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Using Health-Related Quality of Life Measures to Predict Cardiac Function in Survivors Exposed to Anthracyclines

From the Divisions of Pediatric Oncology, Biostatistics and Epidemiology, and Cardiology, Department of Pediatrics; and the Center for Outcomes Research, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, PA; The Divisions of Pediatric Cardiology, Hematology/Oncology, Children's Hospital Medical Center, Cincinnati, OH; The Division of Pediatric Cardiology, New York University of Medicine; and the Department of Pediatric Cardiology, Memorial Sloan-Kettering Medical Center, New York, NY

Address reprint requests to Jeffrey H. Silber, MD, PhD, the Center for Outcomes Research, the Children's Hospital of Philadelphia, 3535 Market St, Suite 1029, Philadelphia, PA 19104; e-mail: silber{at}email.chop.edu

PURPOSE: 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 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.

CONCLUSION: 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.

Supported by the National Heart, Lung, and Blood Institute (grant R01 HL-50424), the National Center for Research Resources (grant M01-RR-00240), and the National Cancer Institute (grant CA-16520).

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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