Abstract
Purpose
The purpose of this population-based study was to examine health-related quality of life (HRQOL) and functional status among breast cancer survivors with heart failure.
Methods
We examined Medicare Health Outcomes Survey data from women aged 65 and older diagnosed with breast cancer in the past 5 years. Surveys were linked to Surveillance, Epidemiology, and End Results cancer registries. Each woman identified with self-reported heart failure (n = 239) was matched to controls without heart failure (n = 685) using propensity scores. The Short Form-36/Veterans Rand-12 measured eight domains of HRQOL. Functional status impairment was measured by limitations in six activities of daily living (ADLs). Linear models estimated associations between heart failure status and HRQOL. Logistic regression models estimated odds ratios for associations between heart failure and ADL impairment. We examined associations for the total study population and subgroups stratified by cancer stage.
Results
Among all study participants, heart failure was associated with significant deficits in every HRQOL domain and impairment in all ADLs (p < 0.01, ORs ranged from 1.74 to 2.47). After stratification by cancer stage, heart failure was associated with physical HRQOL deficits across all cancer stages (physical function, vitality, general health) and mental HRQOL deficits only in women with stage I/II cancer (role-emotional, social function). Women with early stage cancer experienced the greatest HRQOL deficits associated with heart failure.
Conclusions
Heart failure in breast cancer survivors is associated with substantial HRQOL deficits and functional status impairment, particularly in early stage cancer. Tailored interventions are needed to improve physical function and mental wellbeing in this high-risk population.
Similar content being viewed by others
References
DeSantis C, Lin C, Mariotto A et al (2014) Cancer treatment and survivorship statistics, 2014. CA Cancer J Clin 64(4):252–271
Fallowfield L, Jenkins V (2015) Psychosocial/survivorship issues in breast cancer: are we doing better? J Natl Cancer Inst 107(1):335. doi:10.1093/jnci/dju335
Mozaffarian D, Benjamin EJ, Go AS et al (2015) Heart disease and stroke statistics—2015 update. Circulation 131(4):29–322
Schmitz KH, Prosnitz RG, Schwartz AL, Carver JR (2012) Prospective surveillance and management of cardiac toxicity and health in breast cancer survivors. Cancer 118(SUPPL.8):2270–2276
Vogeli C, Shields AE, Lee TA et al (2007) Multiple chronic conditions: prevalence, health consequences, and implications for quality, care management, and costs. J Gen Intern Med 22:391–395. doi:10.1007/s11606-007-0322-1
Carver JR, Shapiro CL, Ng A et al (2007) American society of clinical oncology clinical evidence review on the ongoing care of adult cancer survivors: cardiac and pulmonary late effects. J Clin Oncol 25(25):3991–4008 http://jco.ascopubs.org/content/25/25/3991.full.pdf
Goodlin S, Wingate S, Albert N et al (2012) Investigating pain in heart failure patients: the pain assessment, incidence, and nature in heart failure (PAIN-HF) study. J Card Fail 18(10):776–783
Lee KS, Song EK, Lennie TA et al (2010) Symptom clusters in men and women with heart failure and their impact on cardiac event-free survival. J Cardiovasc Nurs. 25(4):263–272. doi:10.1097/JCN.0b013e3181cfbb88
Pressler SJ, Subramanian U, Perkins SM et al (2011) Measuring depressive symptoms in heart failure: validity and reliability of the patient health questionnaire-8. Am J Crit Care 20(2):146–152. doi:10.4037/ajcc2010931
Pressler S, Subramanian U, Kareken D et al (2010) Cognitive deficits and health-related quality of life in chronic heart failure. J Cardiovasc Nurs. 25(3):189–198
