Assessment of the quality of life of patients with advanced and end-stage cancer or serious infections with a symptom-based or an impact-based instrument

In 1992 a project was started in which home care technology was made availa ble to patients with cancer or serious infections. Primary care providers w ere trained and supported to administer parenteral drugs and fluids in the home setting. Between 1992 and 1995 we applied the Rotterdam Symptom Checkl ist (RSCL) and the Sickness Impact Profile (SIP) as questionnaires for qual ity of life (QoL) assessment in a group of 112 hospitalized patients who we re prepared to receive further treatment at home. Scores on the RSCL reveal ed a high level of symptomatology in both the physical and the psychologica l dimension. Factor analysis showed a five-factor rather than a two-factor structure. The SIP showed considerable restrictions in daily living, partic ularly in the physical dimension. Whereas the RSCL and the SIP correlated w ell in the psychological and physical dimensions in advanced cancer patient s, this correlation disappeared in the group of endstage cancer patients, T he data indicate that the health-related QoL of end-stage cancer patients c annot be reliably be assessed with a symptom-based instrument alone; it nee ds to be supplemented by other instruments, such as the SIP.