Somaia M. Ebeid¹, Safaa H. Ali¹, Heba Y. Kamel^1*, Ahmed A. Elbaz², Hazem M. El-Hariri³

Show more
¹ Departments of Geriatric Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
² Departments of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
³ Department of Community Medicine Research, National Research Center, Cairo, Egypt.
Show less

Abstract: Background: Post hepatitis C virus chronic liver disease (CLD) is prevalent among the Egyptian population with a bad impact upon their quality of life (QOL). Hepatocellular carcinoma (HCC) is one of the long term and fatal complications of CLD and it also has its negative impact on patient’s quality of life. Aim: To assess impact of CLD and HCC on the quality of life of group of hospitalized elderly patients. Methodology: Ninety elderly patients were divided into three groups: 30 elderly with post hepatitis C virus CLD, 30 elderly with HCC and 30 others free of liver disease as control group (Cn), all were recruited from the in-patient ward and the outpatient clinic of the Geriatric Department, Ain-Shams University Hospital. After giving consent, comprehensive geriatric assessment was done with assessment of their quality of life by using the Short Form-36 health survey (SF-36). Investigations including liver enzymes, serum albumin, serum bilirubin and abdominal ultrasound were done. Results: All QOL domains were the highest among control group, followed by HCC group and the least among CLD group. The differences were statistically significant in most subscales and total score [Mean of Cn = 81.9 ± 12.4, Mean of CLD = 47.5 ± 21.9, Mean of HCC = 62.3 ± 16.1; P Cn/CLD ≤ 0.001, P Cn/HCC ≤ 0.001, P CLD/HCC = 0.004]. Albumin was the only biochemical marker correlated positively with total SF score and two subscales (PF and EF) [r = 0.408; P = 0.025]. Conclusion & Recommendation: Our study showed a decrease in the QOL of Egyptian post hepatitis C virus CLD and HCC patients compared with Egyptian population norms. The results showed that CLD were more affected than HCC patients. This had a particularly serious negative impact on their life. The findings indicate a need for updated counseling and educational materials designed to provide adequate information and consistent healthcare service to this patient setting.

Keywords: Post Hepatitis C Virus Chronic Liver Diseases, Hepatocellular Carcinoma, Quality of Life, Short Form-36 Health Survey

Cite this paper: Ebeid, S. , H. Ali, S. , Kamel, H. , A. Elbaz, A. and El-Hariri, H. (2015) Impact of Post Hepatitis C Chronic Liver Disease and Hepatocellular Carcinoma on Health Related Quality of Life. Advances in Aging Research, 4, 177-186. doi: 10.4236/aar.2015.46019.

References

[1]   Bergner, M. (1989) Quality of Life, Health Status and Clinical Research. Medical Care, 27, S148-S156.
http://dx.doi.org/10.1097/00005650-198903001-00012

[2]   Testa, M. and Simonson, D. (1996) Assessment of Quality-of-Life Outcomes. New England Journal of Medicine, 334, 835-840.
http://dx.doi.org/10.1056/NEJM199603283341306

[3]   Wilson, I. and Cleary, P. (1995) Linking Clinical Variables with Health-Related Quality of Life: A Conceptual Model of Patient Outcomes. JAMA, 273, 59-65.
http://dx.doi.org/10.1001/jama.1995.03520250075037

[4]   Addington-Hall, J. and Kalra, L. (2001) Who Should Measure Quality of Life? BMJ, 322, 1417-1420.
http://dx.doi.org/10.1136/bmj.322.7299.1417

[5]   Marchesini, G., Bianchi, G., Amodio, P., Salerno, F., Merli, M., Panella, C., et al. (2001) Factors Associated with Poor Health-Related Quality of Life of Patients with Cirrhosis. Gastroenterology, 120, 170-178.
http://dx.doi.org/10.1053/gast.2001.21193

[6]   Younossi, Z.M. and Guyatt, G. (1998) Quality-of-Life Assessments and Chronic Liver Disease. The American Journal of Gastroenterology, 93, 1037-1041.
http://dx.doi.org/10.1111/j.1572-0241.1998.00325.x

