Health-Related Quality of Life in Patients with Hepatocellular Carcinoma Treated with Initial Transarterial Chemoembolization
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To investigate the impact of the first transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) on health-related quality of life (HRQoL) and identify predictors for low HRQoL following TACE.
Materials and Methods
HRQoL was prospectively evaluated in 79 patients with standardized questionnaires (QlQ-C30 and HCC18) pre- and 2 weeks post-TACE. Treatment response was evaluated using common tumour response criteria. Clinical parameters [e.g. Eastern Cooperative Oncology Group (ECOG) performance status, Model of End Stage Liver Disease (MELD) score], tumour load and pre-TACE HRQoL scores were tested for predicting HRQoL after TACE.
Patients showed a 12.1% decrease in global health score (GHS). Major decreases were observed for physical (−21.4%), role (−23.4%), and social (−21.5%) functioning and increases in symptom severity for fatigue (+30.1%), loss of appetite (+25.3%), pain (+19.4%) after TACE. ECOG performance status >1 was associated with increased nausea/vomiting (p = 0.002) and decreased GHS (p = 0.01). MELD score >10 was associated with increased fatigue (p = 0.021) and abdominal swelling (p < 0.001). Our study showed an increase in symptom severity in patients with no symptoms before TACE for pain (p = 0.005) and abdominal swelling (p < 0.001).
The first TACE for treatment of HCC does not result in a major loss of HRQoL in general. For TACE as a palliative therapy maintaining HRQoL is of critical importance and standardized HRQoL assessment can help to detect HRQoL problems.
KeywordsTACE HCC HRQLQ-HCC18 EORTC Patient-tailored treatment
Health-related quality of life
European Organisation for Research and Treatment of Cancer
Response evaluation criteria in solid tumours
World Health Organization
Modified response evaluation criteria in solid tumours
European Association for the Study of the Liver
Model of End Stage Liver Disease
Eastern Cooperative Oncology Group
Global health status
Barcelona Clinic Liver Cancer
Society of Interventional Radiology
Selective internal radiotherapy
Radio frequency ablation
- DEB TACE
Drug-eluting beads TACE
This study was supported by a Grant from the ART (Arbeitsgemeinschaft Regionale Tumortherapie; German workforce for regional tumour therapy).
JBH and DBH: Conception, acquisition of data, draft, interpretation, MN and NS: Acquisition of data, FW: Revision, conception, draft, AV: Revision, MMK: Major Revision CVIR clinical part, SM: Major Revision CVIR radiological part, TR: Conception, interpretation, draft, revision.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
Human and Animal Rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
- 5.Wang Y-B, Chen M-H, Yan K, Yang W, Dai Y, Yin S-S. Quality of life after radiofrequency ablation combined with transcatheter arterial chemoembolization for hepatocellular carcinoma: comparison with transcatheter arterial chemoembolization alone. Qual Life Res. 2007;16:389–97.CrossRefPubMedGoogle Scholar
- 8.Doffoël M, Bonnetain F, Bouché O, Vetter D, Abergel A, Fratté S, et al. Multicentre randomised phase III trial comparing Tamoxifen alone or with Transarterial Lipiodol Chemoembolisation for unresectable hepatocellular carcinoma in cirrhotic patients (Fédération Francophone de Cancérologie Digestive 9402). Eur J Cancer. 2008;44:528–38.CrossRefPubMedGoogle Scholar
- 11.Chie W-C, Blazeby JM, Hsiao C-F, Chiu H-C, Poon RT, Mikoshiba N, et al. 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, vol. 55. Hoboken: Wiley Subscription Services, Inc., A Wiley Company; 2012. p. 1122–9.Google Scholar
- 15.Anota A, Boulin M, Dabakuyo-Yonli S, Hillon P, Cercueil J-P, Minello A, et al. An explorative study to assess the association between health-related quality of life and the recommended phase II dose in a phase I trial: idarubicin-loaded beads for chemoembolisation of hepatocellular carcinoma, vol. 6. London: BMJ Open. British Medical Journal Publishing Group; 2016. p. e010696.Google Scholar
- 21.Oliveri RS, Wetterslev J, Gluud C. Transarterial (chemo)embolisation for unresectable hepatocellular carcinoma. Cochrane Database Syst Rev. Hoboken: Wiley; 2011. p. CD004787.Google Scholar
- 24.Llovet JM, Fuster J, Bruix J, Barcelona-Clínic Liver Cancer Group. The Barcelona approach: diagnosis, staging, and treatment of hepatocellular carcinoma. Liver Transpl, vol. 10. Hoboken: Wiley Subscription Services, Inc., A Wiley Company; 2004. p. S115–20.Google Scholar
- 27.Greten T, Malek N, Schmidt S, Arends J, Bartenstein P, Bechstein W, et al. Diagnostik und Therapie des hepatozellulären Karzinoms, vol. 51. Z Gastroenterol.: ©Georg Thieme Verlag KG; 2013. p. 1269–326.Google Scholar
- 33.Salem R, Gilbertsen M, Butt Z, Memon K, Vouche M, Hickey R, et al. Increased quality of life among hepatocellular carcinoma patients treated with radioembolization, compared with chemoembolization. Clin Gastroenterol Hepatol. 2013;11(1358–1365):e1.Google Scholar
- 34.Xing M, Webber G, Prajapati HJ, Chen Z, El-Rayes B, Spivey JR, et al. Preservation of quality of life with doxorubicin drug-eluting bead transarterial chemoembolization for unresectable hepatocellular carcinoma: longitudinal prospective study. J Gastroenterol Hepatol. 2015;30:1167–74.CrossRefPubMedGoogle Scholar
- 35.Niessen C, Wiggermann P, Velandia C, Stroszczynski C, Pereira PL. Transarterial chemoembolization—status quo in Germany, vol. 185. Fortschr Röntgenstr.: ©Georg Thieme Verlag KG; 2013. p. 1089–94.Google Scholar
- 36.Kemmler G, Holzner B, Kopp M, Dünser M, Margreiter R, Greil R, et al. Comparison of two quality-of-life instruments for cancer patients: the functional assessment of cancer therapy-general and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30. JCOs. 1999;17:2932–40.Google Scholar