**6. Family caregivers for home care recipients with advanced non-cancer diseases**

Conditions as congestive heart failure, end-stage renal disease, chronic obstructive pulmonary disease, liver failure and dementia represent the non-malignant lifethreatening illnesses which require a complex home care. The different trajectories of functional decline are useful for the home care providers, helping them to tailor strategies and make a better plan of care. Lunney identified four theoretical trajectories of chronic illnesses: sudden death, cancer death or terminal phase, death from organ failure and frailty and dementia [81]. In cancer, the clinical status of the patients is acceptable until the disease does not respond to the treatment and the rapid decline makes easier to predict the terminal stage. In non-oncological chronic diseases, the trajectory is different with several deteriorations and improvements of the clinical state and a slow decline line. In dementia or general frailty, the illness trajectory has a gradual and prolonged decline. The trajectory of renal failure disease may be that of a steady decline, with the rate of this decline varying according to the underlying renal pathology and other comorbidities [82]. Sometime the issues of caring for patients with non-oncological illnesses is more difficult than for patients with cancer because the prevalence of symptoms is higher and there is a prolonged trajectory of decline.

Patients with non-oncological illnesses as opposed to patients with cancer are older and have many comorbidities and cognitive impairment. The barriers in home care assistance for the recipients with non-cancer illnesses include less predictable trajectory, the lack of knowledge regarding the care needs of end-stage period, the low use of and late referral to palliative care [83], the possible overwhelm of the palliative care services, the necessity of knowledge in different specialties and the necessity of training in the areas of symptom control [84], and prognostication in non-malignant disease tends to be less accurate than in cancer [85]. These recipients require a multidisciplinary home care team, because they have a multidimensional area of caring. The involvement of the family caregivers is valuable and implies management of digestive problems, balance of fluid and food intake, nutritional status and care of bedsores. Needs such as: fall risks, self-care capacity, instrumental activities of daily living, dementia, fecal and urinary incontinence are difficult to solve [86]. Compared with cancer patients, the non-malignant patient's needs are more complex: moderate and severe neurological issues, psychiatric problems, needs for assistance with defecation and bladder function and moderate and severe deterioration of vigilance (somnolent and comatose) [87]. A higher proportion of non-cancer patients was discharged and died at home, and the proportion of readmitted patients to the hospital was less than for oncological patients [87].