[7]   Foster, G.R., Goldin, R.D. and Thomas, H.C. (1998) Chronic Hepatitis C Virus Infection Causes a Significant Reduction in Quality of Life in the Absence of Cirrhosis. Hepatology, 27, 209-212.
http://dx.doi.org/10.1002/hep.510270132

[8]   Cordoba, J., Flavia, M., Jacas, C., Sauleda, S., Esteban, J.I., Vargas, V., et al. (2003) Quality of Life and Cognitive Function in Hepatitis C at Different Stages of Liver Disease. Journal of Hepatology, 39, 231-238.
http://dx.doi.org/10.1016/S0168-8278(03)00189-2

[9]   Poupon, R.E., Chretien, Y., Chazouilleres, O., Poupon, R., Chwalow, J. and the French-PBC Study Group (2004) Quality of Life in Patients with Primary Biliary Cirrhosis. Hepatology, 40, 489-494.
http://dx.doi.org/10.1002/hep.20276

[10]   Bonkovsky, H.L., Woolley, J.M. and the Consensus Interferon Study Group (1999) Reduction of Health-Related Quality of Life in Chronic Hepatitis C and Improvement with Interferon Therapy. Hepatology, 29, 264-270.
http://dx.doi.org/10.1002/hep.510290124

[11]   Spiegel, B.M.R., Younossi, Z.M., Hays, R.D., Revicki, D., Robbins, S. and Kanwal, F. (2005) Impact of Hepatitis C on Health-Related Quality of Life: A Systematic Review and Quantitative Assessment. Hepatology, 41, 790-800.
http://dx.doi.org/10.1002/hep.20659

[12]   Svirtlih, N., Pavic, S., Terzic, D., Delic, D., Simonovic, J., Gvozdenovic, E., et al. (2008) Reduced Quality of Life in Patients with Chronic Viral Liver Disease as Assessed by SF12 Questionnaire. Journal of Gastrointestinal and Liver Diseases, 17, 405-409.

[13]   Parkin, D.M., Bray, F., Ferlay, J. and Pisani, P. (2005) Global Cancer Statistics, 2002. CA: A Cancer Journal for Clinicians, 55, 74-108.
http://dx.doi.org/10.3322/canjclin.55.2.74

[14]   El-Serag, H.B., Marrero, J.A., Rudolph, L. and Reddy, K.R. (2008) Diagnosis and Treatment of Hepatocellular Carcinoma. Gastroenterology, 134, 1752-1763.
http://dx.doi.org/10.1053/j.gastro.2008.02.090

[15]   El-Serag, H.B., Davila, J.A., Petersen, N.J. and McGlynn, K.A. (2003) The Continuing Increase in the Incidence of Hepatocellular Carcinoma in the United States: An Update. Annals of Internal Medicine, 139, 817-823.
http://dx.doi.org/10.7326/0003-4819-139-10-200311180-00009

[16]   Kiyosawa, K., Umemura, T., Ichijo, T., Matsumoto, A., Yoshizawa, K., Gad, A. and Tanaka, E. (2004) Hepatocellular Carcinoma: Recent Trends in Japan. Gastroenterology, 127, S17-S26.
http://dx.doi.org/10.1053/j.gastro.2004.09.012

[17]   Bianchi, G., Loguercio, C., Sgarbi, D., Abbiati, R., Brunetti, N., De Simone, T., Zoli, M. and Marchesini, G. (2003) Reduced Quality of Life of Patients with Hepatocellular Carcinoma. Digestive and Liver Disease, 35, 46-54.
http://dx.doi.org/10.1016/S1590-8658(02)00011-7

[18]   Poon, R.T.P., Fan, S.T., Yu, W.C., Lam, B.K.Y., Chan, F.Y.S. and Wong, J. (2001) A Prospective Longitudinal Study of Quality of Life after Resection of Hepatocellular Carcinoma. Archives of Surgery, 136, 693-699.
http://dx.doi.org/10.1001/archsurg.136.6.693

[19]   Tanabe, G., Ueno, S., Maemura, M., Kihara, K., Aoki, D., Yoshidome, S., et al. (2001) Favorable Quality of Life after Repeat Hepatic Resection for Recurrent Hepatocellular Carcinoma. Hepato-Gastroenterology, 48, 506-510.

