title: Functional status and quality of life among breast cancer survivors with heart failure: results of the Medicare Health Outcomes Survey.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA. joharr@umich.edu.
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Harrison
authors.affiliation: Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Davis
authors.affiliation: Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Barton
authors.affiliation: Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Janz
authors.affiliation: Center for Enhancing Quality of Life in Chronic Illness, School of Nursing, Indiana University, Indianapolis, IN, USA.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Pressler
authors.affiliation: Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Friese
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000523:psychology*; D005260:Female; D006333:Heart Failure / Q000473:pathology / Q000523:psychology*; D006801:Humans; D006278:Medicare; D011788:Quality of Life / Q000523:psychology*; D057566:Self Report; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D014481:United States
keywords: Breast cancer; Cancer survivor; Comorbidity; Health-related quality of life; Heart failure; Patient report