Advertisement

Prognostic association of demographic and clinical factors with the change rates of symptoms and depression among patients with hepatocellular carcinoma

  • Jyh-Jou Chen
  • Sheng-Shiung Huang
  • In-Fun Li
  • Kuan-Pin Lin
  • Shiow-Luan TsayEmail author
Original Article

Abstract

Purpose

To identify the predictive value of demographic and clinical factors for determining changes in physical and depressive symptom among hepatocellular carcinoma (HCC) patients over time.

Methods

We performed a prospective cohort study of 128 patients newly diagnosed with HCC in Taiwan. Each patient had four time-point data after the follow-up. Patients’ physical symptoms were evaluated with the Edmonton Symptom Assessment System (ESAS). Psychological symptoms were evaluated with the Hospital Anxiety and Depression Scale (HADS). Clinical factors and demographic characteristics were predictors of physical and psychological symptoms, as estimated by a generalized estimating equation (GEE).

Results

We found that patients who had a smoking habit and Barcelona Clinic Liver Cancer (BCLC) Stage B disease underwent radiofrequency ablation therapy (RFA) or liver resection, and those who had higher alanine aminotransferase (GPT) level reported more symptoms from baseline to 1 month. Symptoms increased from baseline to 3 months in elderly patients and patients with higher GPT levels. Additionally, patients who had jobs, underwent liver resection, and had BCLC Stage C disease had increased symptoms of depression from baseline to 1 month; in particular, BCLC Stage D disease had negative long-term effects on depression scores from baseline to four-time points following therapy.

Conclusion

Advanced BCLC stage and undergoing RFA or liver resection were most closely associated with worsening physical and psychological symptoms over time. Clinical professionals should pay attention to these factors that affect physical and psychological symptoms during treatment.

