Functional Living Index-Cancer Research Articles

The effect of diaphragmatic breathing on nausea, vomiting and functional status among breast cancer patients undergoing chemotherapy

PurposeTo examine the effect of diaphragmatic breathing (DB) on nausea, vomiting, and functional status among breast cancer patients undergoing chemotherapy in Indonesia. MethodsA quasi experimental study with non-equivalent pretest and posttest control group was conducted. A total of forty-eight breast cancer patients (24 DB and 24 control participants) undergoing chemotherapy participated in this study selected conveniently. DB intervention was performed to the intervention group after chemotherapy cycle twice a day for six days, meanwhile the control group received usual care. A set of questionnaires was used to collect data consisting of Patient Information Form, Rhodes Index Nausea, Vomiting and Retching (RINVR) and The Functional Living Index-Cancer (FLI-C). Data were analyzed and interpreted using Generalized Linear Model, Wilcoxon Test, Paired T Test and Mann-Whitney U test. ResultsThere were significant changes in RINVR mean scores for the intervention group that started on the third day after chemotherapy (p = 0.000); meanwhile, the significant changes in RINVR mean scores for the control group began on the fifth day (p = 0.000). The total score of FLI-C was significantly different between the intervention and control groups (p = 0.000). ConclusionDB could decrease nausea and vomiting, and increase functional status of breast cancer patients undergoing chemotherapy. It can be promoted as a useful low-cost self-management approach and an additional and complementary therapy to manage chemotherapy-related nausea and vomiting.

Investigation of symptom management and functional state of women who underwent breast cancer surgery.

The aim of this study was to investigate the symptom management and the functional status of women who underwent surgery for breast cancer. This cross-sectional descriptive study was conducted in a university hospital surgical oncology clinic. This study was conducted on 80 patients who had undergone breast cancer surgery in the last 5 years in a surgical oncology clinic of a university hospital. Study data were collected using the patient identification form, Symptom-Management Self-Efficacy Scale Related to Chemotherapy in Breast Cancer, and Functional Living Index-Cancer. The data were analyzed with the SPSS program. The mean total score of Symptom-Management Self-Efficacy Scale Related to Chemotherapy in Breast Cancer was found to be 157.28±36.86, and the mean total score of the Functional Living Index-Cancer was found to be 103.79±18.77. When the correlation between the Functional Living Index-Cancer and Symptom-Management Self-Efficacy Scale Related to Chemotherapy in Breast Cancer scales used in the study was examined, it was determined that there was a positive statistically significant correlation (p<0.05) between the subscale and scale total scores. As a result of the study, it was determined that the self-efficacy and functional status of the patients were poor. Their functional status was also determined to be improved as the symptom self-efficacy levels increased.

Impact of symptom burden and self-efficacy on functional status in advanced breast cancer patients: A path analysis.

This correlational study aims at exploring the correlations between symptom burden, functional status, and self-efficacy in advanced breast cancer patients and to analyze their paths of influence. The study was performed with 122 patients with advanced breast cancer receiving outpatient chemotherapy between April 10, 2021 and April 29, 2022. Data were collected using a sociodemographic information form, the MD Anderson Symptom Inventory, the Functional Living Index-Cancer, and the Symptom Management Self-Efficacy Scale for Breast Cancer Related to Chemotherapy. Kruskal-Wallis, Mann-Whitney U, and Spearman correlation tests and path analysis were used for data evaluation. Less-educated individuals had a higher symptom burden and poorer self-efficacy. Low-income level was related to poor self-efficacy. Symptom severity did not directly influence functional status but affected it indirectly through self-efficacy, while symptom interference and self-efficacy had a direct impact on functional status. This study mainly concludes that symptom burden and self-efficacy affect functional status in advanced breast cancer patients receiving chemotherapy. Self-efficacy-enhancing interventions may be helpful strategies for symptom relief and improvement in functional status in this population.

