Open Access Article
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Symptom Concerns and Quality of Life in Hepatobiliary Cancers

Virginia Sun

Betty R. Ferrell

Gloria Juarez

Lawrence D. Wagman

Yun Yen

Vincent Chung
hepatocellular, carcinoma, symptom burden
ONF 2008, 35(3), E45-E52. DOI: 10.1188/08.ONF.E45-E52

Purpose/Objectives: To describe the symptom concerns of patients with hepatocellular carcinoma (HCC) and pancreatic cancer and explore the effect of symptoms on patients' quality of life (QOL).

Design: Descriptive, longitudinal study.

Setting: Ambulatory clinics of a comprehensive cancer center.

Sample: 45 patients actively receiving treatment for either HCC or pancreatic cancer.

Methods: Patients were followed from baseline for three months, with outcome measures repeated monthly. Outcome measures included the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) and the Functional Assessment of Chronic Illness Therapy-Spirituality Subscale (FACIT-Sp-12). Descriptive analysis of demographic, treatment, and symptom data was conducted, followed by two-way repeated measures analysis of variance of FACT-Hep and FACIT-Sp-12 scale scores by diagnosis and treatment type.

Main Research Variables: Symptoms, QOL.

Findings: Overall QOL is poor in patients with hepatobiliary cancer, and this trend continues over time. Symptoms such as abdominal pain, fatigue, weight loss, and poor appetite commonly are reported in this population.

Conclusions: Patients with hepatobiliary cancer suffer from multiple symptoms that may have a negative affect on overall QOL. Specific QOL domains, such as physical and functional well-being, are of particular concern for patients.

Implications for Nursing: The identification of specific symptom and QOL concerns in hepatobiliary cancers will enhance clinical care and aid in the future development of multidisciplinary interventions for this understudied cancer population.

