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.
Eur J Heart Fail. 2023 Sep;25(9):1635-1647. doi: 10.1002/ejhf.2951. Epub 2023 Aug 22.
Health-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.
Summary 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.
The 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.
健康相关生活质量（HRQoL）在癌症中非常重要，通常使用 EORTC QLQ-C30 进行评估。癌症的心血管 HRQoL 可以使用 ESC HeartQoL 问卷进行测量。我们比较了这些工具，并研究了它们的预后价值。
前瞻性评估了 290 名患有晚期癌症（3/4 期：81%，1 年死亡率：36%）和 50 名健康对照者的 EORTC QLQ-C30（0-100 分）和 ESC HeartQoL（0-3 分）问卷的综合评分。此外，还进行了身体功能和活动评估。与对照组相比，两种问卷均显示癌症患者的 HRQoL 降低（EORTC QLQ-C30：67±20 与 91±11，p<0.001；ESC HeartQoL：1.8±0.8 与 2.7±0.4，p<0.001）。这些工具彼此之间具有很强的相关性（综合评分[ r=0.76]、身体[ r=0.81]和情绪子量表[r=0.75，均 p<0.001]），并且与全因死亡率独立相关（最佳截断值：EORTC QLQ-C30<82.69：危险比[HR]2.33，p=0.004；ESC HeartQoL<1.50：HR1.85，p=0.004-调整性别、年龄、左心室射血分数、N 末端 pro-B 型利钠肽[NT-proBNP]、高敏肌钙蛋白 T、癌症分期/类型），但性别之间的关联强度没有差异（p 交互作用>0.9）。同时使用两种问卷可确定三个死亡率最高的风险组，这些组的患者两种截断值均低于（与两种截断值均高于的患者相比：HR3.60，p<0.001）。两种截断值均低于的患者 NT-proBNP 较高，身体功能和活动能力降低。
EORTC QLQ-C30 和 ESC HeartQoL-评估癌症和心血管 HRQoL-均与癌症患者的死亡率增加相关，通过结合这两种方法进行分层，其相关性更强。HRQoL 评分降低与心血管生物标志物升高和功能状态降低有关。
