The increasing prevalence of cancer patients under treatment and the trend toward """"""""dehospitalization"""""""" of care will lead to more people receiving care outside of the protective environment of the hospital. How patients are affected by this trend and how well the community support system meets the demands of these patients is an important issue for the present and the future. Demands (needs) for assistance at home arise due to patients' inability to meet their daily living and treatment-related needs independently. The overall goal of the proposed project is to describe and analyze the home care needs and services used by cancer patients with recurrent or metastatic cancer who are initiating chemotherapy or radiation therapy in three different areas of the Northeastern United States. Patients receiving treatment in a rural (Central Pennsylvania) an urban (New York City) and statewide (Rhode Island) setting will be assessed. Within the context of a longitudinal interview, service tracking, and telephone generated service diary data collection effort, patients' needs and their correlates will be described. In addition, we will; describe changes in patients (N=650) needs over the course of the six month post-treatment initiation period test whether increases in patients' needs are mirrored in increases in the level and intensity of services provided; test a model of the determinants of patients' needs, adequacy of care, and the use of formal agency services; describe the extent of emotional and socio-economic burden experienced by families (N=650) providing care to patients and how the prevelence and intensity of burden changes in relation to progression of disease and anti-tumor treatment; and test the extent to which levels of patient and caregiver burden place patients at risk of inadequate care and whether this relationship is modified by the introduction of formal home care services. The policy implications of study findings will be examined in the light of current public and private insurance reimbursement for home care services with specific reference to those types of services that are most needed by the cancer patient population.
