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Quality of life changes in patients undergoing treatment for hepatocellular carcinoma

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Abstract

Purpose

Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related death worldwide. One of the primary treatment goals for incurable advanced cases is to prolong quality of life (QoL). Thus, to determine which HCC therapies may be linked to a more favorable QoL, we assessed the association between QoL changes and different treatments in HCC patients.

Methods

We analyzed a non-randomized multicenter longitudinal study, which included 171 patients treated with surgery (n = 53), ablation (n = 53) or embolization (n = 65) from seven centers: four Asian and three European sites. All participants completed the EORTC QLQ-C30 and QLQ-HCC18 questionnaires before and after treatment. Propensity scores were calculated and used in addition to race for adjustment in the logistic regression model to account for the confounding effects of patient characteristics including age, gender, race, employment, living with family, at least one comorbid condition, years since diagnosis, prior treatment history, BCLC stage, Child–Pugh grade, cirrhosis, bilirubin levels and QoL score before treatment.

Results

After adjustment for confounders, patients tended to have higher odds of QoL deterioration when treated with ablation versus embolization (dyspnea: p = 0.019; appetite loss: p = 0.018; body image: p = 0.035) or ablation versus surgery (dyspnea: p = 0.099; appetite loss: p = 0.100; body image: p = 0.038).

Conclusions

There were significant differences in QoL deterioration across different treatment groups. This information may assist patients and providers when selecting patient-centered treatment approaches for HCC.

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References

  1. Maluccio, M., & Covey, A. (2012). Recent progress in understanding, diagnosing, and treating hepatocellular carcinoma. CA: A Cancer Journal for Clinicians, 62(6), 394–399.

    Google Scholar 

  2. Venook, A. P., Papandreou, C., Furuse, J., & de Guevara, L. L. (2010). The incidence and epidemiology of hepatocellular carcinoma: A global and regional perspective. Oncologist, 15(Suppl 4), 5–13.

    Article  PubMed  Google Scholar 

  3. Jemal, A., Bray, F., Center, M. M., Ferlay, J., Ward, E., & Forman, D. (2011). Global cancer statistics. CA: A Cancer Journal for Clinicians, 61(2), 69–90.

    Google Scholar 

  4. Greten, T. F., Papendorf, F., Bleck, J. S., Kirchhoff, T., Wohlberedt, T., Kubicka, S., et al. (2005). Survival rate in patients with hepatocellular carcinoma: A retrospective analysis of 389 patients. British Journal of Cancer, 92(10), 1862–1868.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. Moinpour, C. M. (1994). Measuring quality of life: An emerging science. Seminars in Oncology, 21(5 Suppl 10), 48–60.

    CAS  PubMed  Google Scholar 

  6. Wang, Y. B., Chen, M. H., Yan, K., Yang, W., Dai, Y., & Yin, S. S. (2007). Quality of life after radiofrequency ablation combined with transcatheter arterial chemoembolization for hepatocellular carcinoma: Comparison with transcatheter arterial chemoembolization alone. Quality of Life Research, 16(3), 389–397.

    Article  PubMed  Google Scholar 

  7. Lee, L. J., Chen, C. H., Yao, G., Chung, C. W., Sheu, J. C., Lee, P. H., et al. (2007). Quality of life in patients with hepatocellular carcinoma received surgical resection. Journal of Surgical Oncology, 95(1), 34–39.

    Article  PubMed  Google Scholar 

  8. Qiao, C. X., Zhai, X. F., Ling, C. Q., Lang, Q. B., Dong, H. J., Liu, Q., & Li, M. D. (2012). Health-related quality of life evaluated by tumor node metastasis staging system in patients with hepatocellular carcinoma. World Journal of Gastroenterology, 18(21), 2689–2694.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Slevin, M. L. (1992). Quality of life: Philosophical question or clinical reality? British Medical Journal, 305(6851), 466–469.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Bruns, H., Kratschmer, K., Hinz, U., Brechtel, A., Keller, M., Buchler, M. W., & Schemmer, P. (2010). Quality of life after curative liver resection: A single center analysis. World Journal of Gastroenterology, 16(19), 2388–2395.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Poon, R. T., Fan, S. T., Yu, W. C., Lam, B. K., Chan, F. Y., & Wong, J. (2001). A prospective longitudinal study of quality of life after resection of hepatocellular carcinoma. Archives of Surgery, 136(6), 693–699.

