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: Muscle mass decreases with age , leading to " sarcopenia , " or low relative muscle mass , in elderly people . Sarcopenia is believed to be associated with metabolic , physiologic , and functional impairments and disability . Methods of estimating the prevalence of sarcopenia and its associated risks in elderly population s are lacking . Data from a  population -based survey of 883 elderly Hispanic and non-Hispanic white men and women living in New Mexico ( the New Mexico Elder Health Survey , 1993 - 1995 ) were analyzed to develop a method for estimating the prevalence of sarcopenia . An anthropometric equation for predicting appendicular skeletal muscle mass was developed from a r and om sub sample ( n = 199 ) of participants and was extended to the total sample . Sarcopenia was defined as appendicular skeletal muscle mass (kg)/height2 ( m2 ) being less than two st and ard deviations below the mean of a young reference group . Prevalences increased from 13 - 24 % in persons under 70 years of age to > 50 % in persons over 80 years of age , and were slightly greater in Hispanics than in non-Hispanic whites . Sarcopenia was significantly associated with self-reported physical disability in both men and women , independent of ethnicity , age , morbidity , obesity , income , and health behaviors . This study provides some of the first estimates of the extent of the public health problem posed by sarcopenia BACKGROUND The prominent clinical feature of cachexia has traditionally been understood to be weight loss ; however , in recognition of the potential for divergent behavior of muscle and adipose tissue , cachexia was recently defined as loss of muscle with or without loss of fat mass . Detailed assessment s are required to verify body composition in patients with cancer cachexia . DESIGN We adopted a population -based approach to study body composition in patients with cancer , with the use of diagnostic computed tomography images acquired for cancer diagnosis and follow-up . A prospect i ve cohort of 441 patients with non-small cell lung cancer , who were referred consecutively to a regional medical oncology service in Alberta , Canada , was evaluated . RESULTS At referral ( median time to death : 265 d ) , mean body mass index ( BMI ; in kg/m(2 ) ) was 24.9 , with 47.4 % of patients being overweight or obese . Only 7.5 % overall were underweight as conventionally understood ( BMI < 18.5 ) . Analysis of computed tomography images showed extremely high heterogeneity of muscle mass within all strata of BMI . The overall prevalence of severe muscle depletion ( sarcopenia ) was 46.8 % and was present in patients in all BMI categories . A much higher proportion of men ( 61 % ) than women ( 31 % ) met the criteria for sarcopenia . CONCLUSIONS Wasting of skeletal muscle is a prominent feature of patients with lung cancer , despite normal or heavy body weights . The significance of muscle wasting in normal-weight , overweight , and obese patients as a nutritional risk factor , as a prognostic factor , and as a predictor of cancer treatment toxicity is discussed in this article PURPOSE This prospect i ve study was design ed in order to compare the most common subjective measurements of physical function in patients with advanced lung cancer with an objective physical functional test ( Simmonds Functional Assessment Tool [ SFA ] ) . PATIENTS AND METHODS One hundred patients agreed to participate and complete the study before or after their outpatient medical oncology appointment . Patients underwent assessment using the  Karnofsky , the Brief fatigue Inventory , The Functional Assessment of Cancer Therapy-Lung patients ( FACT-L ) and the  Edmonton Symptom Assessment Scale ( ESAS ) . These results were compared to the SFA tool . The SFA consists of six tasks : tying a belt , putting coins in a cup , reaching above head , st and ing up/sitting down , reaching forward and walking 50 feet . RESULTS Ninety-nine patients completed the study over 8 months : median Karnofsky performance status was 85 ( 70 to 100 ) , Edmonton Symptom Assessment Scale ( ESAS ) score ( 0 to 10 ) was generally low ( 0.5 to 2.8 ) . SFA scores were significantly different in patients compared to a control group . The correlation between the subscales of the SFA and the Karnofsky , the Brief