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: 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 Background ‘ Taste ’ changes are commonly reported during  chemotherapy .  It is unclear to what extent this relates to actual changes in taste function or to changes in appetite and food liking and how these changes affect dietary intake and nutritional status . Patients and methods This prospect i ve , repeated measures cohort study recruited participants from three oncology clinics . Women ( n = 52 ) prescribed adjuvant chemotherapy  underwent st  and ardised testing of taste perception , appetite and food liking  at six time points to measure change from baseline . Associations between taste and hedonic changes and nutritional outcomes were examined . Results Taste function was significantly reduced early in chemotherapy cycles ( p<0.05 ) but showed recovery by late in the cycle . Ability to correctly identify salty , sour and umami tastants was reduced . Liking of sweet food decreased early and mid-cycle ( p<0.01 ) but not late cycle . Liking of savory food was not significantly affected . Appetite decreased early in the cycle ( p<0.001 ) . Reduced taste function was associated with lowest kilojoule intake ( r = 0.31 ; p = 0.008 ) as was appetite loss with reduced kilojoule ( r = 0.34 ; p = 0.002 ) and protein intake ( r = 0.36 ; p = 0.001 ) early in the third chemotherapy cycle . Decreased appetite early in the third and final chemotherapy cycles was associated with a decline in BMI ( p = < 0.0005 ) over the study period . Resolution of taste function , food liking and appetite was observed 8 weeks after chemotherapy completion . There was no association between taste change and dry mouth , oral mucositis or nausea . Conclusion The results reveal , for the first time , the cyclical yet transient effects of adjuvant chemotherapy on taste function and the link between taste and hedonic changes , dietary intake and nutritional outcomes . The results should be used to inform reliable pre-chemotherapy education 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 BACKGROUND & AIMS A phase III , r and omized non-inferiority study was carried out to compare a two-drug combination ( including nutraceuticals , i.e. antioxidants ) with carnitine + celecoxib ± megestrol acetate for the treatment of cancer-related anorexia/cachexia syndrome ( CACS ) : the primary endpoints were increase of lean body mass ( LBM ) and improvement of total daily physical activity . Secondary endpoint was : increase of physical performance tested by grip strength and 6-min walk test . METHODS Sixty eligible patients were r and omly assigned to : arm 1 , L-carnitine 4 g/day + Celecoxib 300 mg/day or arm 2 , L-carnitine 4 g/day + celecoxib 300 mg/day + megestrol acetate 320 mg/day , all orally . All patients received as basic treatment polyphenols 300 mg/day , lipoic acid 300 mg/day , carbocysteine 2.7 g/day , Vitamin E , A , C. Treatment duration was 4 months . Planned sample size was 60 patients . RESULTS The results did not show a significant difference between tre atment arms in both primary and secondary endpoints . Analysis of changes from baseline showed that LBM ( by dual-energy X-ray absorptiometry and by L3 computed tomography ) increased significantly in both arms as well as physical performance assessed by 6MWT . Toxicity was quite negligible and comparable between arms . CONCLUSIONS The results of the present study showed a non-inferiority of arm 1 ( two-drug combination ) vs arm 2 ( two-drug combination + megestrol acetate ) . Therefore , this simple , feasible , effective , safe , low cost with favorable cost-benefit profile , two-drug approach could be suggested in the clinical practice to implement CACS treatment Goals of workThe aims of this secondary analysis were to determine the prevalence of nutrition impact symptoms in medical oncology patients at 1 , 6 , and 12 months after commencement of chemotherapy  and to investigate the relationship of these symptoms to quality of life ( QoL ) and performance status . Material s and methods A prospect i ve longitudinal survey was conducted in 219 medical oncology patients who had commenced chemotherapy in the past month . The Rotterdam Symptom Assessment  scale assessed the number and distress level of symptoms . The association between symptoms and global QoL and performance status as measured by the Life Satisfaction Scale was investigated . Main results Symptom prevalence as determined by the proportion of patients experiencing at least one nutrition impact symptom was 79 % and 72 % at 1 and 6 months after starting chemotherapy . Even at 12 months , symptom prevalence was 46 % . The