human
***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: OBJECTIVES To characterize and compare quality of life ( QOL ) in patients with head and neck cancer shortly before initial treatment and 1 year later and to study the predictors of changes in QOL over 1 year . DESIGN Prospect i ve cohort study . SETTING Three otolaryngology clinics . PATIENTS Three hundred sixteen patients having newly diagnosed squamous cell head and neck cancer . MAIN OUTCOME MEASURE Health-related QOL was assessed using the  36-item Short-Form Health Survey  and a head and neck cancer-specific QOL scale .  RESULTS Over 1 year , QOL decreased for physical functioning measures and eating but improved for mental health QOL . Depression and smoking were major predictors of poor QOL at baseline . Major predictors of change in QOL from baseline to 1 year were treatment factors , especially feeding tube placement ( 9 scales ) , chemotherapy ( 3 scales ) , and radiation therapy ( 3 scales ) . Baseline smoking and depressive symptoms also remained significant predictors of several QOL scales at 1 year . CONCLUSIONS Health-related physical QOL tended to decline over 1 year and mental health QOL improved . The major predictors of change in QOL were treatment factors , smoking , and depressive symptoms . Physicians should alert patients to the relative effects on QOL one may experience with different treatments BACKGROUND Early discontinuation of adjuvant endocrine therapy may affect the outcome of treatment in breast cancer patients . The aim of this study was to assess age-specific persistence and age-specific survival outcome based on persistence status . METHODS Patients enrolled in the Tamoxifen Exemestane Adjuvant Multinational trial were included . Nonpersistence was defined as discontinuing the assigned endocrine treatment within 1 year of follow-up because of adverse events , intercurrent illness , patient refusal , or other reasons . Endpoints were the breast cancer-specific and overall survival times . Analyses were stratified by age at diagnosis ( < 65 years , 65 - 74 years , ≥75 years ) . RESULTS Overall , 3,142 postmenopausal breast cancer patients were included : 1,682 were aged < 65 years , 951 were aged 65 - 74 years , and 509 were aged ≥75 years . Older age was associated with a higher proportion of nonpersistence within 1 year of follow-up . In patients aged < 65 years , nonpersistent patients had lower breast cancer-specific and overall survival probabilities . In patients aged 65 - 74 years and patients aged ≥75 years , the survival times of persistent and nonpersistent patients were similar . CONCLUSION Nonpersistence within 1 year of follow-up was associated with lower breast cancer-specific and overall survival probabilities in patients aged < 65 years , but it was not associated with survival outcomes in patients aged 65 - 74 years or in patients aged ≥75 years . These results suggest that extrapolation of outcomes from a young to an elderly breast cancer population may be insufficient and urge age-specific breast cancer studies Background : There is no single generally accepted clinical definition of frailty . Previously developed tools to assess frailty that have been shown to be predictive of death or need for entry into an institutional facility have not gained acceptance among practising clinicians . We aim ed to develop a tool that would be both predictive and easy to use . Methods : We developed the 7-point Clinical Frailty Scale and applied it and other established tools that measure frailty to 2305 elderly patients who participated in the second stage of the Canadian Study of Health and Aging ( CSHA ) . We followed this cohort prospect ively ; after 5 years , we determined the ability of the Clinical Frailty Scale to predict death or need for institutional care , and correlated the results with those obtained from other established tools . Results : The CSHA Clinical Frailty Scale was highly correlated ( r = 0.80 ) with the Frailty Index . Each 1-category increment of our scale significantly increased the medium-term risks of death ( 21.2 % within about 70 mo , 95 % confidence interval [ CI ] 12.5%–30.6 % ) and entry into an institution ( 23.9 % , 95 % CI 8.8%–41.2 % ) in multivariable models that adjusted for age , sex and education . Analyses of receiver operating characteristic curves showed that our Clinical Frailty Scale performed better than measures of cognition , function or comorbidity in assessing risk for death ( area under the curve 0.77 for 18-month and 0.70 for 70-month mortality ) . Interpretation : Frailty is a valid and clinical ly