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Kim MS, Uhm JY. Impact of discriminant factors on the comfort-care of nurses caring for trans-arterial chemoembolisation patients. Support Care Cancer 2022; 30:7773-7781. [PMID: 35710640 DOI: 10.1007/s00520-022-07221-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 03/13/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE This study was conducted to identify the levels of comfort-care provided by trans-arterial chemoembolisation (TACE) nurses and examine the discriminant factors thereof. METHODS Nurses (n = 146) with experience in caring for TACE patients, participated in this study. The data were collected using an online self-rated questionnaire and analysed with descriptive statistics and discriminant analysis. The discriminating factors included perception of post-embolisation syndrome and symptom interference, caring attitude, barriers to pain and nausea/vomiting management, and supportive care competence. RESULTS The participants were classified into three groups, depending on the level of their comfort-care: "low" (n = 27), "moderate" (n = 88), and "high" (n = 31) comfort-care groups. One function significantly discriminated between the low and high comfort-care groups and correctly classified 79.3% of the participants in the cross-validation run. Supportive care competence (0.864), caring attitude (0.685), perception of symptom interference (0.395), perception of post-embolisation syndrome (0.321), and barriers to nausea/vomiting management (- 0.343) were significant discriminant factors of comfort-care. CONCLUSION A low proportion of the participants provided high levels of comfort-care, which was determined by five discriminant factors. The study's findings imply that the development of supportive care competence, authentic human caring attitude, early detection of patients' symptoms and symptom interference, and the development of manuals and guidelines for removing barriers for nausea and vomiting are needed to improve the comfort-care of nurses caring for TACE patients.
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Affiliation(s)
- Myoung Soo Kim
- Department of Nursing, Pukyong National University, Yongso-ro 45, Busan, 48513, Korea
| | - Ju-Yeon Uhm
- Department of Nursing, Pukyong National University, Yongso-ro 45, Busan, 48513, Korea.
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Wohlleber K, Heger P, Probst P, Engel C, Diener MK, Mihaljevic AL. Health-related quality of life in primary hepatic cancer: a systematic review assessing the methodological properties of instruments and a meta-analysis comparing treatment strategies. Qual Life Res 2021; 30:2429-2466. [PMID: 34283381 PMCID: PMC8405513 DOI: 10.1007/s11136-021-02810-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Patient-reported outcomes including health-related quality of life (HRQoL) are important oncological outcome measures. The validation of HRQoL instruments for patients with hepatocellular and cholangiocellular carcinoma is lacking. Furthermore, studies comparing different treatment options in respect to HRQoL are sparse. The objective of the systematic review and meta-analysis was, therefore, to identify all available HRQoL tools regarding primary liver cancer, to assess the methodological quality of these HRQoL instruments and to compare surgical, interventional and medical treatments with regard to HRQoL. METHODS A systematic literature search was conducted in MEDLINE, the Cochrane library, PsycINFO, CINAHL and EMBASE. The methodological quality of all identified HRQoL instruments was performed according to the COnsensus-based Standards for the selection of health status Measurements INstruments (COSMIN) standard. Consequently, the quality of reporting of HRQoL data was assessed. Finally, wherever possible HRQoL data were extracted and quantitative analyses were performed. RESULTS A total of 124 studies using 29 different HRQoL instruments were identified. After the methodological assessment, only 10 instruments fulfilled the psychometric criteria and could be included in subsequent analyses. However, quality of reporting of HRQoL data was insufficient, precluding meta-analyses for 9 instruments. CONCLUSION Using a standardized methodological assessment, specific HRQoL instruments are recommended for use in patients with hepatocellular and cholangiocellular carcinoma. HRQoL data of patients undergoing treatment of primary liver cancers are sparse and reporting falls short of published standards. Meaningful comparison of established treatment options with regard to HRQoL was impossible indicating the need for future research.