most common symptoms included dry mouth , nausea , and constipation with the most distressing symptoms reported as dry mouth , diarrhea , and stomach pain . A higher number of symptoms was associated with lower QoL ( T1 : r = −0.35 , n = 217 , P < 0.05 ; T2 : r = −0.406 , n = 194 , P < 0.001 ; T3 : r = −0.353 , n = 157 , P < 0.001 ) . Patients experiencing more symptoms were more likely to have lower performance status at T2 and T3 ( T2 : n = 189 , P = 0.019 ; T3 : n = 143 , P = 0.003 ) . Conclusion Nutrition impact symptoms were commonly experienced , even 12 months following commencement of chemotherapy , and were associated with poorer QoL and performance status . This highlights the importance of early identification and management of nutrition impact symptoms with adequate follow-up in order to provide optimal care for people with cancer BACKGROUND Two previous GINECO elderly specific studies in advanced ovarian cancer ( AOC ) patients highlighted the prognostic value of geriatric covariates for overall survival ( OS ) . PATIENTS AND METHODS This open-label prospect i ve trial was design ed to identify the impact of geriatric covariates on OS in AOC patients ≥70 years treated with first-line carboplatin .  RESULTS Geriatric covariates of the 111 patients included median age 79 years ( ≥80 years : 41 % ) ; performance status ( PS ) ≥2 : 47 % ; ≥3 major comorbidities : 24 % ; ≥4 comedications : 68 % ; activities of daily living ( ADL ) score < 6 : 55 % ; instrumental activities of daily living ( IADL ) score < 25 : 69 % ; Hospital Anxiety and Depression Scale ( HADS ) > 14 : 37 %  . The median OS was 17.4 months . Overall , 74 % of patients completed the six planned chemotherapy cycles . Grade 3 - 4 haematological toxic effects were frequent ( 50 % ) but manageable . Grade 3 - 4 non-haematological toxicities included fatigue ( 15 % ) , anorexia ( 12 % ) , infections ( 9 % ) and thrombosis ( 2 % ) . A survival score = exp(0.327*GVS ) was developed , where the geriatric vulnerability score ( GVS ) is the sum of the following ( each assigned a value of one ) : albuminaemia < 35 g/l ; ADL score < 6 ; IADL score < 25 ; lymphopaenia < 1 G/l ; and HADS > 14 . With a cut-off ≥3 , GVS discriminated two groups with significantly different OS , treatment completion , severe adverse events and unplanned hospital admissions rates . CONCLUSIONS The GVS is a valuable tool for identifying vulnerable patients when treating an elderly AOC population BACKGROUND Elderly patients with advanced non-small-cell lung cancer ( NSCLC ) may derive similar benefit from platinum-based chemotherapy as younger patients .  Quality of life ( QoL ) and comprehensive geriatric assessment ( CGA ) is often advocated to assess benefits and risks . PATIENTS AND METHODS A total of 181 chemotherapy-naive patients [ ≥70 years , performance score ( PS ) of 0 - 2 ] with stage III-IV NSCLC received carboplatin and gemcitabine ( CG ) ( n = 90 ) or carboplatin and paclitaxel ( CP ) ( n = 91 ) every 3 weeks for up to four cycles . Primary end point was change in global QoL from baseline compared with week 18 . Pretreatment CGA and mini geriatric assessment during and after treatment were undertaken . A principal component ( PC ) analysis was carried out to determine the underlying dimensions of CGA and QoL and subsequently related to survival . RESULTS There were no changes in QoL after treatment . The number of QoL responders ( CG arm , 12 % ; CP arm , 5 % ) was not significantly different . CGA items were only associated with neuropsychiatric toxicity . Quality -adjusted survival was not different between treatment arms . The PC analysis derived from nine CGA , six QoL and one PS score indicated only one dominant dimension . This dimension was strongly prognostic , and physical and role functioning , Groningen Frailty Indicator and Geriatric Depression Scale were its largest contributors . CONCLUSIONS Paclitaxel or gemcitabine added to carboplatin did not have a differential effect on global QoL. CGA was associated with toxic effects in a very limited manner . CGA and QoL items measure one underlying dimension , which is highly prognostic BACKGROUND In routine practice , the evaluation of the nutritional status of patients with cancer is not always performed although there is frequent modification as disease progresses . The vali date d screening and evaluation tools currently available are time-consuming and costly . In this study we analysed factors that could be used to identify patients likely to need nutritional surveillance or intervention . PATIENTS AND METHODS A cross-sectional survey was carried out for 2 weeks in June 2006 on 477 patients 
    Output:
    
agent
