title: Differences in health-related quality of life between European and Asian patients with hepatocellular carcinoma.
abstract: OBJECTIVE
  The aim of this study is to explore the possible effects of clinical and cultural characteristics of hepatocellular carcinoma on patients' health-related quality of life (HRQoL).
  
  
  METHODS
  Patients with hepatocellular carcinoma from Asian and European countries completed the EORTC QLQ-C30 and the EORTC QLQ-HCC18. Comparisons were made using Student's t-test and Wilcoxon rank-sum test with method of false discovery to correct multiple comparisons. Multiway analysis of variance and model selection were used to assess the effects of clinical characteristics and geographic areas.
  
  
  RESULTS
  Two hundred and twenty-seven patients with hepatocellular carcinoma completed questionnaires. After adjusting for demographic and clinical characteristics, Asian patients still had significantly better HRQoL scores in emotional functioning, insomnia, (QLQ-C30) and in sexual interest (QLQ-HCC18). We also found an interaction in physical functioning (QLQ-C30) and fatigue (QLQ-HCC18) between geographic region and marital status, married European had worse HRQoL scores than Asian singles.
  
  
  CONCLUSIONS
  Both clinical characteristics and geographic areas affected the HRQoL in with hepatocellular carcinoma. Cultural differences and clinical differences in the pattern of disease due to active surveillance of Asian countries may explain the results.
authors.affiliation: Department of Public Health, Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan.
authors.forename: Wei-Chu
authors.initials: WC
authors.lastname: Chie
authors.affiliation: Centre for Surgical Research, School of Social & Community Medicine, University of Bristol, Bristol, UK.|Division of Surgery, Head & Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Blazeby
authors.affiliation: Division of Clinical Trial Statistics, Institute of Population Health Sciences, National Health Research Institutes, Taiwan.
authors.forename: Chin-Fu
authors.initials: CF
authors.lastname: Hsiao
authors.affiliation: Department of Healthcare Administration and Medical Informatics, Kaoshiung Medical University, Taiwan.
authors.forename: Herng-Chia
authors.initials: HC
authors.lastname: Chiu
authors.affiliation: Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong, Japan.
authors.forename: Ronnie T
authors.initials: RT
authors.lastname: Poon
authors.affiliation: Department of Adult Nursing/Palliative Care Nursing, Graduate School of Medicine, University of Tokyo, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Mikoshiba
authors.affiliation: Institute of Liver Studies, King's College Hospital, London, UK.
authors.forename: Gillian
authors.initials: G
authors.lastname: Al-Kadhim
authors.affiliation: Institute of Liver Studies, King's College Hospital, London, UK.
authors.forename: Nigel
authors.initials: N
authors.lastname: Heaton
authors.affiliation: Institute of Liver Studies, King's College Hospital, London, UK.
authors.forename: Jozer
authors.initials: J
authors.lastname: Calara
authors.affiliation: Department of Hepatology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Collins
authors.affiliation: Department of Hepatology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
authors.forename: Katharine
authors.initials: K
authors.lastname: Caddick
authors.affiliation: Psychoncology Unit, Sant'Andrea Hospital - Faculty of Medicine and Psychology Sapienza, University of Rome, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Costantini
authors.affiliation: Assistance-Publique Hôpitaux de Paris, APHP, Hôpital Beaujon, Department of Radiology, Clichy, France.|Université Paris Diderot, Sorbonne Paris Cité, INSERM Centre de recherche Biomédicale Bichat Beaujon, Paris, France.
authors.forename: Valerie
authors.initials: V
authors.lastname: Vilgrain
authors.affiliation: Division of Clinical Trial Statistics, Institute of Population Health Sciences, National Health Research Institutes, Taiwan.
mesh_terms: D000368:Aged; D044466:Asian People; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000523:psychology*; D003430:Cross-Sectional Studies; D005060:Europe; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: cultural difference; hepatocellular carcinoma; quality of life; the EORTC questionnaire