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: Objective : The study aim ed at evaluating the activity and toxicity of gemcitabine monochemotherapy in a unselected series of elderly patients with advanced bladder cancer . The secondary objectives were to establish whether there is a correlation between treatment and Comprehensive Geriatric Assessment ( CGA ) and , in addition , to determine overall patient survival . Methods : Treatment consisted of six courses of chemotherapy with gemcitabine at a dosage of 1,200 mg/m2 on days 1 and 8 , every 21 days . CGA , as described by Gruppo Italiano di Oncologia Geriatrica , was assessed for evaluating the functional status of patients before , during , and after treatment . Results : Twenty-five patients were enrolled ( M/F 22/3 ) , 22 of these were evaluable for response and 23 for toxicity . Characteristics of patients : median age 76 years ( range 71–87 ) ; ECOG performance status ( PS ) 1 in 12 patients and 2 in 13 patients ; clinical stage III in 6 patients and IV in 19 patients . At the end of the therapy the parameters of CGA improved in 4 cases ( 17 % ) , remained unchanged in 17 cases ( 74 % ) and worsened only in 2 cases ( 9 % ) . Two patients were not evaluable . Response evaluation showed 3 ( 13.5 % ) complete responses ( CRs ) and 7 ( 32 % ) partial responses ( PRs ) , for an overall response rate of 45.5 % [ 95 % confidence interval ( CI ) , 24.3–65.7 % ] . Three ( 13.5 % ) patients had stable disease ( SD ) and 9 ( 41 % ) disease progression ( DP ) . Median overall survival was 8 months and median time to progression was 5 months . Treatment was generally well tolerated , with 1 patient having grade 3 gastrointestinal toxicity and 3 having grade 4 neutropenia . Conclusions : We conclude that gemcitabine can be safely administered in monochemotherapy , is effective and does not worsen the functional status of elderly patients with advanced bladder cancer Abstract Seventeen elderly patients with advanced progressive non small cell lung cancer ( NSCLC ) were treated with oral etoposide at the daily dose of 100 mg for 14 days every 3 - 4 weeks with pharmacokinetic monitoring . One partial response and 6 stabilizations were documented with a median overall duration of 13 weeks ( range 8 - 32 ) . The median survival was 24 weeks with an apparent advantage for non-progressive patients ( 40 weeks vs. 18 weeks ) . The treatment was well tolerated especially by those patients without concomitant illness , suggesting the crucial role of a careful selection of the geriatric population . Toxicity was not related to the etoposide plasma level , but was clearly dependent on comorbidity . A geriatric assessment rather than chronological age therefore appears to be more reliable in the selection of elderly patients for clinical trials . The easy self-management , favorable toxicity profile and synergy with other compounds makes oral etoposide suitable for further clinical -pharmacological studies in elderly patients OBJECTIVES To test the hypothesis that early and rogen deprivation therapy ( ADT ) has no proven survival advantage in older men with biochemical recurrence ( BCR ) of prostate cancer ( PCa ) , and it may contribute to geriatric frailty . METHODS We conducted a case-control study of men aged 60 + years with BCR on ADT ( n = 63 ) vs PCa survivors without recurrence ( n = 71 ) .  Frailty prevalence , " obese " frailty , Short Physical Performance Battery ( SPPB ) scores , and falls were compared . An exploratory analysis of frailty biomarkers ( C-reactive protein , erythrocyte sedimentation rate , hemoglobin , albumin , and total cholesterol ) was performed . Summary statistics and univariate and multivariate regression analyses were conducted . RESULTS More patients on ADT  were obese ( body mass index > 30 ; 46.2 % vs 20.6 % ; P = .03 ) . There were no statistical differences in SPPB ( P = .41 ) or frailty ( P = .20 ) . Using a proposed " obese " frailty criteria , 8.7 % in ADT group were frail and 56.5 % were " prefrail , " compared with 2.9 % and 48.8 % of controls ( P = .02 ) . Falls in the last year were higher in the ADT group ( 14.3 % vs 2.8 % ; P = .02 ) . In analyses controlling for age , clinical characteristics , and comorbidities , the ADT group trended toward significance for " obese " frailty ( P = .14 ) and falls ( OR = 4.74 , P = .11 ) . Comorbidity significantly increased the likelihood of " obese " frailty ( P = .01 ) and falls ( OR 2.02 , P = .01 ) . CONCLUSIONS Men with BCR on ADT  are frailer using proposed modified " obese " frailty criteria . They may have lower performance status and more falls . A larger , prospect i ve trial is necessary to establish a causal link between ADT use and progression of frailty and disability BACKGROUND Development of a geriatric screening tool is necessary to identify elderly cancer patients who would benefit from comprehensive geriatric assessment ( CGA ) .  