title: Depressive symptoms after treatment in hepatocellular carcinoma survivors: prevalence, determinants, and impact on health-related quality of life.
abstract: OBJECTIVE
  The purposes of this study were to investigate the prevalence and determinants of depressive symptoms among hepatocellular carcinoma (HCC) survivors and to evaluate the impact of depressive symptoms on health-related quality of life (HRQOL).
  
  
  METHODS
  A cross-sectional study was conducted on 128 consecutive patients attending an outpatient clinic in Japan 1 year or more after curative treatment. To assess depressive symptoms and HRQOL, the participants were asked to complete the Center for Epidemiologic Studies Depressive Symptoms Scale, the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, and EORTC QLQ-HCC18, respectively. Multiple logistic regression models were used to identify factors associated with depressive symptoms. EORTC QLQ-C30 and EORTC QLQ-HCC18 scores were compared between participants with and without depressive symptoms.
  
  
  RESULTS
  The prevalence of depressive symptoms among the HCC survivors was 28.3%. The multiple logistic regression analysis revealed that the determinants of depressive symptoms included poor Karnofsky performance status (odds ratio [OR] = 4.59, 95% CI = 1.03-20.55, p = 0.04), poor liver function (OR = 3.22, 95% CI = 1.11-10.0, p = 0.03), living alone (OR = 6.87, 95% CI = 2.53-18.63, p = 0.0002), and unemployment (OR = 5.18, 95% CI = 1.73-15.54, p = 0.003). Survivors with depressive symptoms had poorer HRQOL in almost all domains compared with survivors with no depressive symptoms.
  
  
  CONCLUSIONS
  This study suggests that after treatment, many HCC survivors experience depressive symptoms that are strongly associated with poorer HRQOL.
authors.affiliation: Department of Adult Nursing/Palliative Care Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Mikoshiba
authors.affiliation: Department of Palliative Nursing, Health Sciences, Graduate School of Medicine, Tohoku University, Sendai, Japan.
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Miyashita
authors.affiliation: Department of Adult Nursing/Palliative Care Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Sakai
authors.affiliation: Department of Gastroenterology, The University of Tokyo, Tokyo, Japan.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Tateishi
authors.affiliation: Department of Gastroenterology, The University of Tokyo, Tokyo, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000523:psychology* / Q000628:therapy; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006304:Health Status; D048550:Hepatic Insufficiency / Q000523:psychology; D006801:Humans; D007564:Japan / Q000453:epidemiology; D017567:Karnofsky Performance Status; D008113:Liver Neoplasms / Q000523:psychology* / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology*; D012111:Residence Characteristics; D012307:Risk Factors; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D014478:Unemployment / Q000523:psychology
keywords: cancer survivors; depressive symptoms; health‐related quality of life; hepatocellular carcinoma; oncology