important construct that is recognizable by physicians . Clinical judgments about frailty can yield useful predictive information Objectives To quantify the proportion of r and omized controlled trials ( RCTs ) specifically design ed for elderly , and to assess their characteristics , as compared to RCTs not specifically design ed for elderly . Design Review and synthesis of published literature . Measurements We search ed PubMed for articles published in the year 2012 . We included RCTs . Articles were excluded if not conducted with human subjects or if findings of secondary analyses were reported . A r and om sample of 10 % was drawn and of this selection the following trial characteristics were extracted : sample size , disease category , age of sample , and age-related inclusion criteria . Clinical trials were defined to be specifically design ed for elderly if a lower age cut-off of ≥ 55 years was used , or when participants had an average age of ≥ 70 years . Results The search strategy yielded 26,740 articles , from which a r and om sample was drawn , result ing in 2375 articles . After exclusion , data was extracted from 1369 publications . Of these 1369 RCTs , 96 ( 7 % ) were specifically design ed for elderly . In comparison with trials not design ed for older adults , trials design ed for elderly contained a significantly larger median number of participants  ( 125 vs. 80 , p = 0.008 ) significantly more trials design ed for elderly fell into the disease categories eye ( 6 % vs. 2 % , p = 0.005 ) , musculoskeletal ( 13 % vs. 7 % , p = 0.023 ) and circulatory system ( 16 % vs. 9 % , p = 0.039 ) . No significant difference was observed with regard to the other disease categories . Conclusion There is a low proportion of RCTs specifically design ed for elderly . As older patients will increasingly form the majority in medical practice , there is an urgent need for stronger evidence for the formulation of treatment guidelines specifically for older adults Objective The aim of this study was to identify risk factors for surgical-site infections ( SSIs ) in patients with head and neck cancer su bmi tted to major clean-contaminated surgery . Study Design This is a prospect i ve study conducted in a tertiary cancer center hospital . Subjects and Methods This study includes 258 patients su bmi tted to a major clean-contaminated head and neck oncologic surgery .  Results The overall SSI rate was 38.8 % . The univariate analysis showed the following significant risk factors : race , tobacco consumption , clinical stage , comorbidities , time duration of the surgical procedure , and flap reconstruction . The final model by logistic regression identified the following independent predictors for SSI : tobacco consumption ( odds ratio [ OR ] = 2.96 ) , presence of metastatic lymph nodes ( OR = 2.05 ) , flap reconstruction ( OR = 2.20 ) , and antimicrobial prophylaxis exceeding 48 hours ( OR=1.89 ) . Conclusion The high-risk patients for SSI in head and neck oncologic surgery were those with cancer at advanced stages , those who were smokers , those presenting comorbidities , those who needed major reconstruction of the surgical wound , or those who were su bmi tted to inadequate antibiotic prophylaxis OBJECTIVE To evaluate the association between pretreatment health-related quality -of-life ( HRQOL ) scores and survival in a heterogeneous cohort of patients with newly diagnosed head and neck squamous cell carcinoma ( HNSCC ) . DESIGN Prospect i ve cohort study . SETTING University hospital and referral center in Western Norway . PATIENTS A total of 106 patients with intact cognitive functioning who were younger than 78 years , were diagnosed as having HNSCC , and underwent treatment with curative intent from November 1 , 2002 , through June 30 , 2005 . MAIN OUTCOME MEASURES Overall survival and HRQOL scores obtained at the time of diagnosis . RESULTS All dichotomized HRQOL sum scores except the functional score ( P = .20 ) were significantly predictive of survival in univariate analyses . The hazard ratios of the dichotomized general symptom , global quality -of-life , and head and neck sum score were 3.66 , 0.31 , and 2.28 , respectively . All sum scores except the dichotomized functional score remained predictive of survival after sequential adjustment for sociodemographic and clinical characteristics , neuroticism , choice of psychological coping , current smoking and alcohol consumption , and comorbidities . Similar findings were found for specific HRQOL indices of physical functioning , dyspnea , sleep disturbance , appetite loss , swallowing , and social