Abstract

Many patients suffering from pancreatic cancer undergo a pancreato-duodenectomy (PD), but the survival rate is low, and post-operative daily activity is difficult. The purposes of this study were to investigate : 1) The relationship between the subjective and objective evaluations of quality of life (QOL) using two scales ; and 2) The factors which influence QOL of the post-operative pancreatic carcinoma patient.

The subjects were 23 PD patients who survived for 1 to 19 years. We visited the patients' homes to interview them and to administer a Quality of Life Index survey Cancer Version (QLI-CV, Ferrans & Powers) and a questionnaire about daily life after the operation. The Performance Status Scale survey (PS) was filled out by two visiting nurses. The QLI survey was administered to establish a subjective index of QOL, whereas the PS survey was filled out by the nurses to establish an objective index. We used these indices to evaluate QOL within the framework outlined by the answers to questions about daily life after the operation.

The results were : 1) The QLI scores exhibited hardly any variation regardless of the extent of the operation ; 2) The QLI scores didn't correspond with the PS scores ; 3) Of the factors included in the questionnaire, the six which most influenced the QLI scores in order of influence were : patient had diarrhea or not ; patient could leave home or not ; age ; patient could cook or not ; marital status ; and patient was aware of their cartinoma diagnosis or not.

After PD the patients' QOL was good even when further digestive organs' disorders remained. Since of the six factors mentioned above three were closely ralated to family relationship, we believed more detailed reseach is needed in the area of family support.

Abstract

This article presented the findings of survey carried out to elucidate the problems of introducing a home-based care system at Kanagawa Cancer Center. The study population consisted of 57 patients with cancer who received continued nursing at home between April 1991 and March 1993. There was no differences between the patients and the total number of discharged patients in regard to age and cancer site.

The findings were : (1) The bad activities of daily life in the surveyed patients were 30-50% for excretion, bathing, clothing, and moving. (2) Ninety percent of the patients were able to eat unaided. (3) The percentage of patients who were single was 17.5%. (4) Apart from medical care, the aid most frequently desired by the patient was related the absence of attendant at home and the structure of their homes (toilet, stairs, bathroom, etc). (5) For medical care aid, the need for stoma supervision, balloon catheter supervision, IVH supervision, or oxygen supervision at home was expressed by 5-10% of the patients. (6) The prognostic factors determined by Cox's proportional hazard model for the patients were metastasis, history of hypertension, history of operation, history of pain supervision, history of IVH supervision, history of oxygen requirement at home and old age.

On the basis of these findings, the conclusion of this survey was that the participation of physicians and nurses employed by the clinic is indispensable for introduction of a home -based care system operated by a hospital that specializes in cancer treatment. It is necessary to develop guidelines that take into account factors other than prognosis for evaluation of the efficacy of the home care and for evaluation of the quality of life of the patients receiving the care.