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Cardiovascular health-related quality of life in cancer: a prospective study comparing the ESC HeartQoL and EORTC QLQ-C30 questionnaire |
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| Authors: | Markus S. Anker Sophia K. Potthoff Alessia Lena Jan Porthun Sara Hadzibegovic Ruben Evertz Corinna Denecke Ann-Kathrin Fröhlich Frederike Sonntag Vera Regitz-Zagrosek Stuart D. Rosen Alexander R. Lyon Thomas F. Lüscher John A. Spertus Stefan D. Anker Mahir Karakas Lars Bullinger Ulrich Keller Ulf Landmesser Javed Butler Stephan von Haehling |
| Affiliation: | 1. Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine CBF, Berlin, Germany;2. Charité-University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine CVK, Berlin, Germany Markus S. Anker and Sophia K. Potthoff share the first authorship.;3. Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine CBF, Berlin, Germany Charité-University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany;4. Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine CVK, Berlin, Germany Norwegian University of Science and Technology, Gjøvik, Norway;5. Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine CBF, Berlin, Germany Charité-University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany;6. Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany;7. Charité-University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine CVK, Berlin, Germany;8. Charité-University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine CVK, Berlin, Germany;9. Institute for Gender in Medicine, Charité University Medicine Berlin, Berlin, Germany Faculty of Medicine, University of Zurich, Zurich, Switzerland;10. Cardio-Oncology Service, Royal Brompton Hospital and National Heart and Lung Institute, London, UK Heart Division, Royal Brompton & Harefield Hospitals, London, UK National Heart and Lung Institute, Imperial College London, London, UK;11. Cardio-Oncology Service, Royal Brompton Hospital and National Heart and Lung Institute, London, UK;12. Cardio-Oncology Service, Royal Brompton Hospital and National Heart and Lung Institute, London, UK Heart Division, Royal Brompton & Harefield Hospitals, London, UK National Heart and Lung Institute, Imperial College London, London, UK Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland;13. University of Missouri-Kansas City's Healthcare Institute for Innovations in Quality and Saint Luke's Mid America Heart Institute, Kansas City, MI, USA;14. German Centre for Cardiovascular Research (DZHK), partner site HH/Kiel/HL, Hamburg, Germany Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;15. German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany Department of Hematology, Oncology, and Tumor Immunology CVK, Charité-University Medicine Berlin corporate member of Free University Berlin and Humboldt University of Berlin, Berlin, Germany;16. German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany Department of Hematology, Oncology and Cancer Immunology, Charité-University Medicine Berlin, Berlin, Germany Max Delbrück Center, Berlin, Germany;17. Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine CBF, Berlin, Germany Charité-University Medicine Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany Berlin Institute of Health (BIH) at Charité Berlin, Universitätsmedizin Berlin, Berlin, Germany;18. Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA Baylor Scott and White Research Institute, Dallas, TX, USA Javed Butler and Stephan von Haehling share the last authorship.;19. Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany Javed Butler and Stephan von Haehling share the last authorship. |
| Abstract: | AimsHealth-related quality of life (HRQoL) is highly relevant in cancer and often assessed with the EORTC QLQ-C30. Cardiovascular HRQoL in cancer can be measured with the ESC HeartQoL questionnaire. We compared these instruments and examined their prognostic value.Methods and resultsSummary scores for EORTC QLQ-C30 (0–100 points) and ESC HeartQoL (0–3 points) questionnaires were prospectively assessed in 290 patients with mostly advanced cancer (stage 3/4: 81%, 1-year mortality: 36%) and 50 healthy controls (similar age and sex). Additionally, physical function and activity assessments were performed. Both questionnaires demonstrated reduced HRQoL in patients with cancer versus controls (EORTC QLQ-C30: 67 ± 20 vs. 91 ± 11, p < 0.001; ESC HeartQoL: 1.8 ± 0.8 vs. 2.7 ± 0.4, p < 0.001). The instruments were strongly correlated with each other (summary scores [r = 0.76], physical [r = 0.81], and emotional subscales [r = 0.75, all p < 0.001]) and independently associated with all-cause mortality (best cut-offs: EORTC QLQ-C30 <82.69: hazard ratio [HR] 2.33, p = 0.004; ESC HeartQoL <1.50: HR 1.85, p = 0.004 – adjusted for sex, age, left ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide [NT-proBNP], high-sensitivity troponin T, cancer stage/type), with no differences in the strength of the association by sex (p-interaction > 0.9). Combining both questionnaires identified three risk groups with highest mortality in patients below both cut-offs (vs. patients above both cut-offs: HR 3.60, p < 0.001). Patients with results below both cut-offs, showed higher NT-proBNP and reduced physical function and activity.ConclusionsThe EORTC QLQ-C30 and ESC HeartQoL – assessing cancer and cardiovascular HRQoL – are both associated with increased mortality in cancer patients, with even greater stratification by combing both. Reduced HRQoL scores were associated with elevated cardiovascular biomarkers and decreased functional status. |
| Keywords: | Quality of life Cancer EORTC QLQ-C30 HeartQoL |