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Affiliation(s)
- Kerstin Wohlleber
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Patrick Heger
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
- The Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Pascal Probst
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
- The Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Härtelstraße 16-18, 04107, Leipzig, Germany
| | - Markus K Diener
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
- The Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - André L Mihaljevic
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
- The Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Health-related quality of life in locally advanced hepatocellular carcinoma treated by either radioembolisation or sorafenib (SARAH trial). Eur J Cancer 2021; 154:46-56. [PMID: 34243077 DOI: 10.1016/j.ejca.2021.05.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/17/2021] [Accepted: 05/23/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The aim of this ancillary study of the SARAH trial is to compare health-related quality of life (HRQoL) in patients with locally advanced or inoperable hepatocellular carcinoma (HCC) treated with transarterial radioembolisation (TARE) or sorafenib. METHODS This study included randomised patients who received either TARE or at least one dose of sorafenib with no major deviation in the protocol and who had at least one QoL follow-up assessment in addition to the baseline evaluation. QoL was assessed from the date of randomisation using the European Organisation for Research and Treatment of Cancer QLQ-C30 questionnaire, until disease progression or other reasons for stopping study participation. Data were analysed using linear mixed and time-dependent models. RESULTS A total of 285 patients were included (122 and 163, in the TARE and sorafenib groups, respectively). Questionnaire completion rates were similar (77.5% versus 80.4%, in the TARE and sorafenib groups, respectively, p = 0.25). Longitudinal HRQoL analysis showed a significant treatment and time effects for fatigue and global health status, and significant treatment, time and treatment by time interaction effects for appetite loss, diarrhoea and social functioning. The median time to deterioration for the global health status was 3.9 months (95% confidence interval [CI] 3.7-4.3) versus 2.6 months (95% CI 2.0-3.0) in the TARE and sorafenib groups, respectively. CONCLUSIONS HRQoL was preserved longer with TARE than with sorafenib in locally advanced HCC. These data could be used to optimise management of patients with advanced or inoperable HCC.
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Guidelines for Perioperative Care for Pancreatoduodenectomy: Enhanced Recovery After Surgery (ERAS) Recommendations 2019. World J Surg 2020; 44:2056-2084. [DOI: 10.1007/s00268-020-05462-w] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Das A, Gabr A, O'Brian DP, Riaz A, Desai K, Thornburg B, Kallini JR, Mouli S, Lewandowski RJ, Salem R. Contemporary Systematic Review of Health-Related Quality of Life Outcomes in Locoregional Therapies for Hepatocellular Carcinoma. J Vasc Interv Radiol 2019; 30:1924-1933.e2. [PMID: 31685362 DOI: 10.1016/j.jvir.2019.07.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 06/03/2019] [Accepted: 07/19/2019] [Indexed: 12/12/2022] Open
Abstract
Health-related quality of life has become an important aspect in oncologic decision making. Recent data suggest that Health-Related Quality of Life (HRQoL) measurements can play an important prognostic role in patients with hepatocellular carcinoma (HCC). Locoregional therapies (LRTs) such as radiofrequency ablation, transarterial chemoembolization, and radioembolization (TARE) are important parts of HCC management. Results demonstrated that radiofrequency ablation treatment results in improving HRQoL compared to surgery for up to 3 years after treatment. Between TARE and transarterial chemoembolization, TARE provides the most benefit in terms of HRQoL. This systematic review investigated contemporary data surrounding HRQoL in patients undergoing LRTs and its impact on clinical decision making.
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Affiliation(s)
- Arighno Das
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago Illinois
| | - Ahmed Gabr
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago Illinois
| | - Daniel P O'Brian
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago Illinois
| | - Ahsun Riaz
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago Illinois
| | - Kush Desai
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago Illinois
| | - Bartley Thornburg
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago Illinois
| | - Joseph R Kallini
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago Illinois
| | - Samdeep Mouli
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago Illinois
| | - Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago Illinois; Department of Medicine, Division of Hematology and Oncology, Northwestern University, Chicago Illinois
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago Illinois; Department of Medicine, Division of Hematology and Oncology, Northwestern University, Chicago Illinois.
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Comparison of health-related quality of life after transarterial chemoembolization and transarterial radioembolization in patients with unresectable hepatocellular carcinoma. Abdom Radiol (NY) 2019; 44:1554-1561. [PMID: 30311050 DOI: 10.1007/s00261-018-1802-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to compare quality of life (QoL) after two different transarterial therapies [transarterial chemoembolization (TACE) and transarterial radioembolization (TARE)] for patients with unresectable hepatocellular carcinoma (HCC) to assess tumor therapy in palliative situation additional to traditional aims like survival or image response. MATERIAL AND METHODS QoL was evaluated with two validated questionnaires (EORTC QLQ-30 and EORTC HCC18) before and 14d after treatment in 94 initial therapies (TACE n = 67; TARE n = 27). QoL changes after treatment were analyzed. Tumor response was evaluated using RECIST/WHO/mRECIST/EASL criteria. A multivariate linear regression was undertaken to identify potential influence factors on change of QoL. RESULTS Mean return rate of questionnaires was 71.3% allowing analysis of 67 therapies (TACE n = 46; TARE n = 21). Initial global health status/QoL was significantly higher in TACE (62.5%) compared to TARE with 50.8%. Absolute global health decrease was higher in TACE (- 10.5%) compared to TARE (- 4.8%, p = 0.396). Also relative global health decrease was higher in TACE (- 16.82%) compared to TARE (- 9.37%). Findings for other items were corresponding, as less impairment was found for TARE compared to TACE for physical/social functioning, fatigue and pain. Objective mRECIST response rate was 22.8% in TACE and 21.1% in TARE. CONCLUSION Neither TACE nor TARE showed a major decrease in QoL after first treatment. TACE showed a slightly but not significantly higher decrease, so this study is not clearly in favor for one treatment. But with the addition that TARE showed less decrease even in patients with higher tumor burden and lower baseline.