Keywords

Hepatocellular carcinoma (HCC) Symptom management theory (SMT) Symptom Depression 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Balogh J, Victor D, Asham EH, Burroughs SG, Boktour M, Saharia A, Li X, Ghobrial RM, Monsour HP (2016) Hepatocellular carcinoma: a review. J Hepatocell Carcinoma 3:41–53.  https://doi.org/10.2147/JHC.S61146 CrossRefGoogle Scholar
  2. 2.
    Bravi F, Bosetti C, Tavani A, Gallus S, La Vecchia C (2013) Coffee reduces risk for hepatocellular carcinoma: an updated meta-analysis. Clinical gastroenterology and hepatology: the official clinical practice. J Am Gastroenterol Assoc 11(11):1413–1421.e1411.  https://doi.org/10.1016/j.cgh.2013.04.039 Google Scholar
  3. 3.
    Wu Q, Qin SK (2013) Features and treatment options of Chinese hepatocellular carcinoma. Chin Clin Oncol 2(4):38.  https://doi.org/10.3978/j.issn.2304-3865.2013.09.07 Google Scholar
  4. 4.
    Umemura T, Ichijo T, Yoshizawa K, Tanaka E, Kiyosawa K (2009) Epidemiology of hepatocellular carcinoma in Japan. J Gastroenterol 44(Suppl 19):102–107.  https://doi.org/10.1007/s00535-008-2251-0 CrossRefGoogle Scholar
  5. 5.
    Yoon SK, Chun HG (2013) Status of hepatocellular carcinoma in South Korea. Chin Clin Oncol 2(4):39.  https://doi.org/10.3978/j.issn.2304-3865.2013.11.08 Google Scholar
  6. 6.
    Ministry of Health and Welfare (2017) Cancer registry annual report. Ministry of Health and Welfare, Taiwan http://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=269&pid=8084. Accessed 15 Aug 2018Google Scholar
  7. 7.
    Patrick DL, Ferketich SL, Frame PS, Harris JJ, Hendricks CB, Levin B, Link MP, Lustig C, McLaughlin J, Ried LD, Turrisi AT 3rd, Unutzer J, Vernon SW (2003) National Institutes of Health state-of-the-science conference statement: symptom management in cancer: pain, depression, and fatigue, July 15-17, 2002. J Natl Cancer Inst 95(15):1110–1117CrossRefGoogle Scholar
  8. 8.
    Kaiser K, Mallick R, Butt Z, Mulcahy MF, Benson AB, Cella D (2014) Important and relevant symptoms including pain concerns in hepatocellular carcinoma (HCC): a patient interview study. Support Care Cancer 22(4):919–926.  https://doi.org/10.1007/s00520-013-2039-5 CrossRefGoogle Scholar
  9. 9.
    Rich N, Singal AG (2014) Hepatocellular carcinoma tumour markers: current role and expectations. Best Pract Res Clin Gastroenterol 28(5):843–853.  https://doi.org/10.1016/j.bpg.2014.07.018 CrossRefGoogle Scholar
  10. 10.
    Shun SC, Chen CH, Sheu JC, Liang JD, Yang JC, Lai YH (2012) Quality of life and its associated factors in patients with hepatocellular carcinoma receiving one course of transarterial chemoembolization treatment: a longitudinal study. Oncologist 17(5):732–739.  https://doi.org/10.1634/theoncologist.2011-0368 CrossRefGoogle Scholar
  11. 11.
    Brant JM, Beck SL, Dudley WN, Cobb P, Pepper G, Miaskowski C (2011) Symptom trajectories during chemotherapy in outpatients with lung cancer colorectal cancer, or lymphoma. Eur J Oncol Nurs 15(5):470–477.  https://doi.org/10.1016/j.ejon.2010.12.002 CrossRefGoogle Scholar
  12. 12.
    Wible BC, Rilling WS, Drescher P, Hieb RA, Saeian K, Frangakis C, Chen Y, Eastwood D, Kim HS (2010) Longitudinal quality of life assessment of patients with hepatocellular carcinoma after primary transarterial chemoembolization. J Vasc Interv Radiol 21(7):1024–1030.  https://doi.org/10.1016/j.jvir.2010.03.005 CrossRefGoogle Scholar
  13. 13.
    Hansen L, Dieckmann NF, Kolbeck KJ, Naugler WE, Chang MF (2017) Symptom distress in patients with hepatocellular carcinoma toward the end of life. Oncol Nurs Forum 44(6):665–673.  https://doi.org/10.1188/17.Onf.665-673 CrossRefGoogle Scholar
  14. 14.
    Lai YH, Shun SC, Hsiao YL, Chiou JF, Wei LL, Tsai JT, Kao CY (2007) Fatigue experiences in hepatocellular carcinoma patients during six weeks of stereotactic radiotherapy. Oncologist 12(2):221–230.  https://doi.org/10.1634/theoncologist.12-2-221 CrossRefGoogle Scholar