Fatigue Inventory , The FACT-L and the ESAS was generally low to moderate ( r values : 0.22 to 0.38 ) . There was generally a moderate correlation between the different subjective scales ( r values : 0.3 to 0.62 ) . CONCLUSION Adherence to the SFA tool was excellent . The low to moderate correlation between the abnormalities found in the objective SFA and the subjective fatigue tests suggest that objective evaluation of the functional capacity provides a potentially useful and independent end-point for clinical trials and therapeutic interventions . These assessment tools should be used complementary to each other to better assess the functional status of patients with advanced lung cancer . Large trials of objective functional assessment are justified The ECOG Scale of Performance Status  ( PS ) is widely used to quantify the functional status of cancer patients , and is an important factor determining prognosis in a number of malignant conditions . The PS describes the status of symptoms and functions with respect to ambulatory status and need for care . PS 0 means normal activity , PS 1 means some symptoms , but still near fully ambulatory , PS 2 means less than 50 % , and PS 3 means more than 50 % of daytime in bed , while PS 4 means completely bedridden . An inter-observer variability study of PS assessment has been carried out to evaluate the non-chance agreement among three oncologists rating 100 consecutive cancer patients .  Total unanimity was observed in 40 cases , unanimity between two observers in 53 cases , and total disagreement in seven cases . Kappa statistics reveal the ability of the observers compared to change alone and were used to evaluate non-chance agreement . Overall Kappa was 0.44 , ( 95 % confidence limits 0.38 - 0.51 ) . The Kappa for PS 0 was 0.55 ( 0.44 - 0.67 ) , while those for PS 1 , 2 , 3 and four were 0.48 ( 0.37 - 0.60 ) , 0.31 ( 0.19 - 0.42 ) , 0.43 ( 0.32 - 0.55 ) , and 0.33 ( 0.33 - 0.45 ) , respectively . If one observer allocated patients to PS 0 - 2 , then another r and omly selected observed placed the patients in the same category with a probability of 0.92 . For patients with PS 3 - 4 the probability that the same category would be chosen was 0.82 . Overall , the non-chance agreement between observers was only moderate , when all ECOG Performance Status groups were considered . However , agreement with regard to allocation of patients to PS 0 - 2 versus 3 - 4 was high . This is of interest because this cut-off is often used in clinical studies Purpose This study aim ed to determine the prevalence of sarcopenia and examine whether sarcopenia was associated with overall and breast-cancer-specific mortality in a cohort of women diagnosed with breast cancer ( stages I – IIIA ) . Methods A total of 471 breast cancer patients from western Washington State and New Mexico who participated in the prospect i ve Health , Eating , Activity , and Lifestyle Study were included in this study . Appendicular lean mass was measured using dual X-ray absorptiometry scans at study inception , on average , 12 months after diagnosis . Sarcopenia was defined as two st and ard deviations below the young healthy adult female mean of appendicular lean mass divided by height squared ( < 5.45 kg/m2 ) . Total and breast-cancer-specific mortality data were obtained from Surveillance Epidemiology and End Results registries . Multivariable Cox proportional hazard models assessed the associations between sarcopenia and mortality . Results Median follow-up was 9.2 years ; 75 women were classified as sarcopenic , and among 92 deaths , 46 were attributed to breast cancer . In multivariable models that included age , race-ethnicity/ study site , treatment type , comorbidities , waist circumference , and total body fat percentage , sarcopenia was independently associated with overall mortality ( hazard ratio ( HR ) = 2.86 ; 95 % CI , 1.67–4.89 ) . Sarcopenic women had increased risk of breast-cancer-specific mortality , although the association was not statistically significant ( HR = 1.95 , 95 % CI , 0.87–4.35 ) . ConclusionS arcopenia is associated with an increased risk of overall mortality in breast cancer survivors and may be associated with breast-cancer-specific mortality . The development of effective interventions to maintain and /or increase skeletal muscle mass to improve prognosis in breast