Quality of life among cancer survivors by model of cancer survivorship care

Background: There were an estimated 16.9 million cancer survivors in the United States in 2019, but there is wide variation in survivorship care. Patient-reported outcomes associated with distinct care models are unknown. Thus, we examined differences in quality of life by cancer survivorship care model. Materials and methods: We conducted a comparative effectiveness trial, recruiting 32 Commission on Cancer-accredited centers in 2015–2016. Sites were characterized as one of three models: 1) Single Consultative visit, 2) Specialized Longitudinal care with ongoing visits at predetermined intervals, 3) Oncology-Embedded care with visits as needed. We included breast, prostate, and colorectal cancer survivors who had completed active treatment but had not yet attended a survivorship visit (n = 991). Quality of life was assessed using 20 physical, 14 social/emotional, and 7 practical concerns, adapted from the Quality of Life-Breast Cancer Survivors and Functional Living Index Cancer scales. 1 , 2 We used frequencies to describe prevalent symptoms and ANOVA to test for global differences in concerns by survivorship care model, post-hoc Tukey’s test for pairwise comparisons, and mixed-effects models to describe changes in quality of life by care model over six-months. Results: While unadjusted results suggested that nearly all concerns worsened over six months, no differences were observed in quality of life concerns by care model for physical or practical concerns. At baseline, social/emotional concerns showed a global difference by model (p = 0.008; pairwise results showed fewer concerns among Oncology-Embedded survivors compared to Specialized Consultative survivors; 12.1 vs 15.2, p < 0.05), but no differences were found at six months (global p = 0.311). Mixed effects models showed no change in quality of life by model over six-months. Conclusions: Our results do not support an association between quality of life and care model over six-months. Still, participants reported many quality of life concerns across domains that must be addressed, regardless of care model.

Impact of naturopathy, yoga, and dietary interventions as adjuvant chemotherapy in the management of stage II and III adenocarcinoma of the colon.

Naturopathy, Yoga and Dietary interventions are known to improve the quality of life in cancer patients. We aim to evaluate the effect of naturopathy interventions along with adjuvant chemotherapy in patients who underwent surgery for Adenocarcinoma of the Colon. A total of 116 adult patients were randomised in to one of the two groups; the experimental group received naturopathy, Yoga and Dietary interventions and the control group received psycho-social counselling in addition to standard chemotherapy. Haematological, biochemical and psychological evaluations were performed at set intervals during a total period of eighteen months starting from the first cycle of adjuvant chemotherapy. Results showed that the overall hemoglobin (p < 0.0001) and carcinoembryonic antigen (CEA) (p = 0.0038) levels were statistically significant in patients on the experimental arm. The rest of the laboratory parameters, viz. total leukocyte count, platelet counts, and serum creatinine levels, for overall data was not statistically significant in both the groups. Psychological attributes such as anxiety, depression, symptom severity, and Functional Living Index: Cancer (FLIC) were found to be statistically significant (p < 0.0001) in the experimental subjects as compared with those in the control. On the whole, men benefited more than women from the study interventions. We conclude that Yoga and Naturopathy interventions in addition to chemotherapy show improvement in overall functional life index along with improvement in haemoglobin in patients with stages II and III Adenocarcinoma of Colon.

The effect of breathing exercise on nausea, vomiting and functional status in breast cancer patients undergoing chemotherapy

ObjectiveThe aim of this study is to determine the effect of breathing exercise on nausea, vomiting, and functional status in breast cancer patients undergoing chemotherapy. MethodsThis randomized controlled trial was conducted with a total of 60 breast cancer patients in the ambulatory chemotherapy unit of a university hospital. The data were collected using Patient Information Form, Functional Living Index-Cancer (FLI-C), Visual Analog Scale, and Patient Diary. The patients were followed up for the first seven days. While the control group received routine nursing care until the posttest, the intervention group received breathing exercise for six days. On the seventh day, FLI-C was repeated for all the patients. ResultsIt was determined that the patients in the intervention group had less number of nausea, vomiting, and retching episodes after the breathing exercise (p < 0.05) and experienced lower severity of nausea (p < 0.05) compared to patients in the control group. ConclusionConsequently, it was determined that the breathing exercise reduced chemotherapy-induced nausea, vomiting and retching in breast cancer patients and affected positively functional status of patients.

