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

Kerstin Wohlleber,André L Mihaljevic,Pascal Probst,Patrick Heger,Markus K Diener,Christoph Engel

doi:10.1007/s11136-021-02810-8

Abstract

PurposePatient-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.MethodsA 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.ResultsA 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.ConclusionUsing 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.

Highlights

Besides survival and treatment-associated adverse events, patient-reported outcomes (PROs) are arguably the most relevant outcome parameters in oncology
Health-related quality of life (HRQoL) is a multidimensional PRO measure that is of special interest in oncology as it provides a ‘personal assessment of the burden and impact
The EORTC QLQ-C30 and the FACT-G have cancer-type-specific supplements (EORTC QLQ-HCC18 and FACT-Hep) which can only be used in combination with the more general questionnaire

Summary

Introduction

Besides survival and treatment-associated adverse events, patient-reported outcomes (PROs) are arguably the most relevant outcome parameters in oncology. A PRO is defined as ‘any outcome evaluated directly by the patient himself or herself and is based on patient’s perception of a disease and its treatment(s)’ [1]. Health-related quality of life (HRQoL) is a multidimensional PRO measure that is of special interest in oncology as it provides a ‘personal assessment of the burden and impact. Quality of Life Research (2021) 30:2429–2466 of a malignant disease and its treatment,’ [1] adding valuable information for a true risk–benefit assessment. This is of special interest when prognosis is limited as in primary malignancies of the liver. Multiple studies have aimed to define suitable HRQoL tools for different clinical settings, e.g. [4, 5], including cancer patients [6,7,8]

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Results

Conclusion