cancer survivors warrants further study . Implication s for Cancer SurvivorsSuch interventions may help breast cancer patients live longer Early identification and treatment of nutritional deficiencies can lead to improved outcomes in the quality of life ( QoL ) and survival of patients with nonsmall cell lung cancer ( NSCLC ) . Noninvasive techniques are needed to evaluate changes in body composition as part of determining nutritional status . The aim of the study was to evaluate the association of nutritional parameters in health-related quality of life ( HRQL ) and survival in patients with advanced NSCLC . Chemotherapy-naïve patients with advanced NSCLC with good performance status Eastern Cooperative Oncology Group ( ECOG ) 0–2 were included prospect ively in the study . We evaluated inflammatory parameters such as C-reactive protein , platelet/lymphocyte index , neutrophil/lymphocyte index , serum interleukin (IL)-6 , and tumor necrosis factor-α , and nutritional variables such as body mass index ( BMI ) and serum albumin levels . Bioelectrical impedance analysis including phase angle was obtained before cisplatin-based chemotherapy was started  . HRQL was assessed by application of the European Organization for Research and Treatment of Cancer Quality of Life Question naire (QLQ)-C30 and QLQ-LC13 instruments at baseline . Overall survival ( OS ) was calculated with the Kaplan-Meier method and analyzed with log-rank and Cox proportional hazard models . One hundred nineteen patients were included .  Mean BMI was 24.8 ± 4.5 kg/m2 , average weight loss of patients was 8.4 % , and median phase angle was 5.8 ° . Malnutrition measured by subjective global assessment ( SGA ) , weight loss > 10 % , BMI > 20 was associated with lower HRQL scales . Patients with ECOG 2 , high content serum IL-6 , lower phase angle , and malnutrition parameters showed lower OS ; however , after multivariate analysis , only ECOG 2 [ Hazard ratio ( HR ) , 2.7 ; 95 % confidence interval ( 95 % CI ) , 1.5–4.7 ; P = 0.001 ] , phase angle ≤5.8 ° ( HR = 3.02 ; 95 % CI : 1.2–7.11 ; P = 0.011 ) , and SGA ( HR = 2.7 ; 95 % CI , 1.31–5.5 ; P = 0.005 ) were associated with poor survival . Patients were divided into low- , intermediate- , and high-risk groups according to regression coefficients ; OS at 1 yr was 78.4 , 53 , and 13.8 % , respectively . Malnutrition is associated with low HRQL and is an independent prognostic factor in advanced NSCLC . The results warrant prospect i ve trials to evaluate the impact of different nutritional interventions on HRQL and survival Background A frequent manifestation of advanced NSCLC is malnutrition , even though there are many studies which relate it with a poor survival , its relation with toxicity has not yet been consistently reported . The aim of this study was to associate malnutrition and albumin serum levels with the occurrence of chemotherapy-induced toxicity in cisplatin plus paclitaxel chemotherapy-treated NSCLC . Methods We prospect ively evaluated 100 stage IV NSCLC patients treated with paclitaxel ( 175 mg/m2 ) and cisplatin ( 80 mg/m2 ) . Malnutrition was assessed using SGA prior treatment . Neutrophil Lymphocyte Ratio ( NLR ) and the Platelet Lymphocyte Ratio ( PLR ) were used to determine the presence of systemic inflammatory response ( SIR ) and were related to the development of toxicity . Toxicity was grade d according to NCI CTCAE version 3.0 after two chemotherapy cycles . Results Median age was 58 ± 10 years , 51 % of patients were malnourished , 50 % had albumin ≤3.0 mg/mL. NLR ≥ 5 was associated with basal hypoalbuminemia ( mean ranks , 55.7 vs. 39 p = 0.006 ) , ECOG = 2 ( 47.2 vs. 55.4 p = 0.026 ) and PLR ≥ 150 were significantly related with a basal body mass index ≤20 ( 56.6 vs. 43.5 ; p = 0.02 ) and hypoalbuminemia ( 58.9 vs. 41.3 ; p = 0.02 ) . Main toxicities observed after 2 cycles of chemotherapy were alopecia ( 84 % ) , nausea ( 49 % ) , neuropathy ( 46 % ) , anemia ( 33 % ) , lymphopenia ( 31 % ) , and leukopen 
    Output:
    
agent
Sarcopenia , as defined by reduced muscle mass alone , was found to be very prevalent in patients with lung cancer , regardless of body mass index , and where present was associated with poorer functional status and overall survival .
The effect of nutritional supplements and ATP infusions on muscle mass showed conflicting results .