We develop and evaluate the G-8 screening tool against various reference tests . PATIENTS AND METHODS Analyses were based on 364 cancer patients aged>70 years scheduled to receive first-line chemotherapy included in a multicenter prospect i ve study . The G-8 consists of seven items from the Mini Nutritional Assessment ( MNA ) question naire and age . Our primary reference test is based on a set of seven CGA scales : Activities Daily Living ( ADL ) , Instrumental ADL , MNA , Mini-Mental State Exam , Geriatric Depression Scale , Cumulative Illness Rating Scale-Geriatrics , and Timed Get Up and Go . We considered the presence of at least one question naire with an impaired score as an abnormal reference exam . Additional reference exams are also discussed . RESULTS The prevalence of being at risk varied from 60 % to 94 % according to the various definitions of the reference test . When considering the primary reference test , a cut-off value of 14 for the G-8 tool provided a good sensitivity estimate ( 85 % ) without deteriorating the specificity excessively ( 65 % ) . CONCLUSION The G-8 shows good screening properties for identifying elderly cancer patients who could benefit from CGA This prospect i ve cohort study of consecutive elderly cancer patients was undertaken to evaluate the role of the multidimensional geriatric assessment ( MGA ) as an aid in treatment decision-making . A total of 571 cancer patients ( aged > or = 70 ) were enrolled during 6-year ( 1999 - 2005 ) . All underwent MGA as part of the first evaluation . In multivariate analysis , the probability of receiving active , instead of palliative , treatment was negatively associated with increasing age ( odds ratio=0.69 every 5 years , p=0.005 ) , living alone ( OR=0.54 , p=0.031 ) , dependence in activities of daily living ( ADL score > 0 , OR=0.41 , p=0.003 ) and a low body-mass index ( BMI ) ( OR=0.51 , p=0.061 ) ; while a positive association emerged for instrumental activities of daily living ( IADL ) score ( OR=1.12 per point , p=0.019 ) . Our data suggest that MGA , in addition to age , is a useful tool in clinical practice for deciding cancer treatment in elderly patients , with a major independent role played by living alone , ADL , IADL and BMI Background Growing evidence suggests that a comprehensive geriatric assessment ( CGA ) in older patients with cancer can detect unsuspected health problems , predict survival , and predict tolerance to chemotherapy . However , studies regarding CGA in cancer patients are scarce in Asia . Methods We prospect ively enrolled 65 elderly cancer patients who were c and i date s of systemic chemotherapy between July 2006 and March 2008 . Baseline CGA data including demographic information , comorbidity , functional status by means of Activities of Daily Living ( ADL ) , and Instrumental Activities of Daily Living ( IADL ) , cognition , psychological state , nutritional status , and medication were collected and analyzed . Quality of life ( QoL ) was assessed by the EORTC question naire QLQ-C30 . Results Of the 65 patients , the median age was 71 years ( range , 65–80 ) , 49 ( 75 % ) were males , and 58 ( 89 % ) had Eastern Cooperative Oncology Group performance status ( ECOG PS ) 0 or 1 . All patients had solid tumor , 74 % received palliative chemotherapy , and 18 % received adjuvant chemotherapy . Twenty-five percent of patients had Charlson ’s comorbidity index score of 2 or more , 23 % were ADL dependent , and 14 % were IADL dependent . Using Mini-Mental Status Exam ( MMSE ) , it was found that 51 % of patients had mild cognitive impairment ( MMSE score 17–24 ) , and 5 % had cognitive impairment ( ≤16 ) . Forty percent of patients had depression by Short form Geriatric Depression Scale ( SGDS ) , 19 % had malnutrition by Mini-Nutritional Assessment ( MNA ) , and 23 % had body mass index ( BMI ) less than 19.4 kg/m2 ( lowest 10 % ) . Global health status/ quality of life ( QoL ) was less than 50 % in 39 % of patients . Frail patients according to the Balducci classification had significantly poor ECOG PS and worse global health status/QoL.  