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World J Hepatol. 2017 Jul 18;9(20):867-883. doi: 10.4254/wjh.v9.i20.867.

Value of quality of life analysis in liver cancer: A clinician's perspective.

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Leung Li, Winnie Yeo, Department of Clinical Oncology, Prince of Wales Hospital, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, China.


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.


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

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Conflict-of-interest statement: No potential conflicts of interest. No financial support.

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