There are very limited data on the correlation between degree of sarcopenia and muscle function , which has a non-linear relationship in older non-cancer population s. CONCLUSIONS Loss of muscle mass is a significant contributor to morbidity in patients with lung cancer .
***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: Muscle mass decreases with age , leading to " sarcopenia , " or low relative muscle mass , in elderly people . Sarcopenia is believed to be associated with metabolic , physiologic , and functional impairments and disability . Methods of estimating the prevalence of sarcopenia and its associated risks in elderly population s are lacking . Data from a  population -based survey of 883 elderly Hispanic and non-Hispanic white men and women living in New Mexico ( the New Mexico Elder Health Survey , 1993 - 1995 ) were analyzed to develop a method for estimating the prevalence of sarcopenia . An anthropometric equation for predicting appendicular skeletal muscle mass was developed from a r and om sub sample ( n = 199 ) of participants and was extended to the total sample . Sarcopenia was defined as appendicular skeletal muscle mass (kg)/height2 ( m2 ) being less than two st and ard deviations below the mean of a young reference group . Prevalences increased from 13 - 24 % in persons under 70 years of age to > 50 % in persons over 80 years of age , and were slightly greater in Hispanics than in non-Hispanic whites . Sarcopenia was significantly associated with self-reported physical disability in both men and women , independent of ethnicity , age , morbidity , obesity , income , and health behaviors . This study provides some of the first estimates of the extent of the public health problem posed by sarcopenia BACKGROUND The prominent clinical feature of cachexia has traditionally been understood to be weight loss ; however , in recognition of the potential for divergent behavior of muscle and adipose tissue , cachexia was recently defined as loss of muscle with or without loss of fat mass . Detailed assessment s are required to verify body composition in patients with cancer cachexia . DESIGN We adopted a population -based approach to study body composition in patients with cancer , with the use of diagnostic computed tomography images acquired for cancer diagnosis and follow-up . A prospect i ve cohort of 441 patients with non-small cell lung cancer , who were referred consecutively to a regional medical oncology service in Alberta , Canada , was evaluated . RESULTS At referral ( median time to death : 265 d ) , mean body mass index ( BMI ; in kg/m(2 ) ) was 24.9 , with 47.4 % of patients being overweight or obese . Only 7.5 % overall were underweight as conventionally understood ( BMI < 18.5 ) . Analysis of computed tomography images showed extremely high heterogeneity of muscle mass within all strata of BMI . The overall prevalence of severe muscle depletion ( sarcopenia ) was 46.8 % and was present in patients in all BMI categories . A much higher proportion of men ( 61 % ) than women ( 31 % ) met the criteria for sarcopenia . CONCLUSIONS Wasting of skeletal muscle is a prominent feature of patients with lung cancer , despite normal or heavy body weights . The significance of muscle wasting in normal-weight , overweight , and obese patients as a nutritional risk factor , as a prognostic factor , and as a predictor of cancer treatment toxicity is discussed in this article PURPOSE This prospect i ve study was design ed in order to compare the most common subjective measurements of physical function in patients with advanced lung cancer with an objective physical functional test ( Simmonds Functional Assessment Tool [ SFA ] ) . PATIENTS AND METHODS One hundred patients agreed to participate and complete the study before or after their outpatient medical oncology appointment . Patients underwent assessment using the  Karnofsky , the Brief fatigue Inventory , The Functional Assessment of Cancer Therapy-Lung patients ( FACT-L ) and the  Edmonton Symptom Assessment Scale ( ESAS ) . These results were compared to the SFA tool . The SFA consists of six tasks : tying a belt , putting coins in a cup , reaching above head , st and ing up/sitting down , reaching forward and walking 50 feet . RESULTS Ninety-nine patients completed the study over 8 months : median Karnofsky