Functional Status, Quality of Life, and Long-Term Survival in a Cohort of Women with Breast Cancer and Heart Failure: Results of the Medicare Health Outcomes Survey

Abstract

The aging population and marked growth of chronic non-communicable disease pose new challenges for the United States healthcare system. Breast cancer survivors with complex chronic conditions are a growing population. Of particular interest are women with chronic heart failure, a progressive, life-limiting condition that affects approximately one third of breast cancer survivors aged 65 and older. Despite the high prevalence of heart failure in this population, little is known about the implications of chronic heart failure for patient outcomes in breast cancer survivors. The purpose of this dissertation research is to examine health-related quality of life (HRQOL), functional status, and survival in a cohort of older women with two complex chronic conditions: breast cancer and heart failure. This dissertation consists of three parts: 1) a concept analysis to examine the concept of cardiotoxic heart failure in breast cancer survivors; 2) a cross-sectional, population-based study to evaluate the relationship between heart failure diagnosis and patient-reported functional status and HRQOL among breast cancer survivors; and 3) a retrospective cohort study to examine the association between heart failure diagnosis and long-term survival among older women with breast cancer. These results will establish the foundation for future prospective research by identifying clinical subgroups of breast cancer survivors at greatest risk for adverse sequelae associated with heart failure, as well as identifying deficits in HRQOL or functional status to target for future intervention. This dissertation provides crucial data to inform a research program focused on management of complex chronic conditions in women, specifically the notable number of breast cancer survivors who also live with chronic heart failure.