eating from the European Organization for Research and Treatment of Cancer 30-Item Core Quality of Life Question naire , version 3.0 , and the Quality of Life-Head and Neck Cancer Module . Moreover , patients in the highest scoring quartiles for the symptom sum scores and /or the lowest scoring quartile for the global score had overall mortality rates of 50 % to 64 % compared with 23 % to 26 % among the other patients . CONCLUSION The HRQOL sum scores and specific indices among HNSCC patients predict survival independently of established known prognostic factors Background Head and neck cancer ( HNC ) is a debilitating disease due in part to its effects on function , including speech , swallowing , and cosmesis . Previous studies regarding depression in HNC have focused on demographic predictors , incidence , and quality of life studies . There is , however , a paucity of studies that objective ly address depressive symptoms in HNC patients and the result ant effects on post-treatment functional performance status . The aim of this study was to assess the relationship between preoperative depressive symptoms  ( PDS ) and postoperative functional performance status ( PFPS ) , in addition to other predictors of rehabilitation and survival . Methods A prospect i ve cohort study was undertaken at the University of Alberta , including all new adult HNC patients undergoing surgery as primary therapy for HNC from May 2013 to January 2014 . Baseline depressive symptoms  were measured on the Quick Inventory of Depressive Symptoms ( QIDS ) question naire 2 weeks preoperatively and PFPS was assessed 12 months postoperatively on the Functional Assessment of Cancer Therapy-Head & Neck ( FACT-HN ) scale . Secondary outcomes included completion of adjuvant therapy , narcotic dependence , return to detrimental habits , loss of follow-up , and length of hospital stay ( LOHS ) . Differences between the Normal-Mild and Moderate-Severe QIDS groups were assessed using Mann – Whitney and Fischer Exact statistical analyses . Results Seventy-one patients were included in the study . Mild and Moderate-Severe PDS were 35.2 % and 18.3 % , respectively . Significantly lower FACT-HN scores were noted in the Moderate-Severe group at 12 months ( p = 0.03 ) . The risk ratio ( RR ) for FACT-HN score < 50 % at 12 months in the Moderate-Severe group was 5.66 . In addition , significantly lower completion of adjuvant treatment ( p = 0.03 ) , significantly higher incidence of narcotic dependence ( p = 0.004 ) , and significantly higher LOHS ( 24 days vs. 18 days ; p = 0.02 ) was observed in the Moderate-Severe group . There was no significant difference in loss of follow-up between the 2 groups ( p = 0.64 ) . Conclusions The incidence and severity of PDS in HNC patients treated with surgery is high ( 53.5 % ) . Patients with Moderate-Severe PDS have significantly decreased PFPS , increased narcotic use , decreased completion of adjuvant therapy , and a longer LOHS . HNC patients should be monitored closely for depressive symptoms OBJECTIVE To examine the association between the outcomes of a pre-operative comprehensive geriatric assessment ( CGA ) and the risk of severe post-operative complications in elderly patients electively operated for colorectal cancer . METHODS One hundred seventy-eight consecutive patients ≥ 70 years electively operated for all stages of colorectal cancer were prospect ively examined . A pre-operative CGA was performed , and patients were categorized as fit , intermediate , or frail . The main outcome measure was severe complications within 30 days of surgery . RESULTS Twenty-one patients ( 12 % ) were categorized as fit , 81 ( 46 % ) as intermediate , and 76 ( 43 % ) as frail . Eighty-three patients experienced severe complications , including three deaths ; 7/21 ( 33 % ) of fit patients , 29/81 ( 36 % ) of intermediate patients and 47/76 ( 62 % ) of frail patients ( p=0.002 ) . Increasing age and ASA classification were not associated with complications in this series . CONCLUSION CGA can identify frail patients who have a significantly increased risk of severe complications after elective surgery for colorectal cancer It has been hypothesized that people in lower socioeconomic groups have worse outcomes because they present with advanced‐stage cancers or receive inadequate treatment . The authors investigated this hypothesis by using  education level 
    Output:
    
agent
Functional and cognitive impairment , depressive symptoms and social isolation are highly prevalent in head and neck cancer patients and associate with high risk of adverse health outcomes .
