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Health-Related Quality of Life in Patients with Hepatocellular Carcinoma Treated with Initial Transarterial Chemoembolization

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Abstract

Purpose

To investigate the impact of the first transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) on health-related quality of life (HRQoL) and identify predictors for low HRQoL following TACE.

Materials and Methods

HRQoL was prospectively evaluated in 79 patients with standardized questionnaires (QlQ-C30 and HCC18) pre- and 2 weeks post-TACE. Treatment response was evaluated using common tumour response criteria. Clinical parameters [e.g. Eastern Cooperative Oncology Group (ECOG) performance status, Model of End Stage Liver Disease (MELD) score], tumour load and pre-TACE HRQoL scores were tested for predicting HRQoL after TACE.

Results

Patients showed a 12.1% decrease in global health score (GHS). Major decreases were observed for physical (−21.4%), role (−23.4%), and social (−21.5%) functioning and increases in symptom severity for fatigue (+30.1%), loss of appetite (+25.3%), pain (+19.4%) after TACE. ECOG performance status >1 was associated with increased nausea/vomiting (p = 0.002) and decreased GHS (p = 0.01). MELD score >10 was associated with increased fatigue (p = 0.021) and abdominal swelling (p < 0.001). Our study showed an increase in symptom severity in patients with no symptoms before TACE for pain (p = 0.005) and abdominal swelling (p < 0.001).

Conclusion

The first TACE for treatment of HCC does not result in a major loss of HRQoL in general. For TACE as a palliative therapy maintaining HRQoL is of critical importance and standardized HRQoL assessment can help to detect HRQoL problems.

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Abbreviations

TACE:

Transarterial chemoembolization

HCC:

Hepatocellular carcinoma

HRQol:

Health-related quality of life

EORTC:

European Organisation for Research and Treatment of Cancer

RECIST:

Response evaluation criteria in solid tumours

WHO:

World Health Organization

mRECIST:

Modified response evaluation criteria in solid tumours

EASL:

European Association for the Study of the Liver

MELD:

Model of End Stage Liver Disease

ECOG:

Eastern Cooperative Oncology Group

GHS:

Global health status

BCLC:

Barcelona Clinic Liver Cancer

SD:

Standard deviation

CPS:

Child–Pugh score

SIR:

Society of Interventional Radiology

SIRT:

Selective internal radiotherapy

RFA:

Radio frequency ablation

DEB TACE:

Drug-eluting beads TACE

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Acknowledgements

This study was supported by a Grant from the ART (Arbeitsgemeinschaft Regionale Tumortherapie; German workforce for regional tumour therapy).

Author's Contribution

JBH and DBH: Conception, acquisition of data, draft, interpretation, MN and NS: Acquisition of data, FW: Revision, conception, draft, AV: Revision, MMK: Major Revision CVIR clinical part, SM: Major Revision CVIR radiological part, TR: Conception, interpretation, draft, revision.

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Authors and Affiliations

  1. Institute for Diagnostic and Interventional Radiology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Jan B. Hinrichs, Davut B. Hasdemir, Maximilian Nordlohne, Frank Wacker, Steffen Marquardt & Thomas Rodt

  2. Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Nora Schweitzer, Arndt Vogel & Martha M. Kirstein

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  1. Jan B. Hinrichs
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Correspondence to Jan B. Hinrichs.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Hinrichs, J.B., Hasdemir, D.B., Nordlohne, M. et al. Health-Related Quality of Life in Patients with Hepatocellular Carcinoma Treated with Initial Transarterial Chemoembolization. Cardiovasc Intervent Radiol 40, 1559–1566 (2017). https://doi.org/10.1007/s00270-017-1681-6

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