CN86 - The effects of progressive muscle relaxation and mindfulness meditation on fatigue, coping styles, and quality of life in breast cancer patients receiving adjuvant paclitaxel regimen: An assessor blinded, three-arm randomized controlled trial

BackgroundThis study aimed to examine the effects of progressive muscle relaxation (PMR) and mindfulness-based stress reduction (MBSR) on fatigue, coping styles and quality of life (QOL) in breast cancer patients receiving adjuvant paclitaxel regimen. MethodsParticipants (stages 1-3) were randomly assigned to either a 12-week (PMR) (n=31), MBSR (n=32) interventions or control group (CG) (n=29). Participants in the intervention groups were instructed on PMR and MBSR, the steps of interventions were recorded a voice recorder, and were asked to listen the recorded audio files during exercises. Participants in the intervention groups continued PMR or MBSR 20min. each day, totally 12 weeks at their home. The CG received only a single time attention placebo education (15min.) on breast cancer before paclitaxel regimen. No intervention was applied to neither the interventions nor the control group until the follow-up assessment (week 14). Data collection tools included Patient Information Form, Brief Fatigue Inventory (BFI), Brief COPE, and the Functional Living Index-Cancer (FLIC). The data were collected at three time points including at baseline, week 12, and week 14. To analyze data repeated measures ANOVA and Kruskal Wallis tests were used. ResultsThe BFI scores were significantly decreased in the MBSR, PMR groups when compared with the CG at week 12 and week 14 (p<.05). The use of emotional support, use of instrumental support, venting, positive reframing, and planning sub-dimension scores of Brief COPE were significantly higher in the MBSR, and PMR groups than the CG at week 12 and week 14 (p<.05). Besides, the humor and acceptance sub-dimension scores of Brief COPE were significantly higher in the MBSR, and PMR groups than the CG at week 14 (p<.05). Regarding FLIC, QOL scores, there were no significant differences between the groups at week 12 and week 14 (p>.05). ConclusionsA brief, PMR and MBSR are simple and effective nursing interventions, initiated concurrently with adjuvant paclitaxel regimen that can be used to manage fatigue, and improve coping styles in patients with breast cancer. Legal entity responsible for the studyThe authors. FundingHacettepe University, Scientific Research Projects Coordination Unit (project THD-2018-17089). DisclosureAll authors have declared no conflicts of interest.

Effects of progressive muscle relaxation and mindfulness meditation on fatigue, coping styles, and quality of life in early breast cancer patients: An assessor blinded, three-arm, randomized controlled trial.

This study aimed to investigate the effects of progressive muscle relaxation (PMR) and mindfulness meditation (MM) on fatigue, coping styles, and quality of life (QOL) in patients with early breast cancer receiving adjuvant paclitaxel. The participants were randomly assigned to either a 12-week (PMR) (n = 31) and MM (n = 32) interventions or control group (CG) (n = 29). The intervention groups continued PMR or MM for 20-min every day, for a total of 12 weeks. The CG received only a single time attention-matched education (15-min) on breast cancer before the start of the paclitaxel regimen. Data collection tools included the Patient Information Form, Brief Fatigue Inventory (BFI), Brief COPE, and Functional Living Index-Cancer (FLIC). Data were collected at baseline, week 12, and week 14. A significant reduction in the BFI scores was reported in the PMR and MM groups when compared with the CG at weeks 12 and 14 (p = .002). Similarly, the use of emotional support and positive reframing sub-dimension scores of Brief COPE were significantly higher in the PMR and MM than in the CG at weeks 12 (p = .017) and 14 (p = .042). Furthermore, the planning and active coping sub-dimension scores were significantly higher in the PMR and MM than in the CG at week 14 (p = .000). Regarding QOL scores, no significant differences were observed between the groups at weeks 12 (p = .486) and 14 (p = .095). PMR and MM are effective interventions that if initiated concurrently with the adjuvant paclitaxel demonstrate similar effects on fatigue and coping styles.