***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: OBJECTIVES To characterize and compare quality of life ( QOL ) in patients with head and neck cancer shortly before initial treatment and 1 year later and to study the predictors of changes in QOL over 1 year . DESIGN Prospect i ve cohort study . SETTING Three otolaryngology clinics . PATIENTS Three hundred sixteen patients having newly diagnosed squamous cell head and neck cancer . MAIN OUTCOME MEASURE Health-related QOL was assessed using the  36-item Short-Form Health Survey  and a head and neck cancer-specific QOL scale .  RESULTS Over 1 year , QOL decreased for physical functioning measures and eating but improved for mental health QOL . Depression and smoking were major predictors of poor QOL at baseline . Major predictors of change in QOL from baseline to 1 year were treatment factors , especially feeding tube placement ( 9 scales ) , chemotherapy ( 3 scales ) , and radiation therapy ( 3 scales ) . Baseline smoking and depressive symptoms also remained significant predictors of several QOL scales at 1 year . CONCLUSIONS Health-related physical QOL tended to decline over 1 year and mental health QOL improved . The major predictors of change in QOL were treatment factors , smoking , and depressive symptoms . Physicians should alert patients to the relative effects on QOL one may experience with different treatments BACKGROUND Early discontinuation of adjuvant endocrine therapy may affect the outcome of treatment in breast cancer patients . The aim of this study was to assess age-specific persistence and age-specific survival outcome based on persistence status . METHODS Patients enrolled in the Tamoxifen Exemestane Adjuvant Multinational trial were included . Nonpersistence was defined as discontinuing the assigned endocrine treatment within 1 year of follow-up because of adverse events , intercurrent illness , patient refusal , or other reasons . Endpoints were the breast cancer-specific and overall survival times . Analyses were stratified by age at diagnosis ( < 65 years , 65 - 74 years , ≥75 years ) . RESULTS Overall , 3,142 postmenopausal breast cancer patients were included : 1,682 were aged < 65 years , 951 were aged 65 - 74 years , and 509 were aged ≥75 years . Older age was associated with a higher proportion of nonpersistence within 1 year of follow-up . In patients aged < 65 years , nonpersistent patients had lower breast cancer-specific and overall survival probabilities . In patients aged 65 - 74 years and patients aged ≥75 years , the survival times of persistent and nonpersistent patients were similar . CONCLUSION Nonpersistence within 1 year of follow-up was associated with lower breast cancer-specific and overall survival probabilities in patients aged < 65 years , but it was not associated with survival outcomes in patients aged 65 - 74 years or in patients aged ≥75 years . These results suggest that extrapolation of outcomes from a young to an elderly breast cancer population may be insufficient and urge age-specific breast cancer studies Background : There is no single generally accepted clinical definition of frailty . Previously developed tools to assess frailty that have been shown to be predictive of death or need for entry into an institutional facility have not gained acceptance among practising clinicians . We aim ed to develop a tool that would be both predictive and easy to use . Methods : We developed the 7-point Clinical Frailty Scale and applied it and other established tools that measure frailty to 2305 elderly patients who participated in the second stage of the Canadian Study of Health and Aging ( CSHA ) . We followed this cohort prospect ively ; after 5 years , we determined the ability of the Clinical Frailty Scale to predict death or need for institutional care , and correlated the results with those obtained from other established tools . Results : The CSHA Clinical Frailty Scale was highly correlated ( r = 0.80 ) with the Frailty Index . Each 1-category increment of our scale significantly increased the medium-term risks of death ( 21.2 % within about 70 mo , 95 % confidence interval [ CI ] 12.5%–30.6 % ) and entry into an institution ( 23.9 % , 95 % CI 8.8%–41.2 % ) in multivariable models that adjusted for age , sex and education . Analyses of receiver operating characteristic curves showed that our Clinical Frailty Scale performed better than measures of cognition , function or comorbidity in assessing risk for death ( area under the curve 0.77 for 18-month and 0.70 for 70-month