81 to 4.76 ( 39 % reduction ) ; for the IDDS group , the scores fell from 7.57 to 3.67 ( 52 % reduction , P = .055 ) . The mean CMM toxicity scores fell from 6.36 to 5.27 ( 17 % reduction ) ; for the IDDS group , the toxicity scores fell from 7.22 to 3.59 ( 50 % reduction , P = .004 ) . The IDDS group had significant reductions in fatigue and depressed level of consciousness ( P < .05 ) . IDDS patients had improved survival , with 53.9 % alive at 6 months compared with 37.2 % of the CMM group ( P = .06 ) . CONCLUSION IDDSs improved clinical success in pain control , reduced pain , significantly relieved common drug toxicities , and improved survival in patients with refractory cancer pain The European Organization for Research on Treatment of Cancer Genitourinary Group performed a multivariate statistical analysis of prognostic factors based on 436 patients entered between 1976 and 1981 in 2 r and omized prospect i ve trials that compared 4 different hormonal treatment regimens . Only previously untreated patients with advanced ( stage T3/T4/M0 or M1 ) prostatic cancer were eligible . After identification of prognostic factors by means of univariate analyses a multivariate analysis using Cox 's proportional hazards regression model was done . This test identified performance status ( according to the Eastern Cooperative Oncology Group scale ) as the most important factor , followed by acid phosphatase ( more than 2 times normal ) for stage M0 cancer patients , and alkaline phosphatase , T category and the presence or absence of associated chronic disease for stage M1 cancer patients . Based on these 4 variables nonbedridden patients with metastatic disease can be divided into 2 groups : poor and good risk patients , with median survivals of 1 and 3 years , respectively . This study shows that routine clinical and laboratory data already provide an excellent indication as to the prognosis BACKGROUND The European Pain in Cancer survey sought to increase underst and ing of cancer-related pain and treatment across Europe . PATIENTS AND METHODS Patients with all stages of cancer participated in a two-phase telephone survey conducted in 11 European countries and Israel in 2006 - 2007 . The survey screened for patients experiencing pain at least weekly , then r and omly selected adult patients with pain of at least moderate intensity occurring several times per week for the last month completed a detailed attitudinal question naire . RESULTS Of 5084 adult patients contacted , 56 % suffered moderate-to-severe pain at least monthly . Of 573 patients r and omly selected for the second survey phase , 77 % were receiving prescription-only analgesics  , with 41 % taking  strong opioids either alone or with other drugs for cancer-related pain . Of those prescribed analgesics , 63 % experienced breakthrough pain . In all , 69 % reported pain-related difficulties with everyday activities ; however , 50 % believed that their quality of life was not considered a priority in their overall care by their health care professional . CONCLUSIONS Across Europe and Israel , treatment of cancer pain is suboptimal . Pain and pain relief should be considered integral to the diagnosis and treatment of cancer ; management guidelines should be revised to improve pain control in patients with cancer Concern that opioids hasten death may be among the reasons that pain is treated inadequately in population s with advanced illness . Studies that assess the true risks are needed . To determine whether survival after last opioid dose change is associated with opioid dosing characteristics and other factors , data from the National Hospice Outcomes Project , a large prospect i ve cohort study involving 13 U.S. hospice programs , were analyzed . Of 1,306 patients , 725 received opioids and underwent at least one dose change before death . Sub sample s based on maximum opioid dose compared patients receiving usual doses with those receiving high-dose therapy . Spearman rank correlations examined bivariate associations between survival after final dose change and other variables , including dose in morphine equivalent mg and percentage dose increase . Multivariate least squares regression analyses determined associations between survival and other variables , including those significant in bivariate analyses . The mean+/-SD number of days between final dose change and death was 12.46+/-23.11 . Multivariate models demonstrated a significant association between shorter survival and higher opioid dose , a cancer diagnosis , unresponsiveness , and pain of < 5 on a 0 - 10 scale , but none