  15. 15.
    Krebber AMH, Buffart LM, Kleijn G, Riepma IC, de Bree R, Leemans CR, Becker A, Brug J, van Straten A, Cuijpers P, Verdonck-de Leeuw IM (2014) Prevalence of depression in cancer patients: a meta-analysis of diagnostic interviews and self-report instruments. Psycho-oncology 23(2):121–130.  https://doi.org/10.1002/pon.3409 CrossRefGoogle Scholar
  16. 16.
    Mikoshiba N, Miyashita M, Sakai T, Tateishi R, Koike K (2013) Depressive symptoms after treatment in hepatocellular carcinoma survivors: prevalence, determinants, and impact on health-related quality of life. Psycho-oncology 22(10):2347–2353.  https://doi.org/10.1002/pon.3300 Google Scholar
  17. 17.
    Yang YL, Liu L, Wang Y, Wu H, Yang XS, Wang JN, Wang L (2013) The prevalence of depression and anxiety among Chinese adults with cancer: a systematic review and meta-analysis. BMC Cancer 13:393.  https://doi.org/10.1186/1471-2407-13-393 CrossRefGoogle Scholar
  18. 18.
    Mahendran R, Lim HA, Tan JY, Kua EH, Griva K (2016) The prevalence and predictors of subsyndromal anxiety and depression in adult Asian cancer patients across the first year of diagnosis. Asia Pac J Clin Oncol 12(4):476–489.  https://doi.org/10.1111/ajco.12562 CrossRefGoogle Scholar
  19. 19.
    Sullivan DR, Forsberg CW, Ganzini L, Au DH, Gould MK, Provenzale D, Slatore CG (2016) Longitudinal changes in depression symptoms and survival among patients with lung cancer: a national cohort assessment. J Clin Oncol 34(33):3984–3991.  https://doi.org/10.1200/jco.2016.66.8459 CrossRefGoogle Scholar
  20. 20.
    Stommel M, Kurtz ME, Kurtz JC, Given CW, Given BA (2004) A longitudinal analysis of the course of depressive symptomatology in geriatric patients with cancer of the breast, colon, lung, or prostate. Health Psychol 23(6):564–573.  https://doi.org/10.1037/0278-6133.23.6.564 CrossRefGoogle Scholar
  21. 21.
    Lydiatt WM, Moran J, Burke WJ (2009) A review of depression in the head and neck cancer patient. Clin Adv Hematol Oncol 7(6):397–403Google Scholar
  22. 22.
    Hockenberry M (2004) Symptom management research in children with cancer. J Pediatr Oncol Nurs 21(3):132–136.  https://doi.org/10.1177/1043454204264387 CrossRefGoogle Scholar
  23. 23.
    Berger AM, Cochrane B, Mitchell SA (2009) The 2009-2013 research agenda for oncology nursing. Oncol Nurs Forum 36(5):E274–E282.  https://doi.org/10.1188/09.Onf.E274-e282 CrossRefGoogle Scholar
  24. 24.
    Musliner KL, Munk-Olsen T, Eaton WW, Zandi PP (2016) Heterogeneity in long-term trajectories of depressive symptoms: patterns, predictors and outcomes. J Affect Disord 192:199–211.  https://doi.org/10.1016/j.jad.2015.12.030 CrossRefGoogle Scholar
  25. 25.
    Byam J, Renz J, Millis JM (2013) Liver transplantation for hepatocellular carcinoma. Hepatobiliary Surg Nutr 2(1):22–30.  https://doi.org/10.3978/j.issn.2304-3881.2012.11.03 Google Scholar
  26. 26.
    Raza A, Sood GK (2014) Hepatocellular carcinoma review: current treatment, and evidence-based medicine. World J Gastroenterol 20(15):4115–4127.  https://doi.org/10.3748/wjg.v20.i15.4115 CrossRefGoogle Scholar
  27. 27.
    Rubinstein MM, Kaubisch A, Kinkhabwala M, Reinus J, Liu Q, Chuy JW (2017) Bridging therapy effectiveness in the treatment of hepatocellular carcinoma prior to orthotopic liver transplantation. J Gastrointest Oncol 8(6):1051–1055.  https://doi.org/10.21037/jgo.2017.08.11 CrossRefGoogle Scholar
  28. 28.
    Haberman M (1999) The measurement of symptom distress. In: Yarbro CH, Frogge MH, Goodman M (eds) Cancer symptom management. Jones & Barlett, Boston, p 11Google Scholar
  29. 29.
    Brant JM, Beck S, Miaskowski C (2010) Building dynamic models and theories to advance the science of symptom management research. J Adv Nurs 66(1):228–240.  https://doi.org/10.1111/j.1365-2648.2009.05179.x CrossRefGoogle Scholar