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    References

    Balboni, T. A., Vanderwerker, L. C., Block, S. D., Paulk, M. E., Lathan, C. S., Peteet, J. R., et al. (2007). Religiousness and spiritual support among advanced cancer patients and associations with end-of-life treatment preferences and quality of life. Journal of Clinical Oncology, 25(5), 555-560.
    Bianchi, G., Loguercio, C., Sgarbi, D., Abbiati, R., Brunetti, N., De Simone, T., et al. (2003). Reduced quality of life of patients with hepatocellular carcinoma. Digestive and Liver Diseases, 35(1), 46-54.
    Carney, C. P., Jones, L., Woolson, R. F., Noyes, R., Jr., & Doebbeling, B. N. (2003). Relationship between depression and pancreatic cancer in the general population. Psychosomatic Medicine, 65(5), 884-888.
    Cella, D. (2005). Quality of life outcomes: Measurement and intervention. Journal of Supportive Oncology, 3(2), 133-134.
    Coleman, J., Olsen, S. J., Sauter, P. K., Baker, D., Hodgin, M. B., Stanfield, C., et al. (2005). The effect of a frequently asked questions module on a pancreatic cancer Web site patient/family chat room. Cancer Nursing, 28(6), 460-468.
    Eid, S., Stromberg, A. J., Ames, S., Ellis, S., McMasters, K. M., & Martin, R. C. (2006). Assessment of symptom experience in patients undergoing hepatic resection or ablation. Cancer, 107(11), 2715-2722.
    Ersek, M., Ferrell, B. R., Dow, K. H., & Melancon, C. H. (1997). Quality of life in women with ovarian cancer. Western Journal of Nursing Research, 19(3), 334-350.
    Ferrell, B., Grant, M., Padilla, G., Vemuri, S., & Rhiner, M. (1991). The experience of pain and perceptions of quality of life: Validation of a conceptual model. Hospice Journal, 7(3), 9-24.
    Ferrell, B. R., Dow, K. H., Leigh, S., Ly, J., & Gulasekaram, P. (1995). Quality of life in long-term cancer survivors. Oncology Nursing Forum, 22(6), 915-922.
    Ferrell, B. R., Grant, M., Funk, B., Garcia, N., Otis-Green, S., & Schaffner, M. L. (1996). Quality of life in breast cancer. Cancer Practice, 4(6), 331-340.
    Ferrell, B. R., Grant, M., Funk, B., Otis-Green, S., & Garcia, N. (1997a). Quality of life in breast cancer. Part I: Physical and social well-being. Cancer Nursing, 20(6), 398-408.
    Ferrell, B. R., Grant, M. M., Funk, B., Otis-Green, S., & Garcia, N. (1997b). Quality of life in breast cancer survivors as identified by focus groups. Psycho-Oncology, 6(1), 13-23.
    Ferrell, B. R., Grant, M. M., Funk, B. M., Otis-Green, S. A., & Garcia, N. J. (1998). Quality of life in breast cancer survivors: implications for developing support services. Oncology Nursing Forum, 25(5), 887-895.
    Fitzsimmons, D., George, S., Payne, S., & Johnson, C. D. (1999). Differences in perception of quality-of-life issues between health professionals and patients with pancreatic cancer. Psycho-Oncology, 8(2), 135-143.
    Heffernan, N., Cella, D., Webster, K., Odom, L., Martone, M., Passik, S., et al. (2002). Measuring health-related quality of life in patients with hepatobiliary cancers: The Functional Assessment of Cancer Therapy-Hepatobiliary questionnaire. Journal of Clinical Oncology, 20(9), 2229-2239.
    Huang, J. J., Yeo, C. J., Sohn, T. A., Lillemoe, K. D., Sauter, P. K., Coleman, J., et al. (2000). Quality of life and outcomes after pancreaticoduodenectomy. Annals of Surgery, 231(6), 890-898.
    Jemal, A., Siegel, R., Ward, E., Murray, T., Xu, J., & Thun, M. J. (2008). Cancer statistics 2008. Retrieved April 14, 2008, from http://www.cancer.org/downloads/STT/2008CAFFfinalsecured.pdf
    Kelsen, D. P., Portenoy, R. K., Thaler, H. T., Niedzwiecki, D., Passik, S. D., Tao, Y., et al. (1995). Pain and depression in patients with newly diagnosed pancreas cancer. Journal of Clinical Oncology, 13(3), 748-755.
    Krech, R. L., & Walsh, D. (1991). Symptoms of pancreatic cancer. Journal of Pain and Symptom Management, 6(6), 360-367.
    Labori, K. J., Hjermstad, M. J., Wester, T., Buanes, T., & Loge, J. H. (2006). Symptom profiles and palliative care in advanced pancreatic cancer: A prospective study. Supportive Care in Cancer, 14(11), 1126-1133.
    Lai, Y. H., Shun, S. C., Hsiao, Y. L., Chiou, J. F., Wei, L. L., Tsai, J. T., et al. (2007). Fatigue experiences in hepatocellular carcinoma patients during six weeks of stereotactic radiotherapy. Oncologist, 12(2), 221-230.
    Lis, C. G., Gupta, D., & Grutsch, J. F. (2006). Patient satisfaction with quality of life as a predictor of survival in pancreatic cancer. International Journal of Gastrointestinal Cancer, 37(1), 35-44.
    McCracken, M., Olsen, M., Chen, M. S., Jr., Jemal, A., Thun, M., Cokkinides, V., et al. (2007). Cancer incidence, mortality, and associated risk factors among Asian Americans of Chinese, Filipino, Vietnamese, Korean, and Japanese ethnicities. CA: A Cancer Journal for Clinicians, 57(4), 190-205.
    Nolan, M. T., Hodgin, M. B., Olsen, S. J., Coleman, J., Sauter, P. K., Baker, D., et al. (2006). Spiritual issues of family members in a pancreatic cancer chat room. Oncology Nursing Forum, 33(2), 239-244.
    Passik, S. D., & Roth, A. J. (1999). Anxiety symptoms and panic attacks preceding pancreatic cancer diagnosis. Psycho-Oncology, 8(3), 268-272.
    Peterman, A. H., Fitchett, G., Brady, M. J., Hernandez, L., & Cella, D. (2002). Measuring spiritual well-being in people with cancer: The Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being Scale (FACITSp). Annals of Behavioral Medicine, 24(1), 49-58.
    Poon, R. T., Fan, S. T., Yu, W. C., Lam, B. K., Chan, F. Y., & Wong, J. (2001). A prospective longitudinal study of quality of life after resection of hepatocellular carcinoma. Archives of Surgery, 136(6), 693-699.
    Sheibani-Rad, S., & Velanovich, V. (2006). Effects of depression on the survival of pancreatic adenocarcinoma. Pancreas, 32(1), 58-61.
    Shun, S. C., Lai, Y. H., Jing, T. T., Jeng, C., Lee, F. Y., Hu, L. S., et al. (2005). Fatigue patterns and correlates in male liver cancer patients receiving transcatheter hepatic arterial chemoembolization. Supportive Care in Cancer, 13(5), 311-317.
    Steel, J., Baum, A., & Carr, B. (2004). Quality of life in patients diagnosed with primary hepatocellular carcinoma: Hepatic arterial infusion of Cisplatin versus 90-Yttrium microspheres (Therasphere). Psycho-Ooncology, 13(2), 73-79.
    Steel, J., Hess, S. A., Tunke, L., Chopra, K., & Carr, B. I. (2005). Sexual functioning in patients with hepatocellular carcinoma. Cancer, 104(10), 2234-2243.
    Steel, J. L., Chopra, K., Olek, M. C., & Carr, B. I. (2007). Health-related quality of life: Hepatocellular carcinoma, chronic liver disease, and the general population. Quality of Life Research, 16(2), 203-215.
    Steel, J. L., Geller, D. A., Gamblin, T. C., Olek, M. C., & Carr, B. I. (2007). Depression, immunity, and survival in patients with hepatobiliary carcinoma. Journal of Clinical Oncology, 25(17), 2397-2405.
    Wang, Y. B., Chen, M. H., Yan, K., Yang, W., Dai, Y., & Yin, S. S. (2007). Quality of life after radiofrequency ablation combined with transcatheter arterial chemoembolization for hepatocellular carcinoma: Comparison with transcatheter arterial chemoembolization alone. Quality of Life Research, 16(3), 389-397.
    Watanabe, I., Sasaki, S., Konishi, M., Nakagohri, T., Inoue, K., Oda, T., et al. (2004). Onset symptoms and tumor locations as prognostic factors of pancreatic cancer. Pancreas, 28(2), 160-165.
    Yeo, W., Mo, F. K., Koh, J., Chan, A. T., Leung, T., Hui, P., et al. (2006). Quality of life is predictive of survival in patients with unresectable hepatocellular carcinoma. Annals of Oncology, 17(7), 1083-1089.
    Zabora, J., BrintzenhofeSzoc, K., Curbow, B., Hooker, C., & Piantadosi, S. (2001). The prevalence of psychological distress by cancer site. Psycho-Oncology, 10(1), 19-28.
    Zhu, A. X. (2003). Hepatocellular carcinoma: Are we making progress? Cancer Investigation, 21(3), 418-428.