Quality of life changes in patients undergoing treatment for hepatocellular carcinoma.
OBJECTIVE
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.
Graduate Institute of Epidemiology and Preventive Medicine, Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan.
Wei-Chu
WC
Chie
Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA. fangyu@unmc.edu.
Fang
F
Yu
Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
Mengqian
M
Li
Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
Lorena
L
Baccaglini
School of Social & Community Medicine, University of Bristol, Bristol, UK.
Jane M
JM
Blazeby
Division of Clinical Trial Statistics, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan.
Chin-Fu
CF
Hsiao
Graduate Institute of Healthcare Administration, Kaohsiung Medical University, Kaohsiung, Taiwan.
Herng-Chia
HC
Chiu
Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong.
Ronnie T
RT
Poon
Department of Adult Nursing/Palliative Care Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Naoko
N
Mikoshiba
Institute of Liver Studies, King's College Hospital, London, UK.
Gillian
G
Al-Kadhimi
Institute of Liver Studies, King's College Hospital, London, UK.
Nigel
N
Heaton
Institute of Liver Studies, King's College Hospital, London, UK.
Jozer
J
Calara
Department of Hepatology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Peter
P
Collins
Department of Hepatology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Katharine
K
Caddick
Psychooncology Unit, Sant'Andrea Hospital-Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
Anna
A
Costantini
Department of Radiology, Assistance-Publique Hôpitaux de Paris, APHP, Hôpital Beaujon, Clichy, France.|Université Paris Diderot, Sorbonne Paris Cité, INSERM Centre de recherche Biomédicale Bichat Beaujon, CRB3 U773 75018, Paris, France.
Valerie
V
Vilgrain
Division of Clinical Trial Statistics, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan.
Chieh
C
Chiang
D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000473:pathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011795:Surveys and Questionnaires
Asian; Carcinoma; Hepatocellular; Quality of life; Treatment