Published online Jul 18, 2017. doi: 10.4254/wjh.v9.i20.867
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
Processing time: 145 Days and 23.2 Hours
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.
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.