Survivorship Issues: A Tool for Determining Heart Health
Network - Winter 2008
The ability of a cancer patient’s heart to function properly concerns Anecita Fadol, Ph.D. As an advanced practice nurse in M. D. Anderson’s Department of Cardiology, she sees patients every day and often has faced the challenge of effectively and efficiently differentiating the symptoms of cancer from those of heart failure.
Now, she has a tool that makes that more possible: the M. D. Anderson Symptom Inventory-Heart Failure, or MDASI-HF. The most encouraging aspect is that, like other nurses working under the direction of Charles Cleeland, Ph.D., chair of the Department of Symptom Research, she developed it as her doctoral dissertation.
Statistics show the importance of such a tool. Of the more than one million people hospitalized each year for heart failure, 10% to 20% are readmitted in two weeks and 30% to 50% are readmitted in six months. The difficulty in diagnosis is that many of the symptoms overlap not only with cancer but with other disease states as well, such as emphysema, obesity, kidney disease, drug-induced edema and cirrhosis.
“The primary reason patients are admitted to our Emergency Center,” Fadol says of M. D. Anderson, “is for heart failure due to poor symptom management. If we can help with that by having a better understanding of their symptoms, we can improve their quality of life.”
Discerning the differences in symptoms
Fadol began to develop this tool in 2004, using the general MDASI developed by Cleeland and his group. This validated symptom inventory defines the 13 most common symptoms with which cancer patients must deal: pain, fatigue, nausea, sleep disturbance, distress, shortness of breath, trouble remembering, lack of appetite, dry mouth, drowsiness, sadness, vomiting and numbness or tingling.
In the process, she interviewed patients, nurses, nurse practitioners and cardiologists, then reviewed both qualitative and quantitative research studies that had been carried out on the subject. In this way, she was able to narrow the list of heart failure symptoms from 30 to 16.
Heart failure experts then helped reduce that to eight not covered by the general MDASI: abdominal bloating, ankle swelling, sleeping without adding more pillows under the head, racing heartbeat (palpitation), nighttime cough, waking up at night with difficulty breathing and sudden weight gain.
“There was overlap in some of the symptoms,” she says. “For example, shortness of breath, fatigue and sadness are similar to both cancer patients and those with heart failure. Because those were already included in the general MDASI, we could eliminate them from the MDASI-HF.”
Fadol and her colleagues hope to use the instrument to help improve symptom management of patients and prevent them from unnecessary hospital admissions. She also hopes that its use might change outcomes. If symptoms can be assessed early on and interventions initiated, that could result in prevention of heart failure complications and ultimately affect a patient’s lifespan and quality of life.