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Sobotka LA, Hinton A, Conteh LF. African Americans are less likely to receive curative treatment for hepatocellular carcinoma. World J Hepatol 2018; 10:849-855. [PMID: 30533185 PMCID: PMC6280157 DOI: 10.4254/wjh.v10.i11.849] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 07/23/2018] [Accepted: 08/21/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To determine if racial disparities continue to exist in the treatment of hepatocellular carcinoma (HCC).
METHODS A retrospective database analysis using the Nationwide Inpatient Sample was performed including patients with a primary diagnosis of HCC. Univariate and multivariate analyses were utilized to determine racial disparities in liver decompensation, treatment, inpatient mortality, and metastatic disease.
RESULTS A total of 62604 patients with HCC were included consisting of 32428 Caucasian, 9726 African-American, 8988 Hispanic, and 11462 patients of other races. Caucasian patients were more likely to undergo curative therapies of liver transplant (OR: 2.66, 95%CI: 1.92-3.68), resection (OR: 1.82, 95%CI: 1.48-2.23), and ablation (OR: 1.77, 95%CI: 1.36-2.30) than African-American patients. Hispanic patients were more likely to undergo transplant (OR: 2.18, 95%CI: 1.40-3.39) and ablation (OR: 1.46, 95%CI: 1.05-2.03) than African-American patients. Patients of other races were more likely to receive a liver transplant (OR: 2.41, 95%CI: 1.62-3.61), resection (OR: 1.79 95%CI: 1.39-2.32), and ablation (OR: 2.03, 95%CI: 1.47-2.80) than African-American patients. There are no differences in the rates of transarterial chemoembolization between races.
CONCLUSION Racial disparities in HCC treatment exist despite emphasis to support equality in healthcare. African-American patients are less likely to undergo curative treatments for HCC.
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Affiliation(s)
- Lindsay A Sobotka
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Alice Hinton
- Division of Biostatistics, College of Public Health, The Ohio State University, OH 43210, United States
| | - Lanla F Conteh
- Department of Gastroenterology and Hepatology, The Ohio State Wexner Medical Center, Columbus, OH 43210, United States
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Quality of life in patients undergoing repetitive TACE for the treatment of intermediate stage HCC. J Cancer Res Clin Oncol 2018; 144:1991-1999. [PMID: 30008024 DOI: 10.1007/s00432-018-2704-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 07/05/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE With a limited overall survival (OS) of 20 months in patients diagnosed with intermediate stage hepatocellular carcinoma (HCC), the preservation of quality of life (QoL) during transarterial chemoembolization (TACE) procedures remains a primary goal. The aim of our study was to evaluate the change in QoL amongst patients undergoing repetitive TACE and to identify specific risk factors that may predict change in QoL. METHODS QoL was assessed in 82 patients undergoing at least two TACE, before and 14 days after TACE, using validated EORTC QLQ-C30 and EORTC HCC18 questionnaires. Tumour response was assessed using established response criteria. Laboratory and clinical parameters were analysed. RESULTS Functional scores decreased due to first TACE treatment (p < 0.01), conversely symptom scores increased significantly (p < 0.01). During repetitive TACE no statistically significant changes were observed. Higher Global Health- and Physical Functioning scores at baseline were identified as independent prognostic factors for greater decrease in QoL. Tumour response did not alter QoL at all. Furthermore higher symptom scales including pain (p = 0.00), nausea and vomiting (p = 0.00) and fever (p < 0.01 for repetitive TACE) at baseline were predictive of a significantly lesser increase of symptom severity, and a greater reduction in pain during a course of TACE. Higher C-reactive protein (CRP) at baseline and female gender were associated with a greater decrease of functional scales and increase of symptom scales. CONCLUSION QoL amongst patients receiving repetitive TACE showed neither significant nor clinically relevant changes over time. Pre-treatment assessment of QoL-scores, clinical and laboratory parameters can improve patient selection for TACE whilst optimizing QoL.