The effects of mindfulness meditation and progressive muscle relaxation on fatigue and quality of life in breast cancer patients receiving adjuvant paclitaxel: A three-arm randomized trial.

e12051 Background: Breast cancer patients often suffer from fatigue during adjuvant paclitaxel regimen which frequently impairs quality of life (QOL). Therefore, this three-arm randomized controlled study aimed to examine the effects of mindfulness-based stress reduction (MBSR) and progressive muscle relaxation (PMR) on fatigue and QOL in breast cancer patients receiving adjuvant paclitaxel. Methods: Participants were randomly assigned to either a MBSR (n = 20), (PMR) (n = 19) or control group (CG) (n = 15). Participants in the intervention groups were instructed on MBSR and PGE, the steps of interventions were recorded a voice recorder and a WhatsApp group was designed by the principal investigator. Participants were asked to listen the recorded audio files during exercises. The intervention groups continued MBSR or PMR 20 min. each day, totally 12 weeks at their home. The CG received only an attention placebo education on breast cancer. Data collection tools included Brief Fatigue Inventory (BFI) and Functional Living Index-Cancer (FLIC). Data were collected at three time points: baseline (T1), week 12 (T2), and week 14 (T3) for follow-up assessment. Kruskal Wallis tests was used for data analysis. Results: BFI scores were significantly lower in the MBSR, PMR groups compared with the CG at T2 and at T3 (p &lt; .01). As for FLIC scores, there were no significant differences between the study groups at T2 and at T3 (p &gt; 0.05). Conclusions: A brief, MBSR and PMR initiated concurrently with adjuvant paclitaxel regimen decreased fatigue severity. Based on the results, MBSR and PMR can be recommended as supportive therapies for breast cancer patients receiving adjuvant paclitaxel.

Effects of magnanimous therapy on coping, adjustment, and living function in advanced lung cancer.

We examined the effects of magnanimous therapy on psychological coping, adjustment, living function, and survival rate in patients with advanced lung cancer. Patients with advanced lung cancer (n = 145) matched by demographics and medical variables were randomly assigned to an individual computer magnanimous therapy group (ic-mt), a group computer magnanimous therapy group (gc-mt), or a control group (ctrl). Over 2 weeks, the ic-mt and gc-mt groups received eight 40-minute sessions of ic-mt or gc-mt respectively, plus usual care; the ctrl group received only usual care. The Cancer Coping Modes Questionnaire (ccmq), the Psychological Adjustment Scale for Cancer Patients (pascp), and the Functional Living Index-Cancer (flic) were assessed at baseline and 2 weeks later. The relationships of changes in those indicators were analyzed, and survival rates were compared. The psychological coping style, adjustment, and living function of the ic-mt and gc-mt groups improved significantly after the intervention (p < 0.01). After 2 weeks, significant (p < 0.01) differences between the treatment groups and the ctrl group in coping style, adjustment, and living function suggested successful therapy. The changes in living function were correlated with changes in psychological coping and adjustment. No difference in efficacy between ic-mt and gc-mt was observed. The survival rate was 31.84% in the ic-mt group and 9.375% in the ctrl group at 2 years after the intervention. In patients with advanced lung cancer, ic-mt and gc-mt were associated with positive short-term effects on psychological coping style, adjustment, and living function, although the magnitude of the effect did not differ significantly between the intervention approaches. The effects on living function are partly mediated by improvements in psychological coping and adjustment.