mortality ) . Interpretation : Frailty is a valid and clinical ly important construct that is recognizable by physicians . Clinical judgments about frailty can yield useful predictive information Objectives To quantify the proportion of r and omized controlled trials ( RCTs ) specifically design ed for elderly , and to assess their characteristics , as compared to RCTs not specifically design ed for elderly . Design Review and synthesis of published literature . Measurements We search ed PubMed for articles published in the year 2012 . We included RCTs . Articles were excluded if not conducted with human subjects or if findings of secondary analyses were reported . A r and om sample of 10 % was drawn and of this selection the following trial characteristics were extracted : sample size , disease category , age of sample , and age-related inclusion criteria . Clinical trials were defined to be specifically design ed for elderly if a lower age cut-off of ≥ 55 years was used , or when participants had an average age of ≥ 70 years . Results The search strategy yielded 26,740 articles , from which a r and om sample was drawn , result ing in 2375 articles . After exclusion , data was extracted from 1369 publications . Of these 1369 RCTs , 96 ( 7 % ) were specifically design ed for elderly . In comparison with trials not design ed for older adults , trials design ed for elderly contained a significantly larger median number of participants  ( 125 vs. 80 , p = 0.008 ) significantly more trials design ed for elderly fell into the disease categories eye ( 6 % vs. 2 % , p = 0.005 ) , musculoskeletal ( 13 % vs. 7 % , p = 0.023 ) and circulatory system ( 16 % vs. 9 % , p = 0.039 ) . No significant difference was observed with regard to the other disease categories . Conclusion There is a low proportion of RCTs specifically design ed for elderly . As older patients will increasingly form the majority in medical practice , there is an urgent need for stronger evidence for the formulation of treatment guidelines specifically for older adults Objective The aim of this study was to identify risk factors for surgical-site infections ( SSIs ) in patients with head and neck cancer su bmi tted to major clean-contaminated surgery . Study Design This is a prospect i ve study conducted in a tertiary cancer center hospital . Subjects and Methods This study includes 258 patients su bmi tted to a major clean-contaminated head and neck oncologic surgery .  Results The overall SSI rate was 38.8 % . The univariate analysis showed the following significant risk factors : race , tobacco consumption , clinical stage , comorbidities , time duration of the surgical procedure , and flap reconstruction . The final model by logistic regression identified the following independent predictors for SSI : tobacco consumption ( odds ratio [ OR ] = 2.96 ) , presence of metastatic lymph nodes ( OR = 2.05 ) , flap reconstruction ( OR = 2.20 ) , and antimicrobial prophylaxis exceeding 48 hours ( OR=1.89 ) . Conclusion The high-risk patients for SSI in head and neck oncologic surgery were those with cancer at advanced stages , those who were smokers , those presenting comorbidities , those who needed major reconstruction of the surgical wound , or those who were su bmi tted to inadequate antibiotic prophylaxis OBJECTIVE To evaluate the association between pretreatment health-related quality -of-life ( HRQOL ) scores and survival in a heterogeneous cohort of patients with newly diagnosed head and neck squamous cell carcinoma ( HNSCC ) . DESIGN Prospect i ve cohort study . SETTING University hospital and referral center in Western Norway . PATIENTS A total of 106 patients with intact cognitive functioning who were younger than 78 years , were diagnosed as having HNSCC , and underwent treatment with curative intent from November 1 , 2002 , through June 30 , 2005 . MAIN OUTCOME MEASURES Overall survival and HRQOL scores obtained at the time of diagnosis . RESULTS All dichotomized HRQOL sum scores except the functional score ( P = .20 ) were significantly predictive of survival in univariate analyses . The hazard ratios of the dichotomized general symptom , global quality -of-life , and head and neck sum score were 3.66 , 0.31 , and 2.28 , respectively . All sum scores except the dichotomized functional score remained predictive of survival after sequential adjustment for sociodemographic and clinical characteristics , neuroticism , choice of psychological coping , current smoking and alcohol consumption , and comorbidities . Similar findings were