***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: 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 Background ‘ Taste ’ changes are commonly reported during  chemotherapy .  It is unclear to what extent this relates to actual changes in taste function or to changes in appetite and food liking and how these changes affect dietary intake and nutritional status . Patients and methods This prospect i ve , repeated measures cohort study recruited participants from three oncology clinics . Women ( n = 52 ) prescribed adjuvant chemotherapy  underwent st  and ardised testing of taste perception , appetite and food liking  at six time points to measure change from baseline . Associations between taste and hedonic changes and nutritional outcomes were examined . Results Taste function was significantly reduced early in chemotherapy cycles ( p<0.05 ) but showed recovery by late in the cycle . Ability to correctly identify salty , sour and umami tastants was reduced . Liking of sweet food decreased early and mid-cycle ( p<0.01 ) but not late cycle . Liking of savory food was not significantly affected . Appetite decreased early in the cycle ( p<0.001 ) . Reduced taste function was associated with lowest kilojoule intake ( r = 0.31 ; p = 0.008 ) as was appetite loss with reduced kilojoule ( r = 0.34 ; p = 0.002 ) and protein intake ( r = 0.36 ; p = 0.001 ) early in the third chemotherapy cycle . Decreased appetite early in the third and final chemotherapy cycles was associated with a decline in BMI ( p = < 0.0005 ) over the study period . Resolution of taste function , food liking and appetite was observed 8 weeks after chemotherapy completion . There was no association between taste change and dry mouth , oral mucositis or nausea . Conclusion The results reveal , for the first time , the cyclical yet transient effects of adjuvant chemotherapy on taste function and the link between taste and hedonic changes , dietary intake and nutritional outcomes . The results should be used to inform reliable pre-chemotherapy education 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 BACKGROUND & AIMS A phase III , r and omized non-inferiority study was carried out to compare a two-drug combination ( including nutraceuticals , i.e. antioxidants ) with carnitine + celecoxib ± megestrol acetate for the treatment of cancer-related anorexia/cachexia syndrome ( CACS ) : the primary endpoints were increase of lean body mass ( LBM ) and improvement of total daily physical activity . Secondary endpoint was : increase of physical performance tested by grip strength and 6-min walk test . METHODS Sixty eligible patients were r and omly assigned to : arm 1 , L-carnitine 4 g/day + Celecoxib 300 mg/day or arm 2 , L-carnitine 4 g/day + celecoxib 300 mg/day + megestrol acetate 320 mg/day , all orally . All patients received as basic treatment polyphenols 300 mg/day , lipoic acid 300 mg/day , carbocysteine 2.7 g/day , Vitamin E , A , C. Treatment duration was 4 months . Planned sample size was 60 patients . RESULTS The results did not show a significant difference between tre atment arms in both primary and secondary endpoints . Analysis of changes from baseline showed that LBM ( by dual-energy X-ray absorptiometry and by L3 computed tomography ) increased significantly in both arms as well as physical performance assessed by 6MWT . Toxicity was quite negligible and comparable between arms . CONCLUSIONS The results of the present study showed a non-inferiority of arm 1 ( two-drug combination ) vs arm 2 ( two-drug combination + megestrol acetate ) . Therefore , this simple , feasible , effective , safe , low cost with favorable cost-benefit profile , two-drug approach could be suggested in the clinical practice to implement CACS treatment Goals of workThe aims of this secondary analysis were to determine the prevalence of nutrition impact symptoms in medical oncology patients at 1 , 6 , and 12 months after commencement of chemotherapy  and to investigate the relationship of these symptoms to quality of life ( QoL ) and performance status . Material s and methods A prospect i ve longitudinal survey was conducted in 219 medical oncology patients who had commenced chemotherapy in the past month . The Rotterdam Symptom Assessment  scale assessed the number and distress level of symptoms . The association between symptoms and global QoL and performance status as measured by the Life Satisfaction Scale was investigated . Main results Symptom prevalence as determined by the proportion of patients experiencing at least one nutrition impact symptom was 79 % and 72 % at 1 and 6 months after starting chemotherapy . Even at 12 months , symptom prevalence was 46 % . The most common symptoms included dry mouth , nausea , and constipation with the most distressing symptoms reported as dry mouth , diarrhea , and stomach pain . A higher number of symptoms was associated with lower QoL ( T1 : r = −0.35 , n = 217 , P < 0.05 ; T2 : r = −0.406 , n = 194 , P < 0.001 ; T3 : r = −0.353 , n = 157 , P < 0.001 ) . Patients experiencing more symptoms were more likely to have lower performance status at T2 and T3 ( T2 : n = 189 , P = 0.019 ; T3 : n = 143 , P = 0.003 ) . Conclusion Nutrition impact symptoms were commonly experienced , even 12 months following commencement of chemotherapy , and were associated with poorer QoL and performance status . This highlights the importance of early identification and management of nutrition impact symptoms with adequate follow-up in order to provide optimal care for people with cancer BACKGROUND Two previous GINECO elderly specific studies in advanced ovarian cancer ( AOC ) patients highlighted the prognostic value of geriatric covariates for overall survival ( OS ) . PATIENTS AND METHODS This open-label prospect i ve trial was design ed to identify the impact of geriatric covariates on OS in AOC patients ≥70 years treated with first-line carboplatin .  RESULTS Geriatric covariates of the 111 patients included median age 79 years ( ≥80 years : 41 % ) ; performance status ( PS ) ≥2 : 47 % ; ≥3 major comorbidities : 24 % ; ≥4 comedications : 68 % ; activities of daily living ( ADL ) score < 6 : 55 % ; instrumental activities of daily living ( IADL ) score < 25 : 69 % ; Hospital Anxiety and Depression Scale ( HADS ) > 14 : 37 %  . The median OS was 17.4 months . Overall , 74 % of patients completed the six planned chemotherapy cycles . Grade 3 - 4 haematological toxic effects were frequent ( 50 % ) but manageable . Grade 3 - 4 non-haematological toxicities included fatigue ( 15 % ) , anorexia ( 12 % ) , infections ( 9 % ) and thrombosis ( 2 % ) . A survival score = exp(0.327*GVS ) was developed , where the geriatric vulnerability score ( GVS ) is the sum of the following ( each assigned a value of one ) : albuminaemia < 35 g/l ; ADL score < 6 ; IADL score < 25 ; lymphopaenia < 1 G/l ; and HADS > 14 . With a cut-off ≥3 , GVS discriminated two groups with significantly different OS , treatment completion , severe adverse events and unplanned hospital admissions rates . CONCLUSIONS The GVS is a valuable tool for identifying vulnerable patients when treating an elderly AOC population BACKGROUND Elderly patients with advanced non-small-cell lung cancer ( NSCLC ) may derive similar benefit from platinum-based chemotherapy as younger patients .  Quality of life ( QoL ) and comprehensive geriatric assessment ( CGA ) is often advocated to assess benefits and risks . PATIENTS AND METHODS A total of 181 chemotherapy-naive patients [ ≥70 years , performance score ( PS ) of 0 - 2 ] with stage III-IV NSCLC received carboplatin and gemcitabine ( CG ) ( n = 90 ) or carboplatin and paclitaxel ( CP ) ( n = 91 ) every 3 weeks for up to four cycles . Primary end point was change in global QoL from baseline compared with week 18 . Pretreatment CGA and mini geriatric assessment during and after treatment were undertaken . A principal component ( PC ) analysis was carried out to determine the underlying dimensions of CGA and QoL and subsequently related to survival . RESULTS There were no changes in QoL after treatment . The number of QoL responders ( CG arm , 12 % ; CP arm , 5 % ) was not significantly different . CGA items were only associated with neuropsychiatric toxicity . Quality -adjusted survival was not different between treatment arms . The PC analysis derived from nine CGA , six QoL and one PS score indicated only one dominant dimension . This dimension was strongly prognostic , and physical and role functioning , Groningen Frailty Indicator and Geriatric Depression Scale were its largest contributors . CONCLUSIONS Paclitaxel or gemcitabine added to carboplatin did not have a differential effect on global QoL. CGA was associated with toxic effects in a very limited manner . CGA and QoL items measure one underlying dimension , which is highly prognostic BACKGROUND In routine practice , the evaluation of the nutritional status of patients with cancer is not always performed although there is frequent modification as disease progresses . The vali date d screening and evaluation tools currently available are time-consuming and costly . In this study we analysed factors that could be used to identify patients likely to need nutritional surveillance or intervention . PATIENTS AND METHODS A cross-sectional survey was carried out for 2 weeks in June 2006 on 477 patients 
    Output:
    