Functional Status and Associated Factors in Patients with Colon Cancer Receiving Chemotherapy

Background: Patients with colon cancer are at risk of developing functional impairment. However, studies on functional status in this population are limited. Objectives: The aim of this pilot study was to evaluate the functional status in patients with colon cancer and determine its association with sociodemographic and disease-related characteristics and perceived family support. Methods: This cross-sectional study included 30 patients (53.3% males) with colon cancer who were followed up by an oncology outpatient clinic in a military hospital in Turkey. Data were collected using a personal data form, the Functional Living Index-Cancer (FLIC), and the Cancer Patient Social Support Scale. Results: The total mean FLIC score of the patients was 112.9 ± 22.4. Female gender and lower levels of family support were associated with poorer functional status (P < 0.05). Conclusions: The functional status of the patients was higher than the moderate level. A greater understanding of factors associated with functional status in patients with colon cancer could provide appropriate interventions to support functional performance and improve health outcomes. Keywords: Colon Cancer; Family Support; Functional Status

Breast Cancer EDGE Task Force Outcomes: Clinical Measures of Health Related Quality of Life

Background: Health related quality of life (HRQOL) is a broad multidimensional concept that usually includes subjective evaluations of both positive and negative aspects of life and has been extensively studied in the breast cancer population. The purpose of this review was to identify evidence-based HRQOL assessment tools found in breast cancer research using the methodology of the Oncology Section Cancer EDGE Task Force. Methods: The authors systematically reviewed the literature for outcome measures used to assess HRQOL in published research involving women diagnosed with breast cancer. The goal was to examine the psychometric properties of commonly used HRQOL measures in order to determine their clinical utility. Results: European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) - Breast 23, BREAST-Q, Functional Assessment of Cancer Therapy (FACT) - Breast, FACT-B+4, EORTC QLQ - Cancer 30, FACT-General, Functional Living Index-Cancer, Ferrans and Powers Quality of Life Index-Cancer Version, Psychological Adjustment to Illness Scale, World Health Organization Quality of Life, and SF-Health Surveys, were highly recommended by the Task Force. Conclusions: A variety of outcome measures have been reported in the literature to assess HRQOL in women diagnosed with breast cancer. Eleven measures were found to have satisfactory psychometric properties and are recommended for clinical use by the researchers on this Task Force.

Quality of life and brain tumors: what beyond the clinical burden?

This study analyzed the subjective facets of quality of life (QoL) and their relation to the type of brain tumor (BT) and phase of disease. Two hundred and ninety-one patients with pinealoblastoma, medulloblastoma, low-grade glioma, anaplastic astrocytoma, or glioblastoma were evaluated. With respect to 110 healthy controls, patients in the phases of radiotherapy/chemotherapy, stable disease, or tumor recurrence were significantly more anxious and depressed compared with patients in the early postoperative period. All patients were impaired in mental flexibility and memory, with preservation of abstract reasoning. The Functional Living Index-Cancer (FLIC), previously validated in cancer and BT patients, yielded six subjective factors (disease perception, affective well-being, role and leisure, personal base, nausea, sharing). None of the FLIC factors were predicted by tumor type, which only related to the physical and cognitive performances and mood scores. Affective well-being, role and leisure, and sharing were predicted by the phase of disease. Personal base, including self-perception and confidence, was independent on tumor progression and treatment. To conclude, QoL encompasses different subjective aspects, which vary in relation to the phase of disease and clinical burden. However, some person-related facets appear independent on tumor progression and treatment, indicating individual resources. Knowing this may guide tailored interventions supporting QoL.

Functional Status in Turkish Women with Gynecological Cancer

Functional status is the ability to perform daily activities. Little is known about quality of life and health status of gynaecological cancer patients. The present study therefore aimed to evaluate the functional status of women receiving treatment for gynecological oncological disease while not hospitalised. This descriptive study covered 42 patients monitored by the Gynecological Oncology Unit in 2011. Data were collected using the Functional Living Index-Cancer and analysed with the chi square test, independent samples t-test, Mann-Whitney U test, one-way ANOVA test and the Kruskal-Wallis H test. Of the 42 cases, 66.7% had been diagnosed within the previous year and 90.5% were undergoing chemotherapy. The most severe symptoms experienced were pain (35.7%), fatigue-weakness (40.5%) and nausea and vomiting (56.5%). Daily activities where the most difficulty was experienced were housework (28.6%), average pace walking (31.0%), carrying more than 5 kg (28.6%). The mean Functional Living Index score was quite high (103.5 ± 24.1). FLIC-C scale scores did not vary with the educational status, diagnosis duration, and family history of cancer (p>0.05). Evaluation of the functional status of gynecological cancer patients and how they cope with problems should indicate to healthcare professionals what help can be given to maintain quality of life.