found for specific HRQOL indices of physical functioning , dyspnea , sleep disturbance , appetite loss , swallowing , and social eating from the European Organization for Research and Treatment of Cancer 30-Item Core Quality of Life Question naire , version 3.0 , and the Quality of Life-Head and Neck Cancer Module . Moreover , patients in the highest scoring quartiles for the symptom sum scores and /or the lowest scoring quartile for the global score had overall mortality rates of 50 % to 64 % compared with 23 % to 26 % among the other patients . CONCLUSION The HRQOL sum scores and specific indices among HNSCC patients predict survival independently of established known prognostic factors Background Head and neck cancer ( HNC ) is a debilitating disease due in part to its effects on function , including speech , swallowing , and cosmesis . Previous studies regarding depression in HNC have focused on demographic predictors , incidence , and quality of life studies . There is , however , a paucity of studies that objective ly address depressive symptoms in HNC patients and the result ant effects on post-treatment functional performance status . The aim of this study was to assess the relationship between preoperative depressive symptoms  ( PDS ) and postoperative functional performance status ( PFPS ) , in addition to other predictors of rehabilitation and survival . Methods A prospect i ve cohort study was undertaken at the University of Alberta , including all new adult HNC patients undergoing surgery as primary therapy for HNC from May 2013 to January 2014 . Baseline depressive symptoms  were measured on the Quick Inventory of Depressive Symptoms ( QIDS ) question naire 2 weeks preoperatively and PFPS was assessed 12 months postoperatively on the Functional Assessment of Cancer Therapy-Head & Neck ( FACT-HN ) scale . Secondary outcomes included completion of adjuvant therapy , narcotic dependence , return to detrimental habits , loss of follow-up , and length of hospital stay ( LOHS ) . Differences between the Normal-Mild and Moderate-Severe QIDS groups were assessed using Mann – Whitney and Fischer Exact statistical analyses . Results Seventy-one patients were included in the study . Mild and Moderate-Severe PDS were 35.2 % and 18.3 % , respectively . Significantly lower FACT-HN scores were noted in the Moderate-Severe group at 12 months ( p = 0.03 ) . The risk ratio ( RR ) for FACT-HN score < 50 % at 12 months in the Moderate-Severe group was 5.66 . In addition , significantly lower completion of adjuvant treatment ( p = 0.03 ) , significantly higher incidence of narcotic dependence ( p = 0.004 ) , and significantly higher LOHS ( 24 days vs. 18 days ; p = 0.02 ) was observed in the Moderate-Severe group . There was no significant difference in loss of follow-up between the 2 groups ( p = 0.64 ) . Conclusions The incidence and severity of PDS in HNC patients treated with surgery is high ( 53.5 % ) . Patients with Moderate-Severe PDS have significantly decreased PFPS , increased narcotic use , decreased completion of adjuvant therapy , and a longer LOHS . HNC patients should be monitored closely for depressive symptoms OBJECTIVE To examine the association between the outcomes of a pre-operative comprehensive geriatric assessment ( CGA ) and the risk of severe post-operative complications in elderly patients electively operated for colorectal cancer . METHODS One hundred seventy-eight consecutive patients ≥ 70 years electively operated for all stages of colorectal cancer were prospect ively examined . A pre-operative CGA was performed , and patients were categorized as fit , intermediate , or frail . The main outcome measure was severe complications within 30 days of surgery . RESULTS Twenty-one patients ( 12 % ) were categorized as fit , 81 ( 46 % ) as intermediate , and 76 ( 43 % ) as frail . Eighty-three patients experienced severe complications , including three deaths ; 7/21 ( 33 % ) of fit patients , 29/81 ( 36 % ) of intermediate patients and 47/76 ( 62 % ) of frail patients ( p=0.002 ) . Increasing age and ASA classification were not associated with complications in this series . CONCLUSION CGA can identify frail patients who have a significantly increased risk of severe complications after elective surgery for colorectal cancer It has been hypothesized that people in lower socioeconomic groups have worse outcomes because they present with advanced‐stage cancers or receive inadequate treatment . The authors investigated this hypothesis by using  education level 
    Output:
    