Conclusion CGA was feasible and could detect multiple unsuspected health problems including functional impairment and malnutrition in Korean elderly cancer patients receiving chemotherapy This prospect i ve study evaluated components of a comprehensive geriatric assessment ( CGA ) to identify rates and predictors of falls in older patients . Fall rates and scores on components of the CGA were compared among adults aged 70 or older in three groups : patients with cancer receiving chemotherapy , patients with cancer not receiving chemotherapy , and community-dwelling adults without cancer . Older adults in the chemotherapy group were hypothesized to fall significantly more often than those in the nonchemotherapy group . Among the patients with cancer , scores on the Activities of Daily Living Scale were a significant predictor of falls . The scores were the only domain of the CGA found to be a significant predictor ; therefore , more research is needed to better underst and fall risk assessment among older patients with cancer . Nurses should conduct fall risk assessment s with measures of functional status as included in a CGA INTRODUCTION Demographic aging poses a problem of management in patients over 65 years old with lung cancer ( LC ) .  Performance status ( PS ) is an index of global activity that , in part , determines treatment . Geriatric indices allow a multifactorial assessment of the elderly subject . The aim of our study is to evaluate whether PS correlates with the geriatric indices in elderly patients with lung cancer . METHODS In a single centre prospect i ve study the  geriatric indices ( ADL , IADL , PINI , MMS )  and the Charlson score ( CS )  were measured before treatment . RESULTS Forty one patients aged 75.7 + /- 6.6 years were included in the study .  PS 3 - 4 was found in 15 % of patients and 44 % had stage IV disease . Half of them were ADL dependent and 95 % were IADL dependent . A MMS<24 was found in 29 % and 17 % had a PINI > 20 . The CS was 2.7 + /- 2.1 . There was a correlation between PS and the geriatric indices but no correlation between PS and CS . CONCLUSION PS is significantly correlated with the geriatric indices but is independent of CS . PS appears to be a good parameter for the assessment of global activity in the elderly subject with LC UNLABELLED Studies of comprehensive geriatric assessment ( CGA ) have shown the importance of follow-up for effectiveness , but this has not been tested in an oncology clinic . In this pilot study , we enrolled 15 early breast cancer patients , aged 70 and older . They received a multidisciplinary CGA every 3 months and structured follow-up from the SAOP nurse practitioner , dietitian , social worker , and pharmacist according to risk . Total follow-up was 6 months . Median age of evaluable patients was 79 years ( range 72 - 87 ) .  Median number of comorbidities by Cumulative Index Rating Scale-Geriatric ( CIRS-G ) was 5 ( 3 - 9 ) at baseline . Ten patients were at pharmacological risk , five at psychosocial risk , and eight at nutritional risk . Patients presented on average six problems initially , and three new problems during follow-up . The intervention directly influenced oncological treatment in four cases . It ensured continuity/coordination of care in seven cases . Success rate in addressing problems was 87 % . Mean Functional Assessment of Cancer Treatment-Breast ( FACT-B ) scores improved from 110.5 ( S.D. 16.7 ) to 116.3 ( S.D. 16.5 ) ( t=0.025 ) . Function and independence were maintained . CONCLUSIONS Older patients with early breast cancer have a high prevalence of comorbidity . A CGA with follow-up has potential for improving the treatment and prognosis of these patients and is feasible in an academic oncology setting BACKGROUND Geriatric assessment has been suggested as a 
    Output:
    
agent
Geriatric assessment  was most often completed to describe a patient 's health and functional status .