The Functional Living Index-Cancer is a reliable and valid instrument in Chinese cancer patients

To evaluate the linguistic and psychometric properties of the Functional Living Index-Cancer (FLIC) in assessing the quality of life of Chinese cancer patients. The English FLIC was translated into Traditional Chinese by the standard forward-backward procedure. After cognitive debriefing, a Traditional Chinese FLIC was administered to 500 cancer patients in a major public hospital in Hong Kong. Of which, 200 were invited to complete the questionnaire in 2weeks. To identify a scale structure appropriate to Chinese, exploratory and confirmatory factor analyses were performed on two randomly split halves of the sample. We identified five scales of the Traditional Chinese FLIC which assess the physical, psychological, hardship, nausea and social aspects. These five scales and the overall scale demonstrated satisfactory fit and had the alpha coefficient ranged from 0.68 to 0.92. The intra-class correlation coefficient ranged from 0.67 to 0.88. In addition, all FLIC scales were negatively associated with the Eastern Cooperative Oncology Group performance status and, also except for the psychological scale, had lower scores in patients who were treated by chemotherapy. The Traditional Chinese FLIC is an appropriate health indicator for Chinese cancer patients.

Optimism, mental health, and quality of life: A study among breast cancer patients

Fifty one breast cancer patients participated in a cross-sectional study developed to assess the relation between their level of optimism, positive and negative mental health, and their quality of life. Patients were measured with the Life Orientation Test (LOT), the Center for Epidemiological Studies Depression Scale (CES-D), and the Functional Living Index-Cancer (FLIC). T-tests revealed that these breast cancer patients reported more optimism than pessimism, more positive than negative mental health, and the majority of the sample reported doing well on each qualify life domain of the FLIC. As expected, individuals who reported more depressive symptoms also reported less qualify of life. Breast cancer patients who scored lower on pessimism showed more positive mental health, but they showed no relation to negative mental health. Women who scored higher on optimism reported better social and mental functioning on the FLIC than women who scored low on optimism.

Translation and validation of Korean Functional Assessment of Cancer Therapy-Esophageal (FACT-E) scale with squamous cell carcinoma and chemoradiation-only patients

The Functional Assessment of Cancer Therapy-Esophageal (FACT-E) Scale version 4 has been used to assess quality of life in patients with squamous cell carcinoma undergoing chemoradiation. We sought to determine whether this scale can be used to assess quality of life in Korean patients with esophageal cancer undergoing chemoradiation. The FACT-E scale version 4 was cross-culturally translated into Korean. Its reliability and validity were assessed in a group of 146 esophageal cancer patients who were scheduled for neoadjuvant chemoradiation (CRT). This procedure was followed by esophagectomy that took place between 2007 and 2010 at Asan Medical Center. All patients completed the FACT-E, Hospital Anxiety and Depression Scale (HADS) and Functional Living Index-Cancer (FLIC) questionnaires at baseline (pre-treatment) and 1month after two cycles of induction chemotherapy followed by CRT. In validating the FACT-E, we found high internal consistency coefficients ranging from 0.72 to 0.91. Good convergent and divergent validities were demonstrated by the FLIC and HADS scales. The FACT-E showed good clinical validity and effectively differentiated between patient groups with different performance status ratings and stages. Changes in clinical status were reflected by changes in FACT-E scores, demonstrating responsiveness to neoadjuvant CRT. The FACT-E has been shown to be a reliable and valid instrument that can now be used to prospectively evaluate the quality of life of Korean patients with esophageal cancer.

