Review
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jul 18, 2017; 9(20): 867-883
Published online Jul 18, 2017. doi: 10.4254/wjh.v9.i20.867
Value of quality of life analysis in liver cancer: A clinician’s perspective
Leung Li, Winnie Yeo
Leung Li, Winnie Yeo, Department of Clinical Oncology, Prince of Wales Hospital, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China
Author contributions: Both authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Winnie Yeo, MBBS (Lond), AKC (Lond), FHKCP (HK), FHKAM (HK), FRCP (Lond), FRCP (Edin), Professor, Department of Clinical Oncology, Prince of Wales Hospital, Faculty of Medicine, the Chinese University of Hong Kong, Shatin, NT, Hong Kong, China. winnieyeo@cuhk.edu.hk
Telephone: +852-26322118 Fax: +852-26487097
Received: February 21, 2017
Peer-review started: February 26, 2017
First decision: March 29, 2017
Revised: May 15, 2017
Accepted: May 22, 2017
Article in press: May 24, 2017
Published online: July 18, 2017
Abstract

Health related quality of life (HRQOL) is increasingly recognized as an important clinical parameter and research endpoint in patients with hepatocellular carcinoma (HCC). HRQOL in HCC patients is multifaceted and affected by medical factor which encompasses HCC and its complications, oncological and palliative treatment for HCC, underlying liver disease, as well as the psychological, social or spiritual reaction to the disease. Many patients presented late with advanced disease and limited survival, plagued with multiple symptoms, rendering QOL a very important aspect in their general well being. Various instruments have been developed and validated to measure and report HRQOL in HCC patients, these included general HRQOL instruments, e.g., Short form (SF)-36, SF-12, EuroQoL-5D, World Health Organization Quality of Life Assessment 100 (WHOQOL-100), World Health Organization Quality of Life Assessment abbreviated version; general cancer HRQOL instruments, e.g., the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30, Functional Assessment of Cancer Therapy (FACT)-General, Spitzer Quality of Life Index; and liver-cancer specific HRQOL instruments, e.g., EORTC QLQ-HCC18, FACT-Hepatobiliary (FACT-Hep), FACT-Hep Symptom Index, Trial Outcome Index. Important utilization of HRQOL in HCC patients included description of symptomatology and HRQOL of patients, treatment endpoint in clinical trial, prognostication of survival, benchmarking of palliative care service and health care valuation. In this review, difficulties regarding the use of HRQOL data in research and clinical practice, including choosing a suitable instrument, problems of missing data, data interpretation, analysis and presentation are examined. Potential solutions are also discussed.

Keywords: Hepatocellular carcinoma, Health related quality of life, Palliative care, Prognosis, Survival, The European Organisation for Research and Treatment of Cancer QLQ-C30, QLQ-HCC18, Index score, Functional Assessment of Cancer Therapy, EQ-5D, Spitzer, Short form 36, FHSI-8, World Health Organization Quality of Life Assessment

Core tip: Health related quality of life (HRQOL) is an important clinical parameter and research endpoint in hepatocellular carcinoma (HCC) patients. Instruments discussed are short form (SF)-36, SF-12, EQ-5D, World Health Organization Quality of Life Assessment (WHOQOL) 100, WHOQOL-BREF, the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30, Functional Assessment of Cancer Therapy (FACT)-G, Spitzer QoL index, EORTC QLQ-HCC18, FACT-Hep, FHSI-8, TOI. Important utilization of HRQOL included measurement and monitoring of HRQOL, treatment endpoint in clinical trial, prognostication of survival, benchmarking of palliative care service and health care valuation. Various difficulties in using HRQOL data in research and clinical practice, including choosing a suitable instrument, missing data, data interpretation, analysis and presentation are explained. Potential solutions are also discussed.