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Role functioning is associated with survival in patients with hepatocellular carcinoma

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Abstract

Background

Prior studies assessing quality of life (QOL) in patients with hepatocellular carcinoma (HCC) primarily included patients with preserved liver function and/or early HCC, leading to overestimation of QOL. Our study’s aim was to evaluate the association of QOL with survival among a cohort of cirrhotic patients with HCC that was diverse with respect to liver function and tumor stage.

Methods

We conducted a prospective cohort study among cirrhotic patients with HCC from a large urban safety-net hospital between April 2011 and September 2013. Patients completed two self-administered surveys, the EORTC QLQ-C30 and QLQ-HCC18, prior to the treatment. We used generalized linear models to identify correlates of QOL. Survival curves were generated using Kaplan–Meier analysis and compared using log rank test to determine whether QOL is associated with survival.

Results

A total of 130 treatment-naïve patients completed both surveys. Patients reported high cognitive and social function (median scores 67) but poor global QOL (median score 50) and poor role function (median score 50). QOL was associated with cirrhosis-related (p = 0.02) and tumor-related (p = 0.02) components of Barcelona Clinic Liver Cancer (BCLC) tumor stage. QOL was associated with survival on univariate analysis (HR 0.37, 95 % CI 0.16–0.85) but became nonsignificant (HR 0.82, 95 % CI 0.37–1.80) after adjusting for BCLC stage and treatment. Role functioning was significantly associated with survival (HR 0.40, 95 % CI 0.20–0.81), after adjusting for Caucasian race (HR 0.31, 95 % CI 0.16–0.59), BCLC stage (HR 1.51, 95 % CI 0.21–1.89), and treatment (HR 0.57, 95 % CI 0.33–0.97).

Conclusions

Role function has prognostic significance and is important to assess in patients with HCC.

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Acknowledgments

This work was conducted with support from the National Center for Advancing Translational Sciences of the National Institutes of Health under award KL2TR001103. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Conflict of interest

None of the authors have any conflict of interest relevant to this manuscript.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA

    Adam Meier, Huram Mok, Pragathi Kandunoori & Amit G. Singal

  2. Department of Surgery, UT Southwestern Medical Center, Dallas, TX, USA

    Adam Yopp

  3. Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA

    Jasmin Tiro & Amit G. Singal

  4. Harold C. Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA

    Adam Yopp, Jasmin Tiro & Amit G. Singal

  5. Division of Digestive and Liver Diseases, Dedman Scholar of Clinical Care, University of Texas Southwestern Medical Center, 5959 Harry Hines Blvd, POB 1, Suite 420, Dallas, TX, 75390-8887, USA

    Amit G. Singal

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  1. Adam Meier
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Correspondence to Amit G. Singal.

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Meier, A., Yopp, A., Mok, H. et al. Role functioning is associated with survival in patients with hepatocellular carcinoma. Qual Life Res 24, 1669–1675 (2015). https://doi.org/10.1007/s11136-014-0895-1

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  • DOI: https://doi.org/10.1007/s11136-014-0895-1

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