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Tong DP, Wu LQ, Chen XP, Li Y. Post-operative care of interventional therapy for 40 liver cancer patients with obstructive jaundice. Eur J Cancer Care (Engl) 2018; 27:e12858. [PMID: 29767833 DOI: 10.1111/ecc.12858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2018] [Indexed: 11/29/2022]
Abstract
The care of 40 patients with primary liver cancer with obstructive jaundice treated with liver puncture bile drainage or biliary stent implantation was reported. Treated with the interventional therapy, patients were observed closely to identify symptoms of hepatic encephalopathy and pain; diet care was well performed. Bile drainage tube and skin acre were performed carefully. Liver function, bilirubin and other biochemical indicators were monitored; occurrence of bleeding, acute pancreatitis, biliary tract infection, leakage of ascites around drainage tube and other complication were observed with good discharge instruction. After this operation, three rounds of liver had poor function, and hepatic encephalopathy and death occurred during hospitalisation. Seven patients had bloody bile drainage fluid after operation; eight had increased blood amylase; nine had biliary infection and four had leakage of ascites around the drainage tube. After positive treatment and care, the situation was improved with varied degrees of jaundice increase.
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Affiliation(s)
- De-Ping Tong
- Department of Oncology, Beibei Traditional Chinese Medical Hospital, Chongqing, China
| | - Li-Qin Wu
- Department of Oncology, Beibei Traditional Chinese Medical Hospital, Chongqing, China
| | - Xiao-Ping Chen
- Department of Oncology, Beibei Traditional Chinese Medical Hospital, Chongqing, China
| | - Yi Li
- Department of Oncology, Beibei Traditional Chinese Medical Hospital, Chongqing, China
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Thayer D, Noda C, Charalel R, Mills A, Chang R, Tao Y, Akinwande O. Survival comparison of hepatocellular carcinoma patients treated with radioembolization versus nonoperative/interventional treatment. J Comp Eff Res 2018; 7:343-356. [PMID: 29553286 DOI: 10.2217/cer-2017-0064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM To compare the overall survival (OS) and liver cancer-specific survival of advanced-stage hepatocellular carcinoma (HCC) patients who received transarterial radioembolization (TARE) with those who received nonoperative/interventional treatment (NOT). MATERIALS & METHODS A total of 12,520 HCC patients from the Surveillance, Epidemiology and End Results database were categorized by treatment with either radioembolization or NOT. Kaplan-Meier and multivariate Cox regression were conducted. RESULTS The TARE group had both a significantly longer median overall survival than the NOT group (TARE = 9 months; NOT = 2 months; p < 0.0001) and a significantly higher probability of liver cancer-specific survival (hazard ratio = 0.474). CONCLUSION TARE appears to provide a significant survival advantage over the NOT population in advanced HCC patients.
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Affiliation(s)
- David Thayer
- Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO 63110, USA
| | - Christopher Noda
- Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO 63110, USA
| | - Resmi Charalel
- Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO 63110, USA
| | - Abigail Mills
- Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO 63110, USA
| | - Randy Chang
- Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St Louis, St Louis, MO 63110, USA
| | - Yu Tao
- Siteman Biostatistics, Washington University School of Medicine in St Louis, St Louis, MO 63110, USA
| | - Olaguoke Akinwande
- Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO 63110, USA.,Siteman Cancer Center, Washington University School of Medicine in St Louis, St Louis, MO 63110, USA
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Rostas JW, Tam AL, Sato T, Scoggins CR, McMasters KM, Martin RCG. Health-related quality of life during trans-arterial chemoembolization with drug-eluting beads loaded with doxorubicin (DEBDOX) for unresectable hepatic metastases from ocular melanoma. Am J Surg 2017; 214:884-890. [PMID: 28754534 DOI: 10.1016/j.amjsurg.2017.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 06/26/2017] [Accepted: 07/11/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND We have previously reported favorable response and survival rates using drug-eluting beads loaded with doxorubicin (DEBDOX) for unresectable hepatic metastases. This study investigates the quality of life (QoL) impact of DEBDOX for the treatment of unresectable hepatic metastases from melanoma. METHODS A multi-center, prospective, non-controlled clinical trial was reviewed. QoL was assessed at baseline and after each treatment, and doxorubicin-specific effects were assessed after each treatment. RESULTS Twenty patients received 61 DEBDOX treatments. After each treatment, at least 83% of patients reported "little" to "none" doxorubicin-related symptoms. For the 8 FACT-Hep subscales, QoL scores were unchanged through 3 treatments for 18 of 24 total time points by ANOVA, with a small-to-moderate ES change through the last treatment in 36 of 40 time points. CONCLUSIONS Hepatic arterial therapy with DEBDOX is safe with minimal QOL changes in treating unresectable liver-dominant melanoma metastasis. CLINICAL TRIAL NCT01010984.