  30. 30.
    Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K (1991) The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 7(2):6–9Google Scholar
  31. 31.
    Forner A, Reig M, Bruix J (2018) Hepatocellular carcinoma. Lancet 391(10127):1301–1314.  https://doi.org/10.1016/S0140-6736(18)30010-2 CrossRefGoogle Scholar
  32. 32.
    Watanabe SM, Nekolaichuk CL, Beaumont C (2012) The Edmonton Symptom Assessment System, a proposed tool for distress screening in cancer patients: development and refinement. Psycho-oncology 21(9):977–985.  https://doi.org/10.1002/pon.1996 CrossRefGoogle Scholar
  33. 33.
    Dong Y, Chen H, Zheng Y, Guo Y, Kwon JH, Liu E, Guo H, Bruera E (2015) Psychometric validation of the Edmonton Symptom Assessment System in Chinese patients. J Pain Symptom Manag 50(5):712–717.e712.  https://doi.org/10.1016/j.jpainsymman.2015.05.018 CrossRefGoogle Scholar
  34. 34.
    Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370CrossRefGoogle Scholar
  35. 35.
    Stern AF (2014) The hospital anxiety and depression scale. Occup Med 64(5):393–394.  https://doi.org/10.1093/occmed/kqu024 CrossRefGoogle Scholar
  36. 36.
    Li Q, Lin Y, Hu C, Xu Y, Zhou H, Yang L, Xu Y (2016) The Chinese version of hospital anxiety and depression scale: psychometric properties in Chinese cancer patients and their family caregivers. Eur J Oncol Nurs 25:16–23.  https://doi.org/10.1016/j.ejon.2016.09.004 CrossRefGoogle Scholar
  37. 37.
    Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the hospital anxiety and depression scale. An updated literature review. J Psychosom Res 52(2):69–77CrossRefGoogle Scholar
  38. 38.
    Arving C, Glimelius B, Brandberg Y (2008) Four weeks of daily assessments of anxiety, depression and activity compared to a point assessment with the hospital anxiety and depression scale. Qual Life Res 17(1):95–104.  https://doi.org/10.1007/s11136-007-9275-4 CrossRefGoogle Scholar
  39. 39.
    Brunot A, Le Sourd S, Pracht M, Edeline J (2016) Hepatocellular carcinoma in elderly patients: challenges and solutions. J Hepatocell Carcinoma 3:9–18.  https://doi.org/10.2147/JHC.S101448 CrossRefGoogle Scholar
  40. 40.
    Nanashima A, Abo T, Nonaka T, Fukuoka H, Hidaka S, Takeshita H, Ichikawa T, Sawai T, Yasutake T, Nakao K, Nagayasu T (2011) Prognosis of patients with hepatocellular carcinoma after hepatic resection: are elderly patients suitable for surgery? J Surg Oncol 104(3):284–291.  https://doi.org/10.1002/jso.21932 CrossRefGoogle Scholar
  41. 41.
    Shih WL, Chang HC, Liaw YF, Lin SM, Lee SD, Chen PJ, Liu CJ, Lin CL, Yu MW (2012) Influences of tobacco and alcohol use on hepatocellular carcinoma survival. Int J Cancer 131(11):2612–2621.  https://doi.org/10.1002/ijc.27508 CrossRefGoogle Scholar
  42. 42.
    Forero CG, Olariu E, Alvarez P, Castro-Rodriguez JI, Blasco MJ, Vilagut G, Perez V, Alonso J (2018) Change in functioning outcomes as a predictor of the course of depression: a 12-month longitudinal study. Qual Life Res 27:2045–2056.  https://doi.org/10.1007/s11136-018-1853-0 CrossRefGoogle Scholar
  43. 43.
    Henry DH, Viswanathan HN, Elkin EP, Traina S, Wade S, Cella D (2008) Symptoms and treatment burden associated with cancer treatment: results from a cross-sectional national survey in the U.S. Support Care Cancer 16(7):791–801.  https://doi.org/10.1007/s00520-007-0380-2 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Internal MedicineChi Mei HospitalLiouyingTaiwan
  2. 2.College of Nursing and Health SciencesDa-Yeh UniversityChanghuaTaiwan
  3. 3.Department of NursingMacKay Memorial HospitalTaipeiTaiwan
  4. 4.Department of NursingMackay Medical CollegeNew Taipei CityTaiwan
  5. 5.Department of NursingHungKuang UniversityTaichungTaiwan

Personalised recommendations