Quality of life of homebound patients with advanced cancer: Assessments by patients, family members, and oncologists

Evaluation of quality of life (QoL) in advanced cancer patients and identification of reliable alternative sources of raters other than the patient, are important topics in a palliative care program for terminally ill patients. In order to investigate such aspects, QoL of 49 homebound cancer patients was evaluated through the Quality of Life Index (QLI) by the patients themselves, their next-of-kin and oncologists on two different occasions (2-3 weeks after admission to the home care program and four weeks later). Patients also completed the Functional Living Index for Cancer (FLIC), and relatives and oncologists filled out the Index of Independence in Activities of Daily Living (ADL-I). Significant associations, in particular on the second assessment, were shown between QLI as rated by the patient, the family and the oncologist. Nevertheless, physicians were less concordant with the patient in rating the single QLI-dimensions support and mood, as also indicated by the significant difference between physicians and patients on QLI mean scores. Signficant levels of concordance were shown between family and oncologist ratings both on QLI and ADL-I. The FLIC was associated with the QLI score, irrespective of the source of rating (the patients themselves, the family member or the oncologist), especially on the second assessment. Karnofsky scores were associated with FLIC-Physical factor and QLI-Relative, but correlations for QLI improved over time. The results indicate that in the context of a home care program, family members most involved in the assistance and, to a less degree, physicians may be helpful in assessing some aspects of the patient’s experience, particularly health and functional dimensiosn of QoL