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Affiliation(s)
- Jack W Rostas
- University of Louisville, Department of General Surgery, Division of Surgical Oncology, Louisville, KY, USA
| | - Alda L Tam
- Department of Interventional Radiology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Takami Sato
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Charles R Scoggins
- University of Louisville, Department of General Surgery, Division of Surgical Oncology, Louisville, KY, USA
| | - Kelly M McMasters
- University of Louisville, Department of General Surgery, Division of Surgical Oncology, Louisville, KY, USA
| | - Robert C G Martin
- University of Louisville, Department of General Surgery, Division of Surgical Oncology, Louisville, KY, USA.
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Li L, Yeo W. Value of quality of life analysis in liver cancer: A clinician’s perspective. World J Hepatol 2017; 9:867-883. [PMID: 28804570 PMCID: PMC5534362 DOI: 10.4254/wjh.v9.i20.867] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/10/2017] [Accepted: 05/24/2017] [Indexed: 02/06/2023] Open
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.
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Anota A, Boulin M, Dabakuyo-Yonli S, Hillon P, Cercueil JP, Minello A, Jouve JL, Paoletti X, Bedenne L, Guiu B, Bonnetain F. An explorative study to assess the association between health-related quality of life and the recommended phase II dose in a phase I trial: idarubicin-loaded beads for chemoembolisation of hepatocellular carcinoma. BMJ Open 2016; 6:e010696. [PMID: 27342239 PMCID: PMC4932346 DOI: 10.1136/bmjopen-2015-010696] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES The objective of this study was to explore the association between health-related quality of life (HRQoL) and the recommended phase 2 dose in a phase I clinical trial according to the Time to HRQoL deterioration approach (TTD). SETTING This is a phase I dose-escalation trial of transarterial chemoembolisation (TACE) with idarubicin-loaded beads performed in cirrhotic patients with hepatocellular carcinoma. Patients had to complete the EORTC QLQ-C30 HRQoL questionnaire at baseline and at days 15, 30 and 60 after TACE. PARTICIPANTS Patients aged ≥18 years with HCC unsuitable for curative treatments were evaluated for the study (N=21). PRIMARY AND SECONDARY OUTCOME MEASUREMENTS The primary objective was to determine the maximum tolerated dose (MTD) of idarubicin loaded after a single TACE session. MTD was defined as the dose level closest to that causing dose-limiting toxicity in 20% of patients. HRQoL was the secondary end point. RESULTS Between March 2010 and March 2011, 9, 6 and 6 patients were included at idarubicin dose levels of 5, 10 and 15 mg, respectively. Calculated MTD of idarubicin was 10 mg. At the 10 mg idarubicin dose, patients presented a longer TTD than at 5 mg, for global health status (HR=0.91 (95% CI 0.18 to 4.72)), physical functioning (HR=0.38 (0.04 to 3.22)), fatigue (HR=0.67 (0.18 to 2.56)) and pain (HR=0.47 (0.05 to 4.24)). CONCLUSIONS These HRQoL results were consistent with the estimated MTD, with a median TTD for global health status of 41 days (21 to NA) at 5 mg, 23 days (20 to NA) at 10 mg and 25 days (17 to NA) at 15 mg. These results show the importance of studying HRQoL in phase I trials. TRIAL REGISTRATION NUMBER NCT01040559; Post-results.
