1083 Health-Related Quality of Life Decreases With Disease Progression From Chronic Liver Disease to Cirrhosis and Hepatocellular Carcinoma

Abstract

INTRODUCTION: Health-related quality of life (HRQOL), an important outcome for cancer patients, is reliably measured by the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep). FACT-Hep predicts disease progression, treatment response and survival in HCC patients. This study aimed to evaluate HRQOL in diverse HCC patients compared to patients with chronic liver disease (CLD) and cirrhosis. METHODS: Since 2018, we have enrolled patients with CLD, cirrhosis and HCC from the University of Miami and Jackson Memorial Hospitals into an observational longitudinal cohort. Clinical data is extracted from the electronic medical record. Participants complete various surveys, including the FACT-Hep version 4.0. Descriptive statistics were used for demographics and disease-specific characteristics. Each FACT-HEP subscale was prorated and combined, if valid. Disease subgroups were compared using Pearson’s chi-squared or Kruskal-Wallis tests. In a subset of participants who completed the Perceived Stress Scale (PSS-10), stress was correlated with HRQOL. RESULTS: From 1/2018 to 3/2019, 333 patients enrolled; 103 have CLD, 131 have cirrhosis and, 99 have HCC (91 cirrhotic HCC and 8 noncirrhotic HCC). The sample is 4% Asian, 16% Black, 34% White and 42% Hispanic. Median age of the CLD group was 54 years vs. 58 years for cirrhotics and 65 years for HCC patients, P < 0.001. Table 1. The FACT-Hep was completed by 223; the prorated score was valid in 211. There were no significant differences in physical, social, or emotional well-being when comparing disease groups. In contrast, participants with cirrhosis or cirrhotic HCC had significantly worse functional well-being compared to those with CLD or noncirrhotic HCC, P 0.001. Patients with cirrhosis with or without HCC scored lowest (worst) on the hepatobiliary subscale. HRQOL was best in non-cirrhotic HCC patients, then CLD patients, then cirrhotic patients followed by cirrhotic-HCC patients, P 0.004. Table 2. The PSS-10 was administered to 38 participants who completed the FACT-Hep. There was a correlation between stress and HRQOL; as stress increased from low to moderate to high, HRQOL decreased significantly, P 0.003. Significant racial differences in HRQOL, P 0.05, disappeared when stratified by disease group. CONCLUSION: Low HRQOL in HCC patients is likely driven by cirrhosis; non-cirrhotic HCC patients had the highest HRQOL. Therefore, alleviation of cirrhosis symptoms may improve HRQOL for most HCC patients.