    Article  CAS  PubMed  Google Scholar 

  12. Toro, A., Pulvirenti, E., Palermo, F., & Di Carlo, I. (2012). Health-related quality of life in patients with hepatocellular carcinoma after hepatic resection, transcatheter arterial chemoembolization, radiofrequency ablation or no treatment. Surgical Oncology, 21(1), e23–e30. doi:10.1016/j.suronc.2011.10.005.

    Article  PubMed  Google Scholar 

  13. Blazeby, J. M., Currie, E., Zee, B. C., Chie, W. C., Poon, R. T., & Garden, O. J. (2004). Development of a questionnaire to assess quality of life in patients with hepatocellular carcinoma, the EORTC QLQ-HCC18. European Journal of Cancer, 40(16), 2439–2444.

    Article  PubMed  Google Scholar 

  14. Chie, W. C., Blazeby, J. M., Hsiao, C. F., Chiu, H. C., Poon, R. T., Mikoshiba, N., et al. (2012). International cross-cultural field validation of an European Organization for Research and Treatment of Cancer questionnaire module for patients with primary liver cancer, the European Organization for Research and Treatment of Cancer quality-of-life questionnaire HCC18. Hepatology, 55(4), 1122–1129.

    Article  PubMed  Google Scholar 

  15. Mikoshiba, N., Tateishi, R., Tanaka, M., Sakai, T., Blazeby, J. M., Kokudo, N., et al. (2012). Validation of the Japanese version of the EORTC hepatocellular carcinoma-specific quality of life questionnaire module. Health and Quality of Life Outcomes, 10(1), 58.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Mickey, R. M., & Greenland, S. (1989). The impact of confounder selection criteria on effect estimation. American Journal of Epidemiology, 129(1), 125–137.

    CAS  PubMed  Google Scholar 

  17. Spreeuwenberg, M. D., Bartak, A., Croon, M. A., Hagenaars, J. A., Busschbach, J. J., Andrea, H., et al. (2010). The multiple propensity score as control for bias in the comparison of more than two treatment arms: An introduction from a case study in mental health. Medical Care, 48(2), 166–174.

    Article  PubMed  Google Scholar 

  18. Firth, D. (1993). Bias reduction of maximum likelihood estimates. Biometrika, 80, 27–38.

    Article  Google Scholar 

  19. Norman, G. R., Sloan, J. A., & Wyrwich, K. W. (2003). Interpretation of changes in health-related quality of life: The remarkable universality of half a standard deviation. Medical Care, 41(5), 582–592.

    PubMed  Google Scholar 

  20. Yang, H. J., Lee, J. H., Lee, D. H., Yu, S. J., Kim, Y. J., Yoon, J. H., et al. (2014). Small single-nodule hepatocellular carcinoma: Comparison of transarterial chemoembolization, radiofrequency ablation, and hepatic resection by using inverse probability weighting. Radiology. doi:10.1148/radiol.13131760.

    Google Scholar 

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Acknowledgments

This study was funded in part by the EORTC Quality of Life Group. JMB is funded in part by the MRC ConDuCT Hub. WCC is funded by the National Science Council, Taiwan, No. NSC97-2314-B002-020-MY3. HCC is funded by the National Science Council, Taiwan, NSC 95-2314-B-037-079-MY3.

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical standard

The original study was approved by institutional review boards at each center. All participants signed an informed consent form. The secondary analysis was conducted on de-identified data.

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Correspondence to Fang Yu.

Additional information

On behalf of the EORTC Quality of Life Group.

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Chie, WC., Yu, F., Li, M. et al. Quality of life changes in patients undergoing treatment for hepatocellular carcinoma. Qual Life Res 24, 2499–2506 (2015). https://doi.org/10.1007/s11136-015-0985-8

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  • DOI: https://doi.org/10.1007/s11136-015-0985-8

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