of these models explained > 10 % of the variance in time till death . Analyses of sub sample s did not reveal additional effects of dose . This analysis revealed that opioid dosing was associated with time till death , but this factor would explain very little of the variation in survival . In a hospice population , survival is influenced by complex factors , many of which may not be measurable . Based on these findings , concern about hastening death does not justify withholding opioid therapy Background Patients with non-small cell lung cancer ( NSCLC ) have a poor prognosis . The objective of this study was to examine the relationship of EORTC QLQ-C30 and QLQ-LC13  and survival in patients with NSCLC undergoing different treatments . Methods Investigators conducted a  health-related quality of life ( HRQOL ) survey of 488 patients with NSCLC : 162 patients undergoing surgery , 312 patients without surgery , and their survival status was prospect ively followed up .  EORTC QLQ-C30 and QLQ-LC13 scores and clinical variables at baseline were analyzed using Cox ’s proportional hazard regression to identify factors that influenced survival . Results Median survival of these 474 patients was 9.82 months . After adjustment , emotional functioning scale , and symptom scales of pain and nausea/vomiting are associated with survival in NSCLC patients with surgery whereas social functioning scale , and symptom scales for fatigue , appetite loss , and financial problems had a significant impact on survival in NSCLC patients without surgery . The results of multivariate analysis showed that none of QLQ-LC13 scales are significant predictors of survival . After simultaneously considering these scales , we found significant independent predictors of survival were nausea/vomiting ( HR = 0.11 , 95 % CI = 0.02 - 0.63 for score > 0 compared with = 0 ) in NSCLC patients with surgery and appetite loss ( HR = 1.77 , 95 % CI = 1.26 - 2.49 for score > 0 compared with = 0 ) in NSCLC patients without surgery . Conclusions HRQOL provides additional predictive information that supplements traditional clinical factors , and is a new prognostic indicator for survival of NSCLC patients under different treatments The aim of this study was to investigate the influence of baseline quality of life ( QoL ) on survival in patients with advanced colorectal cancer . From 1992 to 1998 , four r and omised clinical trials in advanced colorectal cancer were conducted at this institution . The European Organization for Research and Treatment of Cancer- Quality of Life Core 30 ( EORTC-QLQ-C30 ) question naire was completed prior to the commencement of chemotherapy . Analyses were performed on median-dichotomised baseline Quality of Life ( QoL ) and clinical prognostic factors . Baseline QoL question naires were completed by 501 patients .  One-year survival was 38.3 and 72.5 % ( P<0.0001 ) for patients with global QoL scores below and above the median ( 67 ) , respectively . Other than cognitive functioning , fatigue , appetite , constipation , diarrhoea and financial domains , all QoL scales were significant independent predictors of survival ( P<0.035 ) . In the final model , the global QoL score remained highly significant as an independent predictor of survival ( P<0.0001 ) . Baseline QoL is a strong independent predictor of survival in patients with advanced colorectal cancer . Measurements should be routinely recorded in clinical trials to stratify cohorts and aid in trial comparison We conducted a prospect i ve cohort study in Japan to investigate associations between negative psychological aspects and  cancer survival . Between July 1999 and July 2004 , a total of 1178 lung cancer patients were enrolled . The question naire asked about socioeconomic variables , smoking status , clinical symptoms , and psychological aspects after diagnosis .  Negative psychological aspects  were assessed for the subscales of 
    Output:
    
However , analgesic use was often used as a surrogate for prostate cancer pain , making it difficult to determine whether pain or opioid exposure was more important in influencing survival .
Conclusions Pain may be associated with shorter survival in patients with cancer , but the mechanism for this relationship is unknown .
The available evidence is insufficient to definitively determine if pain independently influences survival in patients with breast , colorectal , or lung cancer .
The majority of studies in prostate cancer show pain to be an independent prognostic factor for OS , and often also incorporate opioid analgesic use in multivariate analysis .