Symptom burden, depression, and spiritual well-being: A comparison of heart failure and advanced cancer patients

David B. Bekelman, John S. Rumsfeld, Edward P. Havranek, Traci E. Yamashita, Evelyn Hutt, Sheldon H. Gottlieb, Sydney M. Dy, Jean S. Kutner

Research output: Contribution to journalArticlepeer-review

168 Scopus citations


Background: A lower proportion of patients with chronic heart failure receive palliative care compared to patients with advanced cancer. OBJECTIVE: We examined the relative need for palliative care in the two conditions by comparing symptom burden, psychological well-being, and spiritual well-being in heart failure and cancer patients. DESIGN: This was a cross-sectional study. PARTICIPANTS: Sixty outpatients with symptomatic heart failure and 30 outpatients with advanced lung or pancreatic cancer. Measurements: Symptom burden (Memorial Symptom Assessment Scale-Short Form), depression symptoms (Geriatric Depression Scale-Short Form), and spiritual well-being (Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being scale). Main Results: Overall, the heart failure patients and the cancer patients had similar numbers of physical symptoms (9.1 vs. 8.6, p∈=∈0.79), depression scores (3.9 vs. 3.2, p∈=∈0.53), and spiritual well-being (35.9 vs. 39.0, p∈=∈0.31) after adjustment for age, gender, marital status, education, and income. Symptom burden, depression symptoms, and spiritual well-being were also similar among heart failure patients with ejection fraction 30, ejection fraction >30, and cancer patients. Heart failure patients with worse heart failure-related health status had a greater number of physical symptoms (13.2 vs. 8.6, p∈=∈0.03), higher depression scores (6.7 vs. 3.2, p∈=∈0.001), and lower spiritual well-being (29.0 vs. 38.9, p∈<∈0.01) than patients with advanced cancer. Conclusions: Patients with symptomatic heart failure and advanced cancer have similar needs for palliative care as assessed by symptom burden, depression, and spiritual well-being. This implies that heart failure patients, particularly those with more severe heart failure, need the option of palliative care just as cancer patients do.

Original languageEnglish (US)
Pages (from-to)592-598
Number of pages7
JournalJournal of general internal medicine
Issue number5
StatePublished - May 2009


  • Depression
  • Heart failure
  • Palliative
  • Quality of life
  • Spirituality
  • Symptoms

ASJC Scopus subject areas

  • Internal Medicine


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