[20]   Fan, S.-Y., Eiser, C. and Ho, M.-C. (2010) Health-Related Quality of Life in Patients with Hepatocellular Carcinoma: A Systematic Review. Clinical Gastroenterology and Hepatology, 8, 559-564.
http://dx.doi.org/10.1016/j.cgh.2010.03.008

[21]   European Association for the Study of the Liver (2009) EASL Clinical Practice Guidelines: Management of Chronic Hepatitis B. Journal of Hepatology, 50, 227-242.
http://dx.doi.org/10.1016/j.jhep.2008.10.001

[22]   Cabrera, R. and Nelson, D.R. (2010) Review Article: The Management of Hepatocellular Carcinoma. Alimentary Pharmacology & Therapeutics, 31, 461-476.
http://dx.doi.org/10.1111/j.1365-2036.2009.04200.x

[23]   Ware, J.E. and Sherbourne, C.D. (1992) The MOS 36-Item Short-Form Health Survey (SF-36): I. Conceptual Framework and Item Selection. Medical Care, 30, 473-483.
http://dx.doi.org/10.1097/00005650-199206000-00002

[24]   Hays, R.D. and Shapiro, M.F. (1992) An Overview of Generic Health-Related Quality of Life Measures For HIV Research. Quality of Life Research, 1, 91-97.
http://dx.doi.org/10.1007/BF00439716

[25]   Stewart, A.L., Sherbourne, C., Hays, R.D., Wells, K.B., Nelson, E.C., Kamberg, C., et al. (1992) Summary and Discussion of MOS Measures. In: Stewart, A.L. and Ware, J.E., Eds., Measuring Functioning and Well-Being: The Medical Outcome Study Approach, Duke University Press, Durham, 345-371.

[26]   Al Abdulmohsin, S.A., Coons, S., Draugalis, J.L.R. and Hays, R.D. (1998) Reliability of an Arabic Version of the RAND-36 Health Survey and Its Equivalence to the US-English Version. Medical Care, 36, 428-432.
http://dx.doi.org/10.1097/00005650-199803000-00018

[27]   Meenakshi, J., Winston, S. and Joel A.B. (2014) Health and Quality of Life Outcomes. Health and Quality of Life Outcomes, 12,173.
http://dx.doi.org/10.1186/s12955-014-0173-5

[28]   Seeff, L.B. and Hoofnagle, J.H. (2002) National Institutes of Health Consensus Development Conference: Management of Hepatitis C. Hepatology, 36, S1-S2.
http://dx.doi.org/10.1002/hep.1840360702

[29]   Hussain, K.B., Fontana, R.J., Moyer, C.A., Su, G.L., Sneed-Pee, N. and Lok, A.S. (2001) Comorbid Illness Is an Important Determinant of Health-Related Quality of Life in Patients with Chronic Hepatitis C. The American Journal of Gastroenterology, 96, 2737-2744.
http://dx.doi.org/10.1111/j.1572-0241.2001.04133.x

[30]   Gifford, S.M., O’Brien, M.L., Bammer, G., Banwell, C. and Stoove, M. (2003) Australian Women’s Experiences of Living with Hepatitis C Virus: Results from a Cross-Sectional Survey. Journal of Gastroenterology and Hepatology, 18, 841-850.
http://dx.doi.org/10.1046/j.1440-1746.2003.03077.x

[31]   Fleming, C.A., Christiansen, D., Nuñes, D., Heeren, T., Thornton, D., Horsburgh Jr., C.R., et al. (2004) Health-Related Quality of Life of Patients with HIV Disease: Impact of Hepatitis C Coinfection. Clinical Infectious Diseases, 38, 572- 578.
http://dx.doi.org/10.1086/381263

[32]   Björnsson, E., Verbaan, H., Oksanen, A., Frydén, A., Johansson, J., Friberg, S., et al. (2009) Health-Related Quality of Life in Patients with Different Stages of Liver Disease Induced by Hepatitis C. Scandinavian Journal of Gastroenterology, 44, 878-887.
http://dx.doi.org/10.1080/00365520902898135