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Affiliation(s)
- Amélie Anota
- Quality of Life in Oncology National Platform, Besançon, France
- Methodological and Quality of Life in Oncology Unit (INSERM UMR 1098), University Hospital of Besançon, Besançon, France
| | - Mathieu Boulin
- INSERM U866, University of Burgundy, Dijon, France
- Department of Pharmacy, University Hospital, Dijon, France
| | - Sandrine Dabakuyo-Yonli
- Quality of Life in Oncology National Platform, Besançon, France
- Biostatistics and Quality of Life Unit (EA 4184), Centre Georges Francois Leclerc, Dijon, France
| | - Patrick Hillon
- INSERM U866, University of Burgundy, Dijon, France
- Department of Hepatogastroenterology, University Hospital, Dijon, France
| | - Jean-Pierre Cercueil
- INSERM U866, University of Burgundy, Dijon, France
- Department of Interventional Radiology, University Hospital, Dijon, France
| | - Anne Minello
- INSERM U866, University of Burgundy, Dijon, France
- Department of Hepatogastroenterology, University Hospital, Dijon, France
| | - Jean-Louis Jouve
- INSERM U866, University of Burgundy, Dijon, France
- Department of Hepatogastroenterology, University Hospital, Dijon, France
| | - Xavier Paoletti
- Department of Biostatistics and Epidemiology, Institut Gustave Roussy, Paris, France
| | - Laurent Bedenne
- INSERM U866, University of Burgundy, Dijon, France
- Department of Hepatogastroenterology, University Hospital, Dijon, France
| | - Boris Guiu
- Department of Radiology, St-Eloi University Hospital, Montpellier, France
| | - Franck Bonnetain
- Quality of Life in Oncology National Platform, Besançon, France
- Methodological and Quality of Life in Oncology Unit (INSERM UMR 1098), University Hospital of Besançon, Besançon, France
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14
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Ahmed S, de Souza NN, Qiao W, Kasai M, Keem LJ, Shelat VG. Quality of Life in Hepatocellular Carcinoma Patients Treated with Transarterial Chemoembolization. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2016; 2016:6120143. [PMID: 27143815 PMCID: PMC4838811 DOI: 10.1155/2016/6120143] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 03/13/2016] [Accepted: 03/24/2016] [Indexed: 02/05/2023]
Abstract
Hepatocellular carcinoma (HCC) is one of the most commonly diagnosed cancers worldwide. Majority of patients with HCC are diagnosed in the advanced stages of disease and hence they are only suitable for palliative therapy. TACE (transarterial chemoembolization) is the most commonly used treatment for unresectable HCC. It is however unclear if TACE improves the quality of life (QoL) in patients with HCC. The aim of this review is to evaluate the impact of TACE on QoL of HCC patients.
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Affiliation(s)
- Saleem Ahmed
- 1Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433
- 2Ministry of Health Holdings, 1 Maritime Square, Singapore 099253
| | - Nurun Nisa de Souza
- 3Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857
- 4Singapore Clinical Research Institute, 31 Biopolis Way, Singapore 138669
| | - Wang Qiao
- 2Ministry of Health Holdings, 1 Maritime Square, Singapore 099253
| | - Meidai Kasai
- 5Department of Gastroenterological Surgery, Sendai Kousei Hospital, 8-15 Hirosemachi, Aoba-ku, Sendai-shi, Miyagi 9800873, Japan
| | - Low Jee Keem
- 1Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433
| | - Vishal G. Shelat
- 1Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433
- *Vishal G. Shelat:
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15
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Chen J, Chen S, Xi W, Wu B, Yu H, Gao Y, Tang J. In Vivo Evaluation of Feeding Arteries of Tumors in Dorsal Sector of the Liver. IRANIAN JOURNAL OF RADIOLOGY 2015; 12:e18801. [PMID: 26557280 PMCID: PMC4632557 DOI: 10.5812/iranjradiol.18801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 10/31/2014] [Accepted: 12/01/2014] [Indexed: 11/16/2022]
Abstract
Background: The identification of the dorsal sector of the liver and its detailed vascular anatomy is of primary importance for surgical practice and segmental transcatheter arterial chemoembolization. Objectives: This study aimed to investigate the feeding arteries of tumors in dorsal sector of the liver. Patients and Methods: Computed tomography (CT) and digital subtraction angiography (DSA) images of eleven patients with tumors of the dorsal sector of the liver were analyzed retrospectively. The hepatic arteries that probably supplied the tumors were observed in DSA images. The case number of each hepatic artery feeding to the tumors was calculated. A scoring method was used to estimate each hepatic artery contribution to the tumor stain in DSA images. The accumulative scores were employed to evaluate the blood supply of feeding arteries of the tumors. Results: The data of the study revealed that right posterior hepatic artery (RPHA) (n = 9), middle hepatic artery (MHA) (n = 8), left medial hepatic artery (LMHA) (n = 6), right anterior hepatic artery (RAHA) (n = 5), and caudate hepatic artery (CaHA) (n = 3) were the feeding arteries of the tumors in dorsal sector in eleven patients. The accumulative scores of RPHA, MHA, RAHA, and LMHA were 23, 17, 11, and 7 points, respectively (χ2 = 6.827, P = 0.078, Friedman test). The total scores of right hepatic artery (RHA) branches and left hepatic artery (LHA) branches were 51 and 11 points, respectively (Z = -2.764, P = 0.006, Wilcoxon rank test). Conclusion: The RPHA, MHA, RAHA, and LMHA might be the main feeding arteries of the tumors in dorsal sector of the liver.
