Health-Related Quality of Life and Adjustment in Patients with Hepatocellular Carcinoma

Abstract The overall purpose of this thesis were to explore the impact of hepatocellular carcinoma (HCC) on patients’ health-related quality of life (HRQOL), the significant predictors of adjustment outcomes, as well as to establish an adjustment model in patients with HCC. This thesis included three studies: systematic review, qualitative and quantitative study. Systematic review. HCC and HRQOL relevant keywords were combined and 36 articles were recruited in this review. The main finding indicated patients with HCC had worse physical, emotional, and functional HRQOL; but better social/family HRQOL than the general population. The medical and physical variables associated with HRQOL also identified. Qualitative study. Thirty-three patients with HCC in Taiwan were recruited, and semi-structured interview was used to collect data to explore patients’ experience in illness journey. Four themes were identified, including the impact of disease, the illness perceptions of HCC, the information needs and the coping strategies. A preliminary model of illness adjustment was also developed. Quantitative study. Standardized questionnaires were used to measure HRQOL, anxiety and depression, illness perceptions, coping, and social support; and demographic and physical variables were also collected (n=286). Patients with HCC had worse global HRQOL, physical, role, cognitive, social functioning, and more higher levels of depression than the general population; and the prevalence of anxiety, depression and emotional distress were 11.27%, 25.44%, and 20.14% respectively. Physical variables explained a significant amount of variance in all EORTC and HADS scores (R2=.17-.62). Illness perceptions explained an additional 4.33%-31.80% of the variance in the EORTC and HADS scores after controlling for ECOG and α-FP. Cognitive representations mediated the effects of ECOG on the EORTC and HADS scores, and coping mediated the effects of cognitive representations on psychological aspects of adjustment outcomes. An adjustment model with multiple pathways was developed based on both quantitative and qualitative findings. Suggestions are made for improving clinical care for patients with HCC and future studies.