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Predicting the survival of terminally ill cancer patients can help in informing patients and their families, in programming therapy and assistance models, and in utilising existing resources correctly. Clinical prediction of survival (CPS) and Karnofsky performance status (KPS) are two factors which have already been described in the literature. The aim of our study was to verify their respective predictive value with regard to actual survival. In our study of 100 consecutive patients, the CPS obtained a higher prediction accuracy than that reported previously (correlation coefficient with actual survival = 0.51) and than that obtained with KPS alone (correlation coefficient = 0.37). The median difference between predicted and expected survival was only 1 week. The resultant predictivity could be further improved by integrating other prognostic factors studied in larger prospective, multicentric studies.

Home care (HC) was created and developed in Romagna, as in other parts of Italy, thanks to the endeavor of a private Institution, the « Istituto Oncologico Romagnolo ». The care Is gratis to advanced cancer patients and is based on the palliative philosophy of treatment of the symptoms and the person within the framework of continuity of care permitted by the oncologic approach. To evaluate the intensiveness of the operation in terms of medical and nursing care by means of quantitative indexes, we examined several variables which emerged from a retrospective analysis of our case study. The average duration of care of the 484 patients in the program as of 31 December 1990 was 84.1 days. Four hundred and twenty-three patients of the 484 (87.1 % of the total) have died and 61 were still in the HC program at the time of this analysis. The 61 living patients were thus excluded from the descriptive analysis to give greater homogeneity to the study group. The average duration of care for the 423 decreased patients was 68.1 days. Out of a total of 28,759 days of HC for the entire group, the patients actually spent 23,534 days (81.8 %) at home. The average duration of hospitalization was 13.5 days, and in 33.2% of the cases it was motivated by psychologic and family causes. The place of death was the home in 44.3 % of the cases. A medical or nursing visit was made at the home every 1.4 days, and the average number of visits per patient was 39.0. Although none of the indexes alone can give overall indications of the intensiveness of a HC service, they may constitute a working proposal for the definition of the most objective criteria possible for the quantitative evaluation of such experiences.