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Affiliation(s)
- Jun Chen
- Department of Radiology, Jiangsu Cancer Hospital, Nanjing Medical University (NMU), Nanjing, China
| | - Shixi Chen
- Department of Radiology, Jiangsu Cancer Hospital, Nanjing Medical University (NMU), Nanjing, China
| | - Wei Xi
- Department of Radiology, Jiangsu Cancer Hospital, Nanjing Medical University (NMU), Nanjing, China
| | - Bei Wu
- Department of Radiology, Jiangsu Cancer Hospital, Nanjing Medical University (NMU), Nanjing, China
| | - Hui Yu
- Department of Radiology, Jiangsu Cancer Hospital, Nanjing Medical University (NMU), Nanjing, China
| | - Yang Gao
- Department of Radiology, Jiangsu Cancer Hospital, Nanjing Medical University (NMU), Nanjing, China
| | - Jinhai Tang
- Department of Surgery, Jiangsu Cancer Hospital, Nanjing Medical University (NMU), Nanjing, China
- Corresponding author: Jinhai Tang, Department of Surgery, Jiangsu Cancer Hospital, Nanjing Medical University (NMU), Nanjing, China. Tel: +86-2583283305, Fax: +86-2583283305, E-mail:
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16
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Kolligs FT, Bilbao JI, Jakobs T, Iñarrairaegui M, Nagel JM, Rodriguez M, Haug A, D'Avola D, op den Winkel M, Martinez-Cuesta A, Trumm C, Benito A, Tatsch K, Zech CJ, Hoffmann RT, Sangro B. Pilot randomized trial of selective internal radiation therapy vs. chemoembolization in unresectable hepatocellular carcinoma. Liver Int 2015; 35:1715-21. [PMID: 25443863 DOI: 10.1111/liv.12750] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 11/19/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS To compare selective internal radiation therapy (SIRT) with transarterial chemoembolization (TACE), the standard-of-care for intermediate-stage unresectable, hepatocellular carcinoma (HCC), as first-line treatment. METHODS SIRTACE was an open-label multicenter randomized-controlled pilot study, which prospectively compared primarily safety and health-related quality of life (HRQoL) changes following TACE and SIRT. Patients with unresectable HCC, Child-Pugh ≤B7, ECOG performance status ≤2 and ≤5 liver lesions (≤20 cm total maximum diameter) without extrahepatic spread were randomized to receive either TACE (at 6-weekly intervals until tumour enhancement was not observed on MRI or disease progression) or single-session SIRT (yttrium-90 resin microspheres). RESULTS Twenty-eight patients with BCLC stage A (32.1%), B (46.4%) or C (21.4%) received either a mean of 3.4 (median 2) TACE interventions (N = 15) or single SIRT (N = 13). Both treatments were well tolerated. Despite SIRT patients having significantly worse physical functioning at baseline, at week-12, neither treatment had a significantly different impact on HRQoL as measured by Functional Assessment of Cancer Therapy-Hepatobiliary total or its subscales. Both TACE and SIRT were effective for the local control of liver tumours. Best overall response-rate (RECIST 1.0) of target lesions were 13.3% and 30.8%, disease control rates were 73.3% and 76.9% for TACE and SIRT, respectively. Two patients in each group were down-staged for liver transplantation (N = 3) or radiofrequency ablation (N = 1). CONCLUSIONS Single-session SIRT appeared to be as safe and had a similar impact on HRQoL as multiple sessions of TACE, suggesting that SIRT might be an alternative option for patients eligible for TACE.