Geriatric assessment  in the oncology setting is feasible , and some domains are associated with adverse outcomes .
However , there is limited evidence that geriatric assessment impacted treatment decision making .
***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 : The study aim ed at evaluating the activity and toxicity of gemcitabine monochemotherapy in a unselected series of elderly patients with advanced bladder cancer . The secondary objectives were to establish whether there is a correlation between treatment and Comprehensive Geriatric Assessment ( CGA ) and , in addition , to determine overall patient survival . Methods : Treatment consisted of six courses of chemotherapy with gemcitabine at a dosage of 1,200 mg/m2 on days 1 and 8 , every 21 days . CGA , as described by Gruppo Italiano di Oncologia Geriatrica , was assessed for evaluating the functional status of patients before , during , and after treatment . Results : Twenty-five patients were enrolled ( M/F 22/3 ) , 22 of these were evaluable for response and 23 for toxicity . Characteristics of patients : median age 76 years ( range 71–87 ) ; ECOG performance status ( PS ) 1 in 12 patients and 2 in 13 patients ; clinical stage III in 6 patients and IV in 19 patients . At the end of the therapy the parameters of CGA improved in 4 cases ( 17 % ) , remained unchanged in 17 cases ( 74 % ) and worsened only in 2 cases ( 9 % ) . Two patients were not evaluable . Response evaluation showed 3 ( 13.5 % ) complete responses ( CRs ) and 7 ( 32 % ) partial responses ( PRs ) , for an overall response rate of 45.5 % [ 95 % confidence interval ( CI ) , 24.3–65.7 % ] . Three ( 13.5 % ) patients had stable disease ( SD ) and 9 ( 41 % ) disease progression ( DP ) . Median overall survival was 8 months and median time to progression was 5 months . Treatment was generally well tolerated , with 1 patient having grade 3 gastrointestinal toxicity and 3 having grade 4 neutropenia . Conclusions : We conclude that gemcitabine can be safely administered in monochemotherapy , is effective and does not worsen the functional status of elderly patients with advanced bladder cancer Abstract Seventeen elderly patients with advanced progressive non small cell lung cancer ( NSCLC ) were treated with oral etoposide at the daily dose of 100 mg for 14 days every 3 - 4 weeks with pharmacokinetic monitoring . One partial response and 6 stabilizations were documented with a median overall duration of 13 weeks ( range 8 - 32 ) . The median survival was 24 weeks with an apparent advantage for non-progressive patients ( 40 weeks vs. 18 weeks ) . The treatment was well tolerated especially by those patients without concomitant illness , suggesting the crucial role of a careful selection of the geriatric population . Toxicity was not related to the etoposide plasma level , but was clearly dependent on comorbidity . A geriatric assessment rather than chronological age therefore appears to be more reliable in the selection of elderly patients for clinical trials . The easy self-management , favorable toxicity profile and synergy with other compounds makes oral etoposide suitable for further clinical -pharmacological studies in elderly patients OBJECTIVES To test the hypothesis that early and rogen deprivation therapy ( ADT ) has no proven survival advantage in older men with biochemical recurrence ( BCR ) of prostate cancer ( PCa ) , and it may contribute to geriatric frailty . METHODS We conducted a case-control study of men aged 60 + years with BCR on ADT ( n = 63 ) vs PCa survivors without recurrence ( n = 71 ) .  Frailty prevalence , " obese " frailty , Short Physical Performance Battery ( SPPB ) scores , and falls were compared . An exploratory analysis of frailty biomarkers ( C-reactive protein , erythrocyte sedimentation rate , hemoglobin , albumin , and total cholesterol ) was performed . Summary statistics and univariate and multivariate regression analyses were conducted . RESULTS More patients on ADT  were obese ( body mass index > 30 ; 46.2 % vs 20.6 % ; P = .03 ) . There were no statistical differences in SPPB ( P = .41 ) or frailty ( P = .20 ) . Using a proposed " obese " frailty criteria , 8.7 % in ADT group were frail and 56.5 % were " prefrail , " compared with 2.9 % and 48.8 % of controls ( P = .02 ) . Falls in the last year were higher in the ADT group ( 14.3 % vs 2.8 % ; P = .02 ) . In analyses controlling for age , clinical characteristics , and comorbidities , the ADT group trended toward significance for " obese " frailty ( P = .14 ) and falls ( OR = 4.74 , P = .11 ) . Comorbidity significantly increased the likelihood of " obese " frailty ( P = .01 ) and falls ( OR 2.02 , P = .01 ) . CONCLUSIONS Men with BCR on ADT  are frailer using proposed modified " obese " frailty criteria . They may have lower performance status and more falls . A larger , prospect i ve trial is necessary to establish a causal link between ADT use and progression of frailty and disability BACKGROUND Development of a geriatric screening tool is necessary to identify elderly cancer patients who would benefit from comprehensive geriatric assessment ( CGA ) .  We develop and evaluate the G-8 screening tool against various reference tests . PATIENTS AND METHODS Analyses were based on 364 cancer patients aged>70 years scheduled to receive first-line chemotherapy included in a multicenter prospect i ve study . The G-8 consists of seven items from the Mini Nutritional Assessment ( MNA ) question naire and age . Our primary reference test is based on a set of seven CGA scales : Activities Daily Living ( ADL ) , Instrumental ADL , MNA , Mini-Mental State Exam , Geriatric Depression Scale , Cumulative Illness Rating Scale-Geriatrics , and Timed Get Up and Go . We considered the presence of at least one question naire with an impaired score as an abnormal reference exam . Additional reference exams are also discussed . RESULTS The prevalence of being at risk varied from 60 % to 94 % according to the various definitions of the reference test . When considering the primary reference test , a cut-off value of 14 for the G-8 tool provided a good sensitivity estimate ( 85 % ) without deteriorating the specificity excessively ( 65 % ) . CONCLUSION The G-8 shows good screening properties for identifying elderly cancer patients who could benefit from CGA This prospect i ve cohort study of consecutive elderly cancer patients was undertaken to evaluate the role of the multidimensional geriatric assessment ( MGA ) as an aid in treatment decision-making . A total of 571 cancer patients ( aged > or = 70 ) were enrolled during 6-year ( 1999 - 2005 ) . All underwent MGA as part of the first evaluation . In multivariate analysis , the probability of receiving active , instead of palliative , treatment was negatively associated with increasing age ( odds ratio=0.69 every 5 years , p=0.005 ) , living alone ( OR=0.54 , p=0.031 ) , dependence in activities of daily living ( ADL score > 0 , OR=0.41 , p=0.003 ) and a low body-mass index ( BMI ) ( OR=0.51 , p=0.061 ) ; while a positive association emerged for instrumental activities of daily living ( IADL ) score ( OR=1.12 per point , p=0.019 ) . Our data suggest that MGA , in addition to age , is a useful tool in clinical practice for deciding cancer treatment in elderly patients , with a major independent role played by living alone , ADL , IADL and BMI Background Growing evidence suggests that a comprehensive geriatric assessment ( CGA ) in older patients with cancer can detect unsuspected health problems , predict survival , and predict tolerance to chemotherapy . However , studies regarding CGA in cancer patients are scarce in Asia . Methods We prospect ively enrolled 65 elderly cancer patients who were c and i date s of systemic chemotherapy between July 2006 and March 2008 . Baseline CGA data including demographic information , comorbidity , functional status by means of Activities of Daily Living ( ADL ) , and Instrumental Activities of Daily Living ( IADL ) , cognition , psychological state , nutritional status , and medication were collected and analyzed . Quality of life ( QoL ) was assessed by the EORTC question naire QLQ-C30 . Results Of the 65 patients , the median age was 71 years ( range , 65–80 ) , 49 ( 75 % ) were males , and 58 ( 89 % ) had Eastern Cooperative Oncology Group performance status ( ECOG PS ) 0 or 1 . All patients had solid tumor , 74 % received palliative chemotherapy , and 18 % received adjuvant chemotherapy . Twenty-five percent of patients had Charlson ’s comorbidity index score of 2 or more , 23 % were ADL dependent , and 14 % were IADL dependent . Using Mini-Mental Status Exam ( MMSE ) , it was found that 51 % of patients had mild cognitive impairment ( MMSE score 17–24 ) , and 5 % had cognitive impairment ( ≤16 ) . Forty percent of patients had depression by Short form Geriatric Depression Scale ( SGDS ) , 19 % had malnutrition by Mini-Nutritional Assessment ( MNA ) , and 23 % had body mass index ( BMI ) less than 19.4 kg/m2 ( lowest 10 % ) . Global health status/ quality of life ( QoL ) was less than 50 % in 39 % of patients . Frail patients according to the Balducci classification had significantly poor ECOG PS and worse global health status/QoL.  