Using health-related quality of life measures to predict cardiac function in survivors exposed to anthracyclines.
OBJECTIVE
As the number of pediatric cancer survivors increases, so does the number of survivors previously exposed to anthracyclines as part of their cancer therapy. Because screening is costly, some have suggested that health-related quality of life (HRQL) measures might be useful in focusing screening tests on those patients with cases most likely to display positive findings. This study reports on the predictive ability of HRQL measures to detect patients with abnormalities on serial cardiac testing.


METHODS
Using 127 patients from the ACE-Inhibitor after Anthracycline (AAA) Trial, this study compared serial measures of the Short Form-36 (SF-36; for ages > 13 years) and Child Health Questionnaire-Child Form 87 (CHQ-CF87; for ages < or = 13 years) to serial cardiac performance tests including echocardiographic shortening fraction, left ventricular end systolic wall stress (LVESWS), LVESWS-index, and maximal cardiac index (MCI; a measure of cardiac output at peak exercise).


RESULTS
Generally, there was no clinically or statistically significant correlation between any HRQL measure and any cardiac function measure except between MCI and vitality and physical functioning. For each of these measures, the correlation between MCI was statistically significant (P < .006), but each HRQL subscale could explain no more than 7% of the variation in MCI. HRQL measures were not predictive of any other cardiac function measure.


CONCLUSIONS
HRQL measures should not be used in isolation as a screen for cardiac function abnormalities in patients exposed to anthracylines who already have a mild degree of ventricular dysfunction. Patient history appears to be no substitute for cardiac testing in this cohort.
Department of Pediatrics, Center for Outcomes Research, the Children's Hospital of Philadelphia, 3535 Market St, Suite 1029, Philadelphia, PA 19104, USA.
Jill P
JP
Ginsberg
Avital
A
Cnaan
Huaqing
H
Zhao
Bernard J
BJ
Clark
Stephen M
SM
Paridon
Alvin J
AJ
Chin
Jack
J
Rychik
Alexa N
AN
Hogarty
Gerald
G
Barber
Monika
M
Rutkowski
Thomas R
TR
Kimball
Cynthia
C
DeLaat
Laurel J
LJ
Steinherz
Jeffrey H
JH
Silber
D000293:Adolescent; D000328:Adult; D018943:Anthracyclines / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000502:physiology*; D006334:Heart Function Tests; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000188:drug therapy; D011237:Predictive Value of Tests; D011788:Quality of Life; D017741:Survivors
D018943:Anthracyclines