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Symptom Burden, Depression, and Spiritual Well-Being: A Comparison of Heart Failure and Advanced Cancer Patients

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ABSTRACT

BACKGROUND

A lower proportion of patients with chronic heart failure receive palliative care compared to patients with advanced cancer.

OBJECTIVE

We examined the relative need for palliative care in the two conditions by comparing symptom burden, psychological well-being, and spiritual well-being in heart failure and cancer patients.

DESIGN

This was a cross-sectional study.

PARTICIPANTS

Sixty outpatients with symptomatic heart failure and 30 outpatients with advanced lung or pancreatic cancer.

MEASUREMENTS

Symptom burden (Memorial Symptom Assessment Scale-Short Form), depression symptoms (Geriatric Depression Scale-Short Form), and spiritual well-being (Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being scale).

MAIN RESULTS

Overall, the heart failure patients and the cancer patients had similar numbers of physical symptoms (9.1 vs. 8.6, p = 0.79), depression scores (3.9 vs. 3.2, p = 0.53), and spiritual well-being (35.9 vs. 39.0, p = 0.31) after adjustment for age, gender, marital status, education, and income. Symptom burden, depression symptoms, and spiritual well-being were also similar among heart failure patients with ejection fraction ≤30, ejection fraction >30, and cancer patients. Heart failure patients with worse heart failure-related health status had a greater number of physical symptoms (13.2 vs. 8.6, p = 0.03), higher depression scores (6.7 vs. 3.2, p = 0.001), and lower spiritual well-being (29.0 vs. 38.9, p < 0.01) than patients with advanced cancer.

CONCLUSIONS

Patients with symptomatic heart failure and advanced cancer have similar needs for palliative care as assessed by symptom burden, depression, and spiritual well-being. This implies that heart failure patients, particularly those with more severe heart failure, need the option of palliative care just as cancer patients do.

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Acknowledgements

This study was funded by the Johns Hopkins Center for Complementary and Alternative Medicine; the Johns Hopkins General Clinical Research Center; and the National Center for Complimentary and Alternative Medicine, NIH. Dr. Bekelman is supported by the University of Colorado-Denver Mordecai Palliative Care Pilot Grants Fund and the University of Colorado-Denver Hartford/Jahnigen Division of Geriatrics Center of Excellence in Geriatric Medicine. Part of this manuscript was presented at the American Heart Association Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke Conference in Baltimore, Maryland, May 2008 and the Society for General Internal Medicine 31st Annual Meeting in Pittsburgh, Pennsylvania, April 2008.

Conflict of Interest

None of the authors have any potential conflicts of interest. The funders did not have a role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; nor in preparation, review, or approval of the manuscript.

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Authors and Affiliations

  1. Department of Medicine, University of Colorado Denver School of Medicine, Aurora, CO, USA

    David B. Bekelman MD, MPH, John S. Rumsfeld MD, PhD, Edward P. Havranek MD, Traci E. Yamashita MS, Evelyn Hutt MD & Jean S. Kutner MD, MSPH

  2. Department of Veterans Affairs Medical Center, Eastern Colorado Health Care System, Denver, CO, USA

    John S. Rumsfeld MD, PhD & Evelyn Hutt MD

  3. Department of Medicine, Denver Health Medical Center, Denver, CO, USA

    Edward P. Havranek MD

  4. Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA

    Sheldon H. Gottlieb MD

  5. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Sydney M. Dy MSc

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  1. David B. Bekelman MD, MPH
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  2. John S. Rumsfeld MD, PhD
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  3. Edward P. Havranek MD
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Correspondence to David B. Bekelman MD, MPH.

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Bekelman, D.B., Rumsfeld, J.S., Havranek, E.P. et al. Symptom Burden, Depression, and Spiritual Well-Being: A Comparison of Heart Failure and Advanced Cancer Patients. J GEN INTERN MED 24, 592–598 (2009). https://doi.org/10.1007/s11606-009-0931-y

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  • DOI: https://doi.org/10.1007/s11606-009-0931-y

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