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Affiliation(s)
- Frank T Kolligs
- Department of Internal Medicine II, University of Munich, Munich, Germany
| | - Jose I Bilbao
- Interventional Radiology, Clinica Universidad de Navarra and Instituto de Investigaciones Sanitarias de Navarra (IDISNA), Pamplona, Spain
| | - Tobias Jakobs
- Institute of Radiology, Krankenhaus der Barmherzigen Brüder, Munich, Germany
| | | | - Jutta M Nagel
- Department of Internal Medicine II, University of Munich, Munich, Germany
| | | | - Alexander Haug
- Department of Nuclear Medicine, University of Munich, Munich, Germany
| | - Delia D'Avola
- Liver Unit, Clinica Universidad de Navarra, Instituto de Investigaciones Sanitarias de Navarra (IDISNA) and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Pamplona, Spain
| | - Mark op den Winkel
- Department of Internal Medicine II, University of Munich, Munich, Germany
| | | | - Christoph Trumm
- Institute of Radiology, University of Munich, Munich, Germany
| | - Alberto Benito
- Department of Radiology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Klaus Tatsch
- Department of Nuclear Medicine, Municipal Hospital Karlsruhe Inc., Karlsruhe, Germany
| | - Christoph J Zech
- Clinic of Radiology and Nuclear Medicine, University of Basel, Basel, Switzerland
| | - Ralf-Thorsten Hoffmann
- Institute and Policlinic of Radiology, University Hospital at the Technische Universitaet Dresden, Dresden, Germany
| | - Bruno Sangro
- Liver Unit, Clinica Universidad de Navarra, Instituto de Investigaciones Sanitarias de Navarra (IDISNA) and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Pamplona, Spain
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17
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Bai M, Reynolds NR, McCorkle R. The promise of clinical interventions for hepatocellular carcinoma from the west to mainland China. Palliat Support Care 2013; 11:503-22. [PMID: 23398641 DOI: 10.1017/s1478951512001137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Hepatocellular carcinoma (HCC) presents a major health problem with its steadily increasing incidence in Western countries, and persistent high fatality rates worldwide. The well-recognized complexity and toxicity of its treatment as well as inadequate care and limited resources in mainland China exacerbate the difficulty of maintaining quality of remaining life of patients living with this illness. The goal of this comprehensive literature review was to identify promising clinical interventions for improving quality of life (QOL) of people with advanced HCC in mainland China. METHOD A comprehensive literature review was performed in China Academic Journals (CAJ), Cochrane, and PubMed databases. The review was confined to studies of randomized controlled trials (RCT) for adults, in Chinese and English, from 1980 to 2012. RESULTS A total of 676 studies in Chinese and 391 studies in English were identified. Eighteen RCTs were selected for the final review, among which three were conducted in mainland China. SIGNIFICANCE OF RESULTS Nurse-led home-based comprehensive interventions using a collaborative care approach addressing multiple dimensions of QOL show promise for enhancing clinical outcomes for people with advanced HCC in mainland China. Education and psychosocial support combined with symptom management early in the illness trajectory and ongoing close attention to physical symptoms, emotional distress, as well as spiritual well-being are crucial for maintaining QOL of people with advanced HCC. Telephone monitoring appears to be a feasible way in rural as well as urban areas. Families are advised to be part of overall interventions. It is warranted that promising interventions aiming at improving QOL for advanced cancer patients reported in Western literature be further tested in mainland China.
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Affiliation(s)
- Mei Bai
- School of Nursing, Yale University, New Haven, Connecticut
| | | | - Ruth McCorkle
- School of Nursing, Yale University, New Haven, Connecticut
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18
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Xu LF, Sun HL, Chen YT, Ni JY, Chen D, Luo JH, Zhou JX, Hu RM, Tan QY. Large primary hepatocellular carcinoma: transarterial chemoembolization monotherapy versus combined transarterial chemoembolization-percutaneous microwave coagulation therapy. J Gastroenterol Hepatol 2013; 28:456-63. [PMID: 23216261 DOI: 10.1111/jgh.12088] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIM To evaluate the clinical benefits of transarterial chemoembolization (TACE) monotherapy or TACE combined with percutaneous microwave coagulation therapy (PMCT) and the long-term survival rate of patients with large primary hepatocellular carcinoma (HCC) treated with these techniques. METHODS This is a retrospective study involving 136 patients with unresectable large HCC (189 tumor nodules, ≥ 5.0 cm in diameter) admitted to Sun Yat-Sen University Memorial Hospital (Guangzhou, China) between January 2004 and December 2011. The median follow-up time was 41 months (range, 6-96 months). Of these patients, 80 patients received TACE monotherapy and 56 patients received TACE combined with PMCT. The median interval between treatments and overall survival (OS) were hierarchically analyzed using log-rank tests. RESULTS All patients successfully underwent TACE alone or TACE with PMCT with no serious complications. The median survival time was 13 months (range, 3-84 months) for the TACE group and 25 months (range, 7-96 months) for the TACE-PMCT group. The 1-year, 3-year, and 5-year OS rates were 62.5%, 17.5%, and 5.0% in the TACE group, respectively. In contrast, in the TACE-PMCT group, the 1-year, 3-year, and 5-year OS rates were 87.5%, 50.0%, and 10.0%, respectively. This difference was statistically significant between the groups (P < 0.001). CONCLUSIONS TACE combined with PMCT had advantages in prolonging OS with satisfying time to progression and improving liver function in patients with large unresectable HCC. The results suggest that further prospective studies are required to confirm the findings of this study.
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Affiliation(s)
- Lin-Feng Xu
- Department of Interventional Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China.
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