performance status was 85 ( 70 to 100 ) , Edmonton Symptom Assessment Scale ( ESAS ) score ( 0 to 10 ) was generally low ( 0.5 to 2.8 ) . SFA scores were significantly different in patients compared to a control group . The correlation between the subscales of the SFA and the Karnofsky , the Brief Fatigue Inventory , The FACT-L and the ESAS was generally low to moderate ( r values : 0.22 to 0.38 ) . There was generally a moderate correlation between the different subjective scales ( r values : 0.3 to 0.62 ) . CONCLUSION Adherence to the SFA tool was excellent . The low to moderate correlation between the abnormalities found in the objective SFA and the subjective fatigue tests suggest that objective evaluation of the functional capacity provides a potentially useful and independent end-point for clinical trials and therapeutic interventions . These assessment tools should be used complementary to each other to better assess the functional status of patients with advanced lung cancer . Large trials of objective functional assessment are justified The ECOG Scale of Performance Status  ( PS ) is widely used to quantify the functional status of cancer patients , and is an important factor determining prognosis in a number of malignant conditions . The PS describes the status of symptoms and functions with respect to ambulatory status and need for care . PS 0 means normal activity , PS 1 means some symptoms , but still near fully ambulatory , PS 2 means less than 50 % , and PS 3 means more than 50 % of daytime in bed , while PS 4 means completely bedridden . An inter-observer variability study of PS assessment has been carried out to evaluate the non-chance agreement among three oncologists rating 100 consecutive cancer patients .  Total unanimity was observed in 40 cases , unanimity between two observers in 53 cases , and total disagreement in seven cases . Kappa statistics reveal the ability of the observers compared to change alone and were used to evaluate non-chance agreement . Overall Kappa was 0.44 , ( 95 % confidence limits 0.38 - 0.51 ) . The Kappa for PS 0 was 0.55 ( 0.44 - 0.67 ) , while those for PS 1 , 2 , 3 and four were 0.48 ( 0.37 - 0.60 ) , 0.31 ( 0.19 - 0.42 ) , 0.43 ( 0.32 - 0.55 ) , and 0.33 ( 0.33 - 0.45 ) , respectively . If one observer allocated patients to PS 0 - 2 , then another r and omly selected observed placed the patients in the same category with a probability of 0.92 . For patients with PS 3 - 4 the probability that the same category would be chosen was 0.82 . Overall , the non-chance agreement between observers was only moderate , when all ECOG Performance Status groups were considered . However , agreement with regard to allocation of patients to PS 0 - 2 versus 3 - 4 was high . This is of interest because this cut-off is often used in clinical studies Purpose This study aim ed to determine the prevalence of sarcopenia and examine whether sarcopenia was associated with overall and breast-cancer-specific mortality in a cohort of women diagnosed with breast cancer ( stages I – IIIA ) . Methods A total of 471 breast cancer patients from western Washington State and New Mexico who participated in the prospect i ve Health , Eating , Activity , and Lifestyle Study were included in this study . Appendicular lean mass was measured using dual X-ray absorptiometry scans at study inception , on average , 12 months after diagnosis . Sarcopenia was defined as two st and ard deviations below the young healthy adult female mean of appendicular lean mass divided by height squared ( < 5.45 kg/m2 ) . Total and breast-cancer-specific mortality data were obtained from Surveillance Epidemiology and End Results registries . Multivariable Cox proportional hazard models assessed the associations between sarcopenia and mortality . Results Median follow-up was 9.2 years ; 75 women were classified as sarcopenic , and among 92 deaths , 46 were attributed to breast cancer . In multivariable models that included age , race-ethnicity/ study site , treatment type , comorbidities , waist circumference , and total body fat percentage , sarcopenia was independently associated with overall mortality ( hazard ratio ( HR ) = 2.86 ; 95 % CI , 1.67–4.89 ) . Sarcopenic women had increased risk of breast-cancer-specific mortality , although the association was not statistically significant ( HR = 