Health-related Quality of Life of Chronic Liver Disease Patients With and Without Hepatocellular Carcinoma

Yuji Kondo; Haruhiko Yoshida; Ryosuke Tateishi; Shuichiro Shiina; Norio Mine; Noriyo Yamashiki; Shinpei Sato; Naoya Kato; Fumihiko Kanai; Mikio Yanase; Hideo Yoshida; Masatoshi Akamatsu; Takuma Teratani; Takao Kawabe; Masao Omata

Disclosures

J Gastroenterol Hepatol. 2007;22(2):197-203. 

In This Article

Abstract and Introduction

Abstract

Background and Aim: Impaired health-related quality of life has been reported in patients with cirrhosis and chronic hepatitis. However, only limited data are available concerning the influence of hepatocellular carcinoma.
Methods: Health-related quality of life was assessed in 97 patients with hepatocellular carcinoma who had been treated successfully with percutaneous ablation therapy, and 97 patients with chronic liver disease without hepatocellular carcinoma matched for age and sex, using the Japanese version of Short-Form 36. Raw scores were transformed using norm-based scoring. The relations with objective variables including status of hepatocellular carcinoma and laboratory data were analyzed.
Results: Health-related quality of life was lower in both groups than in the general population. Patients with hepatocellular carcinoma and patients in the control group showed similar scores. By multivariate analysis, liver function, especially serum albumin, strongly predicted health-related quality of life, but status of hepatocellular carcinoma did not.
Conclusions: Impaired health-related quality of life was not associated with the presence of hepatocellular carcinoma but dependent on the level of liver function, indicating the importance of preserving liver function in following up patients. Serum albumin level was a useful objective variable to assess health-related quality of life of patients with chronic liver disease.

Introduction

Health-related quality of life (HRQOL) has become a vitally important aspect in clinical practice.[1] Among patients with chronic liver disease, impairment in HRQOL has been reported.[2,3,4,5,6,7,8] Hepatocellular carcinoma (HCC), one of the major sequelae of chronic liver diseases, is now increasing worldwide[9,10] and the HRQOL of patients with HCC is an area of interest.[11,12,13]

Owing to recent advances in diagnostic imaging and availability of tumor biomarkers specific to HCC, the cancer can now often be detected at an early stage,[14] where there are presumably no specific symptoms associated with HCC. The impact of these small HCC on HRQOL remains uncertain.

In the past two decades, percutaneous tumor ablation techniques, such as percutaneous ethanol injection therapy (PEIT) and radiofrequency ablation (RFA), have been accepted as effective and safe therapies for patients with small HCC who are not candidates for hepatic resection.[15,16,17,18,19,20,21] These less-invasive therapies may be preferable from the viewpoint of patients' HRQOL, especially because of the high recurrence rate of HCC even after complete tumor removal,[22,23] which requires repeated treatment of each recurrence.

The Short Form-36 (SF-36) health survey is a generic health status measurement consisting of 36 items in eight domains, which has demonstrated good reliability and validity in chronic disease populations, including patients with chronic liver diseases.[2,4,5,7] After the introduction of Japanese version of SF-36,[24,25] it is now used commonly in Japanese HRQOL studies. HRQOL assessment is also essential for cost-effectiveness analysis. SF-36 has also been employed in utility estimates based on patients' reports for measuring quality-adjusted life years in Western countries.[26,27,28,29]

In clinical practice, HRQOL prediction from objective variables is necessary and may be useful. For that purpose, the relationship between subjective HRQOL scores and objective clinical variables, such as presence of ascites, status of HCC and laboratory data, should be analyzed further.

We conducted this study to elucidate the influence of HCC on HRQOL using the SF-36.

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