Conclusion CGA was feasible and could detect multiple unsuspected health problems including functional impairment and malnutrition in Korean elderly cancer patients receiving chemotherapy This prospect i ve study evaluated components of a comprehensive geriatric assessment ( CGA ) to identify rates and predictors of falls in older patients . Fall rates and scores on components of the CGA were compared among adults aged 70 or older in three groups : patients with cancer receiving chemotherapy , patients with cancer not receiving chemotherapy , and community-dwelling adults without cancer . Older adults in the chemotherapy group were hypothesized to fall significantly more often than those in the nonchemotherapy group . Among the patients with cancer , scores on the Activities of Daily Living Scale were a significant predictor of falls . The scores were the only domain of the CGA found to be a significant predictor ; therefore , more research is needed to better underst and fall risk assessment among older patients with cancer . Nurses should conduct fall risk assessment s with measures of functional status as included in a CGA INTRODUCTION Demographic aging poses a problem of management in patients over 65 years old with lung cancer ( LC ) .  Performance status ( PS ) is an index of global activity that , in part , determines treatment . Geriatric indices allow a multifactorial assessment of the elderly subject . The aim of our study is to evaluate whether PS correlates with the geriatric indices in elderly patients with lung cancer . METHODS In a single centre prospect i ve study the  geriatric indices ( ADL , IADL , PINI , MMS )  and the Charlson score ( CS )  were measured before treatment . RESULTS Forty one patients aged 75.7 + /- 6.6 years were included in the study .  PS 3 - 4 was found in 15 % of patients and 44 % had stage IV disease . Half of them were ADL dependent and 95 % were IADL dependent . A MMS<24 was found in 29 % and 17 % had a PINI > 20 . The CS was 2.7 + /- 2.1 . There was a correlation between PS and the geriatric indices but no correlation between PS and CS . CONCLUSION PS is significantly correlated with the geriatric indices but is independent of CS . PS appears to be a good parameter for the assessment of global activity in the elderly subject with LC UNLABELLED Studies of comprehensive geriatric assessment ( CGA ) have shown the importance of follow-up for effectiveness , but this has not been tested in an oncology clinic . In this pilot study , we enrolled 15 early breast cancer patients , aged 70 and older . They received a multidisciplinary CGA every 3 months and structured follow-up from the SAOP nurse practitioner , dietitian , social worker , and pharmacist according to risk . Total follow-up was 6 months . Median age of evaluable patients was 79 years ( range 72 - 87 ) .  Median number of comorbidities by Cumulative Index Rating Scale-Geriatric ( CIRS-G ) was 5 ( 3 - 9 ) at baseline . Ten patients were at pharmacological risk , five at psychosocial risk , and eight at nutritional risk . Patients presented on average six problems initially , and three new problems during follow-up . The intervention directly influenced oncological treatment in four cases . It ensured continuity/coordination of care in seven cases . Success rate in addressing problems was 87 % . Mean Functional Assessment of Cancer Treatment-Breast ( FACT-B ) scores improved from 110.5 ( S.D. 16.7 ) to 116.3 ( S.D. 16.5 ) ( t=0.025 ) . Function and independence were maintained . CONCLUSIONS Older patients with early breast cancer have a high prevalence of comorbidity . A CGA with follow-up has potential for improving the treatment and prognosis of these patients and is feasible in an academic oncology setting BACKGROUND Geriatric assessment has been suggested as a 
    Output:
    