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

Evaluation of quality of life in patients with advanced cancer and identification of reliable raters in addition to patients are important aspects of a palliative care program. In a study of these aspects, 49 homebound patients with advanced cancer completed the Quality of Life Index (QLI) and the Functional Living Index for Cancer (FLIC) two to three weeks after admission to the home care program (Time I) and four weeks later (Time 2). Their primary caregivers (relatives) and oncologists completed the QLI and the Index of independence in Activities of Daily Living (ADL-I); the oncologists also completed the Karnofsky Performance Status scale (KPS). No difference was found between the QLI ratings of patients and relatives, whereas the oncologists rated the patients' quality of life as being better than the patients did. Significant associations, particularly at Time 2, were found among the QLI scores of patients, relatives, and oncologists. Regarding the QLI subscales, the relatives' scores were less concordant with those of patients on Health and Support, and the oncologists' scores were less concordant with those of patients on Support and Mood. Relatives' and oncologists' ratings on the ADL-I were significantly concordant. The FLIC scores were associated with the QLI scores regardless of which group supplied the ratings, especially at Time 2. The relatives' QLI scores were also associated with the oncologists' KPS scores at Time I, whereas all QLI scores, regardless of the source of ratings, were associated with KPS scores at Time 2. The results indicated that in the context of a home care program, the relatives most involved in the patient's care and, to a lesser degree, oncologists may be helpful in assessing some aspects of the patient's cancer experience.