Same kind of palliative care may be needed, researcher says
FRIDAY, May 2 (HealthDay News) -- Heart failure is as crushing a blow to someone's psychological well-being as cancer, a new study finds.
Indeed, people in the study with the most severe degrees of heart failure, the inability to supply the body with oxygen-carrying blood, had measures of severity of symptoms, depression and loss of spiritual well-being that are seen in people with advanced cancer, Dr. David Bekelman, an assistant professor of medicine at the University of Colorado at Denver Health Sciences Center, reported Friday at an American Heart Association meeting in Baltimore.
Palliative care, aimed at improving quality of life as the end of a life approaches, is often offered to people with advanced cancer, Bekelman said. "We should consider offering it to people with heart failure," he noted.
The study compared 60 people with heart failure severe enough to cause symptoms but not hospitalization with 30 people with advanced cancer of the lung or pancreas.
"We looked at physical symptoms, things like fatigue, weakness and pain," Bekelman said. "A second measure was of depression, and a third was of spiritual well-being."
Heart failure and cancer patients reported similar numbers of physical symptoms. The scores for depression on a standard test were slightly higher in heart failure than in cancer -- 3.9 versus 3.2.
"The measure of spiritual well-being we used looked at two domains, a sense of meaning and peace and a sense of faith," Bekelman said. The people with heart failure scored lower than those with cancer.
When the people with the most severe forms of heart failure were singled out, their scores on all three measures were worse than for people with advanced cancer.
Survival in heart failure severe enough to send someone to the hospital is comparable to that in advanced cancer, with death coming an average of 1.6 years after hospitalization.
"We're very good at treating the physical part of heart failure," Bekelman said. "But people suffer in other ways that also should warrant attention. It's important that we offer it to them."
The burden of heart failure is well known to physicians, but "nonprofessionals dont realize it," said Dr. Gerald L. DeVaughn, a clinical associate professor of medicine at Drexel University in Philadelphia.
"People given the option of heart failure or cancer might think that heart failure is the choice," he said. "But heart failure is quite lethal. Many cancers have a better prognosis."
Caretakers for people with heart failure should take its effects into account, DeVaughn said.
Symptoms such as dry mouth, constipation and shortness of breath can be improved with medical management, he said, while depression can be treated with medication and counseling.
"If they mention that spirituality is important in their lives, we should endeavor to have them see someone in that area, such as a chaplain," Bekelman said.
Approaches used to improve spiritual well-being in cancer, such as psychotherapy, should also be considered in heart failure, he said.
"People with cancer get all kinds of supportive services, but people with heart failure don't," Bekelman said.
Symptoms and treatment of heart failure are described by the American Heart Association.
SOURCES: David Bekelman, M.D., assistant professor, medicine, University of Colorado Denver School of Medicine; Gerald L. DeVaughn, clinical associate professor, medicine, Drexel University, Philadelphia; May 2, 2008, presentation, American Heart Association Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke, Baltimore
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