1.95 , 95 % CI , 0.87–4.35 ) . ConclusionS arcopenia is associated with an increased risk of overall mortality in breast cancer survivors and may be associated with breast-cancer-specific mortality . The development of effective interventions to maintain and /or increase skeletal muscle mass to improve prognosis in breast cancer survivors warrants further study . Implication s for Cancer SurvivorsSuch interventions may help breast cancer patients live longer Early identification and treatment of nutritional deficiencies can lead to improved outcomes in the quality of life ( QoL ) and survival of patients with nonsmall cell lung cancer ( NSCLC ) . Noninvasive techniques are needed to evaluate changes in body composition as part of determining nutritional status . The aim of the study was to evaluate the association of nutritional parameters in health-related quality of life ( HRQL ) and survival in patients with advanced NSCLC . Chemotherapy-naïve patients with advanced NSCLC with good performance status Eastern Cooperative Oncology Group ( ECOG ) 0–2 were included prospect ively in the study . We evaluated inflammatory parameters such as C-reactive protein , platelet/lymphocyte index , neutrophil/lymphocyte index , serum interleukin (IL)-6 , and tumor necrosis factor-α , and nutritional variables such as body mass index ( BMI ) and serum albumin levels . Bioelectrical impedance analysis including phase angle was obtained before cisplatin-based chemotherapy was started  . HRQL was assessed by application of the European Organization for Research and Treatment of Cancer Quality of Life Question naire (QLQ)-C30 and QLQ-LC13 instruments at baseline . Overall survival ( OS ) was calculated with the Kaplan-Meier method and analyzed with log-rank and Cox proportional hazard models . One hundred nineteen patients were included .  Mean BMI was 24.8 ± 4.5 kg/m2 , average weight loss of patients was 8.4 % , and median phase angle was 5.8 ° . Malnutrition measured by subjective global assessment ( SGA ) , weight loss > 10 % , BMI > 20 was associated with lower HRQL scales . Patients with ECOG 2 , high content serum IL-6 , lower phase angle , and malnutrition parameters showed lower OS ; however , after multivariate analysis , only ECOG 2 [ Hazard ratio ( HR ) , 2.7 ; 95 % confidence interval ( 95 % CI ) , 1.5–4.7 ; P = 0.001 ] , phase angle ≤5.8 ° ( HR = 3.02 ; 95 % CI : 1.2–7.11 ; P = 0.011 ) , and SGA ( HR = 2.7 ; 95 % CI , 1.31–5.5 ; P = 0.005 ) were associated with poor survival . Patients were divided into low- , intermediate- , and high-risk groups according to regression coefficients ; OS at 1 yr was 78.4 , 53 , and 13.8 % , respectively . Malnutrition is associated with low HRQL and is an independent prognostic factor in advanced NSCLC . The results warrant prospect i ve trials to evaluate the impact of different nutritional interventions on HRQL and survival Background A frequent manifestation of advanced NSCLC is malnutrition , even though there are many studies which relate it with a poor survival , its relation with toxicity has not yet been consistently reported . The aim of this study was to associate malnutrition and albumin serum levels with the occurrence of chemotherapy-induced toxicity in cisplatin plus paclitaxel chemotherapy-treated NSCLC . Methods We prospect ively evaluated 100 stage IV NSCLC patients treated with paclitaxel ( 175 mg/m2 ) and cisplatin ( 80 mg/m2 ) . Malnutrition was assessed using SGA prior treatment . Neutrophil Lymphocyte Ratio ( NLR ) and the Platelet Lymphocyte Ratio ( PLR ) were used to determine the presence of systemic inflammatory response ( SIR ) and were related to the development of toxicity . Toxicity was grade d according to NCI CTCAE version 3.0 after two chemotherapy cycles . Results Median age was 58 ± 10 years , 51 % of patients were malnourished , 50 % had albumin ≤3.0 mg/mL. NLR ≥ 5 was associated with basal hypoalbuminemia ( mean ranks , 55.7 vs. 39 p = 0.006 ) , ECOG = 2 ( 47.2 vs. 55.4 p = 0.026 ) and PLR ≥ 150 were significantly related with a basal body mass index ≤20 ( 56.6 vs. 43.5 ; p = 0.02 ) and hypoalbuminemia ( 58.9 vs. 41.3 ; p = 0.02 ) . Main toxicities observed after 2 cycles of chemotherapy were alopecia ( 84 % ) , nausea ( 49 % ) , neuropathy ( 46 % ) , anemia ( 33 % ) , lymphopenia ( 31 % ) , and leukopen 
    Output:
    