Tang W, Yu C, Yeh S (2010) Fatigue and its related factors in patients with chronic heart failure. J Clin Nurs 19(1–2):69–78. doi:10.1111/j.1365-2702.2009.02959.x
Tymkew H, Templin L (2011) Patients with chronic obstructuve pulmonary disease or congested heart failure in a home health setting are at a high fall risk: a descriptive study. Am Phys Ther 22(4):25
Heo S, Doering LV, Widener J, Moser DK (2008) Predictors and effect of physical symptom status on health-related quality of life in patients with heart failure. Am J Crit Care 17(2):124–132
Juenger J, Schellberg D, Kraemer S et al (2002) Health related quality of life in patients with congestive heart failure: comparison with other chronic diseases and relation to functional variables. Heart 87(3):235–241
Harrison JM, Pressler SJ, Friese CR (2016) Cardiotoxic heart failure in breast cancer survivors: a concept analysis. J Adv Nurs 72(7):1518–1528. doi:10.1111/jan.12988
Harris DJ, Douglas PS (2000) Enrollment of women in cardiovascular clinical trials funded by the National Heart, Lung, and Blood Institute. N Engl J Med 343(7):475–480. doi:10.1097/00006254-200101000-00022
Heiat A, Gross CP, Krumholz HM (2002) Representation of the elderly, women, and minorities in heart failure clinical trials. Arch Intern Med 162(15):1682–1688. doi:10.1001/archinte.162.15.1682
Heo S, Moser DK, Pressler SJ, Dunbar SB, Mudd-Martin G, Lennie TA (2014) Psychometric properties of the symptom status questionnaire-heart failure. J Cardiovasc Nurs:1–9. doi:10.1097/JCN.0000000000000102
Wenger NK (2002) Women, heart failure, and heart failure therapies. Circulation 105(13):1526–1528. doi:10.1161/01.CIR.0000014121.94868.81
Clauser SB, Haffer SC (2008) SEER-MHOS: a new federal collaboration on cancer outcomes research. Health Care Financ Rev. 29(4):1–4
SEER-Medicare Health Outcomes Survey (SEER-MHOS) Linked Database: MHOS Survey Instruments. Natl Cancer Inst. 2016. http://healthcaredelivery.cancer.gov/seer-mhos/.
Stover AM, Mayer DK, Muss H, Wheeler SB, Lyons JC, Reeve BB (2014) Quality of life changes during the pre- to postdiagnosis period and treatment-related recovery time in older women with breast cancer. Cancer 120(12):1881–1889. doi:10.1002/cncr.28649
Alberg AJ, Singh S (2001) Epidemiology of breast cancer in older women: implications for future healthcare. Drugs Aging 18(10):761–772
Ballinger RS, Fallowfield LJ (2009) Quality of life and patient-reported outcomes in the older breast cancer patient. Clin Oncol 21(2):140–155. doi:10.1016/j.clon.2008.11.003
Hansen BB, Klopfer SO (2006) Optimal full matching and related designs via network flows. J Comput Graph Stat 15(3):609–627
R Development Core Team:R. A language and environment for statistical computing. 2010. http://www.r-project.org.
Turner-Bowker D, Bartley P, Ware J (eds) (2002) SF-36VR health survey & “SF” bibliography: third edition (1988–2000). Quality-Metric, Inc., Lincoln, RI
Iqbal SU, Rogers W, Selim AJ, et al. The Veterans Rand 12 Item Health Survey (VR-12): What It Is and How It Is Used.; 2008. http://www.hosonline.org/globalassets/hos-online/publications/veterans_rand_12_item_health_survey_vr-12_2007.pdf. Accessed March 18, 2016.
Fleishman JA, Selim AJ, Kazis LE (2010) Deriving SF-12v2 physical and mental health summary scores: a comparison of different scoring algorithms. Qual Life Res 19(2):231–241. doi:10.1007/s11136-009-9582-z
Hays RD, Farivar SS, Liu H (2005) Approaches and recommendations for estimating minimally important differences for health-related quality of life measures. COPD 2(1):63–67. doi:10.1081/COPD-200050663
Walsh EG, Nason CA, Moore A, Khatutsky G, Caswell C. Pilot Test of the Medicare Health Survey for PACE and EverCare: PACE Pilot Report. Baltimore, MD; 2003. http://www.rti.org/pubs/pilottestpace.pdf.
