Quality of life for oncology patients during the terminal period. Validation of the HRCA-QL index.
OBJECTIVE
The evolution of performance status, disability, and quality of life (QL) according to the Hebrew Rehabilitation Center for Aged QL (HRCA-QL) index for cancer patients through their terminal period is described. The assessment of HRCA-QL validity and reliability is also described.


METHODS
A total of 200 cancer patients were followed up from the onset of their "terminal phase" until they died. Information on symptoms, performance, disability and QL were collected by patient's oncologists in hospital and by their family practitioners and community nurses when the patient was at home. Health measures were: the HRCA-QL index, Karnofsky performance status (KPS) and the Independence in Activities of Daily Living (IADL) index.


RESULTS
The three indices were acceptable for a fair number of patients at the start of the terminal phase. Almost two-thirds had a KPS > or =60. With respect to the IADL index, the patients were independent in five of the six functions, with 80% having a HRCA-QL equal to or greater than 4. The median duration of the terminal period was 59 days. All three indices declined progressively, with marked deterioration in the last 2 weeks. The HRCA-QL index was highly correlated with KPS and the IADL index, had good internal consistency and showed an acceptable test-retest and inter-rater reliability. The HRCA-QL index was reactive to clinical changes.


CONCLUSIONS
All three scales confirmed that terminal patients experience a progressive loss of performance, increase in dependence and deterioration of QL as they approach the end of life. Based in these results, we consider the HTCA-QL index valid for use in terminal cancer patients.
Llobera
Joan
J
Department of Evaluation and Accreditation, Conselleria de Salut i Consum, Balears, C/Cecili Metel 18, 07003 Palma de Mallorca, Spain. jllobera@dgaval.caib.es
Esteva
Magdalena
M
Benito
Enric
E
Terrasa
Josefa
J
Rifà
Juli
J
Pons
Onofre
O
Maya
Ascensión
A
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D011788:Quality of Life; D015203:Reproducibility of Results; D012107:Research Design; D012680:Sensitivity and Specificity; D013030:Spain; D016019:Survival Analysis; D013727:Terminal Care / Q000379:methods / Q000592:standards*; D019452:Terminally Ill / Q000523:psychology*; D013997:Time Factors