Role functioning is associated with survival in patients with hepatocellular carcinoma
- 165 Downloads
Prior studies assessing quality of life (QOL) in patients with hepatocellular carcinoma (HCC) primarily included patients with preserved liver function and/or early HCC, leading to overestimation of QOL. Our study’s aim was to evaluate the association of QOL with survival among a cohort of cirrhotic patients with HCC that was diverse with respect to liver function and tumor stage.
We conducted a prospective cohort study among cirrhotic patients with HCC from a large urban safety-net hospital between April 2011 and September 2013. Patients completed two self-administered surveys, the EORTC QLQ-C30 and QLQ-HCC18, prior to the treatment. We used generalized linear models to identify correlates of QOL. Survival curves were generated using Kaplan–Meier analysis and compared using log rank test to determine whether QOL is associated with survival.
A total of 130 treatment-naïve patients completed both surveys. Patients reported high cognitive and social function (median scores 67) but poor global QOL (median score 50) and poor role function (median score 50). QOL was associated with cirrhosis-related (p = 0.02) and tumor-related (p = 0.02) components of Barcelona Clinic Liver Cancer (BCLC) tumor stage. QOL was associated with survival on univariate analysis (HR 0.37, 95 % CI 0.16–0.85) but became nonsignificant (HR 0.82, 95 % CI 0.37–1.80) after adjusting for BCLC stage and treatment. Role functioning was significantly associated with survival (HR 0.40, 95 % CI 0.20–0.81), after adjusting for Caucasian race (HR 0.31, 95 % CI 0.16–0.59), BCLC stage (HR 1.51, 95 % CI 0.21–1.89), and treatment (HR 0.57, 95 % CI 0.33–0.97).
Role function has prognostic significance and is important to assess in patients with HCC.
KeywordsLiver cancer Quality of life Role function Prognosis
This work was conducted with support from the National Center for Advancing Translational Sciences of the National Institutes of Health under award KL2TR001103. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Conflict of interest
None of the authors have any conflict of interest relevant to this manuscript.
- 1.El-Serag, H. B. (2012). Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology, 142(1264–1273), e1261.Google Scholar
- 9.Singal AG, X. L, Tiro J, Kandunoori P, Adams-Huet B, et al. (2014) Racial, social, and clinical determinants of hepatocellular carcinoma surveillance. The American Journal of Medicine. doi: 10.1016/j.amjmed.2014.07.027
- 11.Bonnetain, F., Paoletti, X., Collette, S., Doffoel, M., Bouche, O., et al. (2008). Quality of life as a prognostic factor of overall survival in patients with advanced hepatocellular carcinoma: Results from two French clinical trials. Quality of Life Research, 17, 831–843.PubMedCrossRefGoogle Scholar
- 20.Blazeby, J. M., Currie, E., Zee, B. C., Chie, W. C., Poon, R. T., et al. (2004). Development of a questionnaire module to supplement the EORTC QLQ-C30 to assess quality of life in patients with hepatocellular carcinoma, the EORTC QLQ-HCC18. European Journal of Cancer, 40, 2439–2444.PubMedCrossRefGoogle Scholar
- 21.Chie, W. C., Blazeby, J. M., Hsiao, C. F., Chiu, H. C., Poon, R. T., et al. (2012). International cross-cultural field validation of an European Organization for Research and Treatment of Cancer questionnaire module for patients with primary liver cancer, the European Organization for Research and Treatment of Cancer quality-of-life questionnaire HCC18. Hepatology, 55, 1122–1129.PubMedCrossRefGoogle Scholar
- 24.de Borja, M. T., Chow, E., Bovett, G., Davis, L., & Gillies, C. (2004). The correlation among patients and health care professionals in assessing functional status using the karnofsky and eastern cooperative oncology group performance status scales. Support Cancer Therapy, 2, 59–63.CrossRefGoogle Scholar
- 25.de Kock, I., Mirhosseini, M., Lau, F., Thai, V., Downing, M., et al. (2013). Conversion of Karnofsky Performance Status (KPS) and Eastern Cooperative Oncology Group Performance Status (ECOG) to Palliative Performance Scale (PPS), and the interchangeability of PPS and KPS in prognostic tools. Journal of Palliative Care, 29, 163–169.PubMedGoogle Scholar