Kautter J, Pope GC (2004) CMS frailty adjustment model. Health Care Financ Rev 26(2):1–19
Quach C, Sanoff HK, Williams GR, Lyons JC, Reeve BB (2015) Impact of colorectal cancer diagnosis and treatment on health-related quality of life among older Americans: a population-based, case-control study. Cancer 121(6):943–950. doi:10.1002/cncr.29125
National Comprehensive Cancer Network. NCCN Practice Guidelines. 2016. https://www.nccn.org/professionals/physician_gls/f_guidelines.
Lenth RV (2001) Some practical guidelines for effective sample size determination. Am Stat 55(3):187–193. doi:10.1198/000313001317098149
Champely S, Ekstrom C, Dalgaard P, Gill J, Wunder J, Rosario H De. Package “pwr.” 2015. https://github.com/heliosdrm/pwr.
StataCorp. Stata Statistical Software: Release 14. 2015.
Bowers J, Fredrickson M, Hansen B. RITools: Randomized Inference Tools. 2016.
Seo Y, Roberts BL, Piña I et al (2008) Predictors of motor tasks essential for daily activities among persons with heart failure. J Card Fail 14(4):296–302. doi:10.1016/j.cardfail.2008.01.005
Rutledge T, Reis VA, Linke SE, Greenberg BH, Mills PJ (2006) Depression in heart failure. J Am Coll Cardiol 48(8):1527–1537. doi:10.1016/j.jacc.2006.06.055
Kissane DW, Grabsch B, Love A, Clarke DM, Blosch S, Smith GC (2004) Psychiatric disorder in women with early stage and advanced breast cancer: a comparative analysis. Aust N Z J Psychiatry 38(5):320–326. doi:10.1111/j.1440-1614.2004.01358.x
Kroenke K, Spitzer RL, Williams JBW (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16(9):606–613. doi:10.1046/j.1525-1497.2001.016009606.x
Lichtman JH, Bigger JT, Blumenthal JA et al (2008) Depression and coronary heart disease: recommendations for screening, referral, and treatment. Circulation 118(17):1768–1775. doi:10.1161/CIRCULATIONAHA.108.190769
Stover AM, Reeve BB, Piper BF et al (2013) Deriving clinically meaningful cut-scores for fatigue in a cohort of breast cancer survivors: a health, eating, activity, and lifestyle (HEAL) study. Qual Life Res 22(9):2279–2292. doi:10.1007/s11136-013-0360-6
Dunlay SM, Manemann SM, Chamberlain AM et al (2015) Activities of daily living and outcomes in heart failure. Circ Heart Fail 8(2):261–267. doi:10.1161/CIRCHEARTFAILURE.114.001542
Phelan EA, Williams B, Penninx BW, LoGerfo JP, Leveille SG (2004) Activities of daily living function and disability in older adults in a randomized trial of the health enhancement program. Journals Gerontol - Ser A Biol Sci Med Sci 59(8):838–843
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
This work was supported by funding from Rackham Graduate School at the University of Michigan and through resources supported by the University of Michigan Hillman Scholars Program.
Conflict of interest
The authors declare that they have no conflict of interest.
Protection of human subjects
The study protocol was reviewed and approved by the University of Michigan Institutional Review Board—Health Sciences and Behavioral Sciences, protocol number HUM00102037. The final results do not include any data that could be used to identify patients.
Informed consent
For this retrospective study, formal consent was not required.
Rights and permissions
About this article
Cite this article
Harrison, J.M., Davis, M.A., Barton, D.L. et al. Functional status and quality of life among breast cancer survivors with heart failure: results of the Medicare Health Outcomes Survey. Support Care Cancer 25, 2463–2473 (2017). https://doi.org/10.1007/s00520-017-3653-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-017-3653-4