Changes in quality of life among newly diagnosed breast cancer patients in Taiwan

To examine changes in quality of life among patients with breast cancer and factors related to it, during the first three months after diagnosis. Numerous studies have examined quality of life among cancer survivors or among patients with cancer after aggressive treatment; such research has demonstrated that quality of life in the third month after surgery can significantly predict quality of life in the long run. In contrast, changes in quality of life causes among patients during the acute treatment phase have not been well studied. Prospective longitudinal study. Newly diagnosed patients with breast cancer were recruited during 2008-2009. Sixty-one cases completed the four data collections on the day before operation and one, two and three months after surgery. Data were collected using the Functional Living Index-Cancer, Symptom Distress Scale, the Self-Efficacy Scale and a 0-10 Anxiety Numeric Rating Scale. Generalized Estimating Equations were applied for data analysis. There were significant changes in quality of life over the three months following surgery, and the worst quality of life was observed in the first month after surgery. Less advanced stages of cancer, lower anxiety, less symptom distress and higher perceived self-efficacy in the preoperative interview could significantly predict which patients experienced more positive quality of life trends. Fatigue, limited shoulder function and perceived poor appearance were the most significant factors predicting changes of quality of life. Preoperative physical and psychological factors, as well as sense of self-efficacy for managing the cancer, are important factors for predicting changes in patients' quality of life. Healthcare providers should be alert to factors contributing to changes of quality of life among patients receiving chemotherapy. Interventions based on these results should be developed and their effectiveness tested for their impact on breast cancer patients' quality of life. Clinical interventions based on these results should be developed to improve breast cancer patients' quality of life.

Home care—a safe and attractive alternative to inpatient administration of intensive chemotherapies

The objective of this study was to evaluate feasibility, safety, perception, and costs of home care for the administration of intensive chemotherapies. Patients receiving sequential chemotherapy in an inpatient setting, living within 30 km of the hospital, and having a relative to care for them were offered home care treatment. Chemotherapy was administered by a portable, programmable pump via an implantable catheter. The main endpoints were safety, patient's quality of life [Functional Living Index-Cancer (FLIC)], satisfaction of patients and relatives, and costs. Two hundred days of home care were analysed, representing a total of 46 treatment cycles of intensive chemotherapy in 17 patients. Two cycles were complicated by technical problems that required hospitalisation for a total of 5 days. Three major medical complications (heart failure, angina pectoris, and major allergic reaction) could be managed at home. Grades 1 and 2 nausea and vomiting occurring in 36% of patients could be treated at home. FLIC scores remained constant throughout the study. All patients rated home care as very satisfactory or satisfactory. Patient benefits of home care included increased comfort and freedom. Relatives acknowledged better tolerance and less asthenia of the patient. Home care resulted in a 53% cost benefit compared to hospital treatment (€420 ± 120/day vs. €896 ± 165/day). Administration of intensive chemotherapy regimens at home was feasible and safe. Quality of life was not affected; satisfaction of patients and relatives was very high. A psychosocial benefit was observed for patients and relatives. Furthermore, a cost-benefit of home care compared to hospital treatment was demonstrated.

The Functional Living Index-Cancer: estimating its reliability based on clinical trial data

The Functional Living Index-Cancer was developed to measure quality of life in cancer trials as an adjunct to the usual clinical outcomes. The scale is considered conceptually good, since it covers a broad range of relevant aspects of quality of life, but the main criticism has been that its reliability has never been properly investigated. In this paper, we investigate the reliability of the FLIC. We apply a new methodology based on linear mixed models that allows estimating reliability from real clinical data. The reliability of the FLIC is estimated using data coming from a longitudinal study in breast cancer. With this new approach, we avoid the need for additional data collection on which classical reliability studies are based. The average reliability of the FLIC over the repeated measurements is satisfactory, even though the initial measurement in the study showed a somewhat lower value. Taking into account the longitudinal character of the measurements, we show that highly reliable information can be obtained with a relatively small number of measurements per patient. The FLIC provides reliable quality of life measurements in patients with breast cancer. Additional studies would be welcome to validate these results in other populations.