[33]   Kwan, J.W., Cronkite, R.C., Yiu, A., Goldstein, M.K., Kazis, L. and Cheung, R.C. (2008) The Impact of Chronic C and Co-Morbid Illnesses on Health-Related Quality of Life. Quality of Life Research, 17, 715-724.
http://dx.doi.org/10.1007/s11136-008-9344-3

[34]   Kang, S., Hwang, S., Lee, S., Chang, F. and Lee, S. (2005) Health-Related Quality of Life and Impact of Antiviral Treatment in Chinese Patients with Chronic Hepatitis C in Taiwan. World Journal of Gastroenterology, 11, 7494-7498.
http://dx.doi.org/10.3748/wjg.v11.i47.7494

[35]   Schwarzinger, M., Dewedar, S., Rekacewicz, C., Elaziz, K.M.A., Fontanet, A., Carrat, F. and Mohamed, M.K. (2004) Chronic Hepatitis C Virus Infection: Does It Really Impact Health-Related Quality of Life? A Study in Rural Egypt. Hepatology, 40, 1434-1441.
http://dx.doi.org/10.1002/hep.20468

[36]   Kondo, Y., Yoshida, H., Tateishi, R., Shiina, S., Mine, N., Yamashiki, N., et al. (2007) Health-Related Quality of Life of Chronic Liver Disease Patients with and without Hepatocellular Carcinoma. Journal of Gastroenterology and Hepatology, 22, 197-203.
http://dx.doi.org/10.1111/j.1440-1746.2006.04456.x

[37]   Steel, J.L., Chopra, K., Olek, M.C. and Carr, B.I. (2007) Health-Related Quality of Life: Hepatocellular Carcinoma, Chronic Liver Disease, and the General Population. Quality of Life Research, 16, 203-215.
http://dx.doi.org/10.1007/s11136-006-9111-2

[38]   Lee, L.J., Chen, C.H., Yao, G., Chung, C.W., Sheu, J.C., Lee, P.H., et al. (2007) Quality of Life in Patients with Hepatocellular Carcinoma Received Surgical Resection. Journal of Surgical Oncology, 95, 34-39.
http://dx.doi.org/10.1002/jso.20374

[39]   Gandhi, S., Khubchandani, S. and Iyer, R. (2014) Quality of Life and Hepatocellular Carcinoma. Journal of Gastrointestinal Oncology, 5, 296-317.

[40]   Wible, B.C., Rilling, W.S., Drescher, P., Hieb, R.A., Saeian, K., Frangakis, C., et al. (2010) Longitudinal Quality of Life Assessment of Patients with Hepatocellular Carcinoma after Primary Transarterial Chemoembolization. Journal of Vascular and Interventional Radiology, 21, 1024-1030.
http://dx.doi.org/10.1016/j.jvir.2010.03.005

[41]   Casanovas, T., Jané, L., Herdman, M., Casado, A., Garcia, B., Prat, B. and Fabregat, J. (2010) Assessing Outcomes in Liver Disease Patients: Reliability and Validity of the Spanish Version of the Liver Disease Quality of Life Questionnaire. Value in Health, 13, 455-462.
http://dx.doi.org/10.1111/j.1524-4733.2009.00688.x

[42]   Shun, S.C., Chiou, J.F., Lai, Y.H., Yu, P.J., Wei, L.L., Tsai, J.T., et al. (2008) Changes in Quality of Life and Its Related Factors in Liver Cancer Patients Receiving Stereotactic Radiation Therapy. Supportive Care in Cancer, 16, 1059- 1065.
http://dx.doi.org/10.1007/s00520-007-0384-y

[43]   Ueno, S., Tanabe, G., Nuruki, K., Yoshidome, S., Kubo, F., Kihara, K., et al. (2002) Quality of Life after Hepatectomy in Patients with Hepatocellular Carcinoma: Implication of Change in Hepatic Protein Synthesis. Hepato-Gastroenter- ology, 49, 492-496.

[44]   Jenneya, M. and Campbellb, S. (1997) Measuring Quality of Life. Archives of Disease in Childhood, 77, 347-350.
http://dx.doi.org/10.1136/adc.77.4.347