Symptom Burden, Depression, and Spiritual Well-Being: A Comparison of Heart Failure and Advanced Cancer Patients
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A lower proportion of patients with chronic heart failure receive palliative care compared to patients with advanced cancer.
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.
This was a cross-sectional study.
Sixty outpatients with symptomatic heart failure and 30 outpatients with advanced lung or pancreatic cancer.
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).
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.
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.
KEY WORDSheart failure quality of life palliative symptoms spirituality depression
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.
- 18.National Comprehensive Cancer Network I. The NCCN Clinical Practice Guidelines in Oncology. Available at www.nccn.org. Accessed February 5, 2009.
- 40.Hunt SA, Abraham WT, Chin MH, et al. ACC/AHA 2005 Guideline update for the diagnosis and management of chronic heart failure in the adult: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing committee to update the 2001 Guidelines for the evaluation and management of heart failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005;112(12):e154–e235.PubMedCrossRefGoogle Scholar
- 44.Gottlieb SH. Palliative care in heart failure. Heart. 2003;3(8):326–35.Google Scholar
- 48.Woodend AK. What’s new in palliative care for patients with heart failure? Can J Cardiovasc Nurs. 2005;15(2):3–4.Google Scholar
- 49.Hunt SA, Abraham WT, Chin MH, et al. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing committee to update the 2001 Guidelines for the evaluation and management of heart failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005;112(12):e154–235.PubMedCrossRefGoogle Scholar
- 50.Field MJ, Cassel CK, ed. Approaching Death: Improving Care at the End of Life. Washington, D.C.: National Academy Press; 1997.Google Scholar