Clinical study
Longitudinal Quality of Life Assessment of Patients with Hepatocellular Carcinoma after Primary Transarterial Chemoembolization

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Purpose

To determine the effects of primary chemoembolization on the health-related quality of life (HRQOL) of patients with hepatocellular carcinoma (HCC).

Materials and Methods

Single-center prospective data collection with longitudinal analysis of HRQOL scores obtained via the Short Form–36 (SF-36) assessment tool was performed before and during serial chemoembolization procedures in 73 patients with HCC. Baseline HRQOL scores were evaluated for significant (P < .05) change within the total patient population during 4, 8, and 12 months of treatment, and separately within a subset of 23 patients who underwent three or more chemoembolization procedures.

Results

Patients had decreased pretreatment baseline scores within all eight scales of the SF-36 compared with healthy age-adjusted norms. Within the total population, mental health scores improved after 4 months of chemoembolization (rate of change, 5.6; P = .05; n = 48), but no significant change was present at 8 or 12 months. Subset patients experienced improvements of mental health scores after the first (score change, 13; P = .008; n = 21) and second procedures (score change, 12.2; P = .002; n = 23) and improvements of bodily pain scores (score change, 9.9; P = .047; n = 21) after the initial procedure. Vitality scores worsened (score change, −7.8; P = .044; n = 21) in the subset after the first chemoembolization.

Conclusions

Patients with HCC are likely to perceive improved mental health during the first 4 months of primary treatment with chemoembolization. In addition, if patients ultimately undergo more than two procedures, they are likely to perceive improved mental health during the first two sessions, with decreased bodily pain during the initial session. Patient-perceived vitality will likely worsen after the initial procedure.

Section snippets

Study Design

Institutional review board approval was obtained for the study, in which prospective, nonrandomized, single-institution data collection with longitudinal analysis of HRQOL data was performed. HRQOL scores were obtained via the Short Form–36 (SF-36) Health Survey Forms (version 1) between October 2000 and October 2005. Study inclusion criteria required that patients have a diagnosis of HCC, receive no previous treatment (eg, surgical resection, transplant, systemic chemotherapy, external-beam

Results

During the course of this study, 196 patients underwent transcatheter chemoembolization at our institution, 116 of whom had HCC. A total of 73 patients who underwent 163 surveyed procedures met our study criteria, during which time 129 SF-36 HRQOL surveys were completed, resulting in a SF-36 completion rate of 79%. Incomplete SF-36 surveys were dispersed among the patients. Time between subsequent chemoembolization procedures was determined by patient-specific clinical and radiographic factors,

Discussion

Mental health scores improved in patients with HCC after 4 months of image-guided transcatheter tumor therapy with chemoembolization. A subset of patients who completed three or more chemoembolization procedures exhibited improved mental health scores after the first and second procedures. This subset also exhibited improvement of bodily pain scores, but worsening of vitality scores, after the first chemoembolization. A search of the English literature found no other longitudinal study

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    None of the authors have identified a conflict of interest.

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