Hepatocellular carcinoma and its impact on quality of life: A review of the qualitative literature

Abstract

Introduction: Hepatocellular carcinoma (HCC) carries significant burden of disease, with high mortality rates and poor prognosis. It is therefore important to consider quality of life (QoL) for patients with HCC. Quantitative research assesses HCC and QoL via standardised measurement tools, but these do not capture the full scope of patient experiences. This review examines the body of qualitative research on this topic, to develop a comprehensive understanding of QoL for this population.Methods: Medline, EMBASE and PsycINFO were systematically searched with keywords relating to HCC, QoL and patient experience. After applying inclusion and exclusion criteria, key findings of included studies were extracted and analysed for themes.Results: Eleven studies were included for thematic analysis, with five themes identified as central to QoL: (1) burden of physical symptoms and treatment side effects;(2) psychological impact and coping strategies; (3) social function and stigma; (4) spiritual wellbeing, sense of self and meaning of illness and (5) pervasive uncertainty. Conclusion:HCC profoundly impacted patients' lives, spanning physical, psychological, social and spiritual QoL domains. While QoL was reduced overall, some features of patient experiences that enhanced QoL were noted. The findings complement data from quantitative studies, helping to build a richer understanding of QoL.hepatocellular carcinoma (one key word preferably), liver neoplasms, palliative care, qualitative research, quality of life | INTRODUCTIONHepatocellular carcinoma (HCC) is the main form of primary liver cancer and one of the most common malignancies worldwide (Bray et al., 2018;McGlynn et al., 2021). Aetiology of HCC varies, but Hepatitis B virus (HBV), Hepatitis C virus (HCV) and high alcohol consumption are all important risk factors (Singal et al., 2020). Liver cirrhosis is a primary risk factor for HCC regardless of underlying cause (Singal et al., 2020). HCC also carries a high mortality rate and is the fourth leading cause of cancer-related deaths (Bray et al., 2018;Singal et al., 2020). Five-year survival rates are globally less than 20%, in part because the absence of symptoms in early stages leads to delayed diagnosis (Laube et al., 2021). By the time of diagnosis, most patients This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Effect of multi-disciplinary team care program on quality of life, anxiety, and depression in hepatocellular carcinoma patients after surgery: A randomized, controlled study

“…HCC has a profound negative impact on patients' QoL (27). In addition, the fear of recurrence, especially after surgery or liver transplantation, also seriously affects this (28).…”

Stigmatization of drinking patients with liver cancer: The role of socioeconomic status

“…In fact, the general public's representation of liver disease often includes the idea that a patient's disease was caused by alcohol consumption, which may be true or not [ 32 , 35 , 36 ]. As a consequence, patients with liver diseases may experience stigma and a strong feelings of shame [ 37 , 38 ]. Several studies showed that stigma can cause considerable distress in liver cancer patients [ 37 , 38 ], increasing the risk of depression and anxiety [ 39 , 40 ] and decreasing patients' quality of life [ 13 ].…”

“…As a consequence, patients with liver diseases may experience stigma and a strong feelings of shame [ 37 , 38 ]. Several studies showed that stigma can cause considerable distress in liver cancer patients [ 37 , 38 ], increasing the risk of depression and anxiety [ 39 , 40 ] and decreasing patients' quality of life [ 13 ].…”

Immunotherapy for the treatment of hepatocellular carcinoma: finally in clinical practice

“…In fact, QoL comprehends not only clinical problems but also psychological, social and financial disease-related burdens: if QoL decreases, and liver function decompensation occurs, an upgrade of supportive treatment strategies is necessary. QoL should be an essential parameter for clinical outcomes in future prospective trials, particularly in those attempting the development of new therapeutic associations ( 12 ). We also strongly agree with SITC guideline on the institution of a more patient-centered medical environment, based on comprehensive counseling and education about expected or unexpected effects from treatment, and involvement in support groups.…”