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S Bordonaro,1 F Romano,1 E Lanteri,1 F Cappuccio,1 R Indorato,2 A Butera,2 A D’Angelo,3 F Ferraù,3 P Tralongo11Medical Oncology Unit, Umberto I Hospital, Rete Assistenza Oncologica, Siracusa, 2Medical Oncology Unit, S Giovanni di Dio Hospital, Agrigento, 3Medical Oncology Unit, S Vincenzo Hospital, Taormina, ItalyIntroduction: The advent of oral chemotherapy agents has had a strong impact on several aspects of the management of cancer patients, including survival rates, health-care expenditure, and health-related quality of life. However, access to care and adherence to oral chemotherapy are central to optimal outcomes.Patients and methods: In this multicenter observational study, we assessed the effect of the “Active Home Care” initiative – a structured, active, home-based cancer-treatment program – on quality of life, health-care utilization, and patient adherence and satisfaction using self-administered questionnaires. Sixty-two patients treated with oral chemotherapy (capecitabine, vinorelbine, imatinib, sunitinib, sorafenib, temozolomide, ibandronate) were enrolled in the program. Weekly home visits were scheduled, each one with a trained nurse who delivered the home-based chemotherapy and reviewed patients’ compliance and treatment toxicity. An oncologist evaluated patients and modified the dosage of oral chemotherapy based on toxicity reported during the previous cycle at bi-weekly visits.Results: A total of 460 home visits were performed between April 2012 and February 2013. The Active Home Care initiative was associated with significant improvements in physical functioning and symptoms, and reductions in the access to cancer facilities. Satisfaction with oral chemotherapy and care received was high. All patients reported having taken their medications according to their prescription, and no patient reported difficulties in managing the oral chemotherapy regimen. Conclusion: The Active Home Care program was associated with improvements in the quality of life of patients and caregivers, better adherence to treatment, and the effective management of therapy and cancer-related symptoms. Home-based cancer treatment may also optimize the utilization of health-care resources.Keywords: advanced cancer, home-based care, quality of life, adherence, patient satisfaction, effective therapy management

Sebastiano Bordonaro Fabio Raiti, Annamaria Di Mari, Calogera Lopiano, Fabrizio Romano, Vitalinda Pumo, Sebastiano Rametta Giuliano, Margherita Iacono, Eleonora Lanteri, Elena Puzzo, Sebastiano Spada, Paolo TralongoUOC Medical Oncology, RAO, ASP 8 Siracusa, ItalyBackground: Active home-based treatment represents a new model of health care. Chronic treatment requires continuous access to facilities that provide cancer care, with considerable effort, particularly economic, on the part of patients and caregivers. Oral chemotherapy could be limited as a consequence of poor compliance and adherence, especially by elderly patients.Methods: We selected 30 cancer patients referred to our department and treated with oral therapy (capecitabine, vinorelbine, imatinib, sunitinib, sorafenib, temozolomide, ibandronate). This pilot study of oral therapy in the patient’s home was undertaken by a doctor and two nurses with experience in clinical oncology. The instruments used were clinical diaries recording home visits, hospital visits, need for caregiver support, and a questionnaire specially developed by the European Organization for Research and Treatment of Cancer (EORTC), known as the QLQ-C30 version 2.0, concerning the acceptability of oral treatment from the patient’s perspective.Results: This program decreased the need to access cancer facilities by 98.1%, promoted better quality of life for patients, as reflected in increased EORTC QLQ-C30 scores over time, allowing for greater adherence to oral treatment as a result of control of drug administration outside the hospital. This model has allowed treatment of patients with difficult access to care (elderly, disabled or otherwise needed caregivers) that in the project represent the majority (78% of these).Conclusions: This model of active home care improves quality of life and adherence with oral therapy, reduces the need to visit the hospital, and consequently decreases the number of lost hours of work on the part of carers. Management of the service by the professionals involved revealed excellent control of the process by nursing staff, with minimal visits involving doctors.Keywords: cancer, treatment, home-based, quality of life, compliance

Vitalinda Pumo, Gabriella Milone, Margherita Iacono, Sebastiano Rametta Giuliano, Annamaria Di Mari, Calogera Lopiano, Sebastiano Bordonaro, Paolo TralongoMedical Oncology Unit, Rete Assistenza Oncologica, Siracusa, ItalyBackground: The progressive increase in the number of patients surviving long term after a diagnosis of malignant disease has led to a focus on the early and late complications of the disease and its treatment. The aim of this study was to investigate the prevalence of complications which may worsen quality of life and shorten long-term survival.Methods: We identified 306 cancer patients who had been disease-free without treatment for at least three years. Of these, 167 with breast cancer were enrolled in this study. A detailed questionnaire-based interview was undertaken to investigate the characteristics of the patients (age, gender, marital status, education), the tumor (date of diagnosis, histology), and treatment. We also used the Beck Depression Inventory to screen for depression, Spitzer’s Quality of Life Index to assess quality of life, and the International Index of Erectile Function and the Female Sexual Function Index to get precise information on sexual function.Results: Psychological effects were reported by 121 (72.4%) subjects. Sexual disorders were identified in 60 (35.9%) subjects. A correlation between frequency of psychological disorders and severity of sexual disorders was reported. The proportion of psychological disorders was higher in younger patients, those who were married, and those with low education.Conclusion: In survivors of breast cancer, the incidences of psychological and sexual affective disorders are significant and frequently correlated, resulting in diminished quality of life.Keywords: psychological, sexual, disorders, survivors, breast cancer