Steel_edit.qxp 4/10/07 3:38 pm Page 87
Gastrointestinal Cancers
Health-related Quality of Life in Patients Diagnosed with Hepatobiliary Carcinoma
a report by
Jennifer L Steel, PhD,
1
Brian I Carr, MD, PhD, FRCP,
1
Marion C Olek, MSc, MPH
2
and T Clark Gamblin, MD
1
1. University of Pittsburgh School of Medicine, Starzl Transplantation Institute, Liver Cancer Center;
2. University of Pittsburgh Medical Center, Starzl Transplantation Institute, Liver Cancer Center
The concept of health-related quality of life (HRQoL) is not often uniformly surgical treatments include systemic and infusional chemotherapy,
defined or measured across disciplines or even within medicine. The hepatic ligation or embolization, percutaneous ethanol injection,
World Health Organization (WHO) defines quality of life as “a state of cryotherapy, radiolabeled antibodies, and radiofrequency ablation. Many
complete physical, mental, and social well-being, and not merely the of these therapies have been demonstrated to have, at best, only modest
absence of disease or infirmity.”
1
In oncology, the measurement of HRQoL improvements in survival;
2–7
as a result, HRQoL becomes paramount.
as an end-point has become routine in clinical trials testing the efficacy of
novel chemotherapeutic agents and/or ablation techniques. However, in Health-related Quality of Life and Hepatobiliary
the area of hepatobiliary carcinoma, where novel therapies and Carcinoma in the Research Setting
randomized controlled trials are less common due to the low prevalence Although randomized clinical trials testing novel therapies in hepatobiliary
of this disease,
2–7
HRQoL has been under-studied.
3
carcinoma are rare,
2–7
one of the major limitations of prior research has
been the lack of standardized instruments for assessing HRQoL as an
The most common of the hepatobiliary cancers is hepatocellular carcinoma outcome in these trials. General HRQoL instruments have long been
(HCC), which accounts for more than 250,000 deaths a year and is the available, but only recently have disease-specific HRQoL instruments been
leading cause of death from cancer in eastern Asia and sub-Saharan developed for patients diagnosed with hepatobiliary carcinoma. The first
Africa.
8
The primary contributing factor in the development of HCC is disease-specific HRQoL instrument developed for hepatobiliary carcinoma
hepatitis B and C.
2
With an estimated 3–4 million people chronically was the Functional Assessment of Cancer Therapy—Hepatobiliary (FACT-
infected with hepatitis C, the incidence of HCC is expected to double in Hep).
17,18
The FACT-Hep is a reliable and valid multidimensional instrument
the next decade in North America.
9,10
In addition to hepatitis B and C, of HRQoL that includes four domains (physical, functional, social and
which are comorbid factors in approximately 40% of US cases, other family, and emotional wellbeing), as well as a disease- and treatment-
contributing factors to HCC include alcohol abuse and/or dependence, specific module for hepatobiliary carcinoma.
18
A second disease-specific
aflatoxin B1 (mycotoxins formed by certain Aspergillus species found in instrument for HCC, the European Organization for Research and
improperly stored grains), hemochromatosis, alpha-l-antitrypsin deficiency,
glycogen storage disease, porphyria cutanea tarda, tyrosinemia, Wilson’s
Jennifer L Steel, PhD, is an Assistant Professor of Surgery in the Division of Transplantation at
disease, and—in rare cases— biliary cirrhosis.
10–13
In a retrospective case-
the University of Pittsburgh and a Visiting Scholar at the Karolinska Institute, Stockholm. Her
control study, patients with cryptogenic cirrhosis had higher rates of research and clinical interests include: health-related quality of life in people diagnosed with
obesity, type 2 diabetes, dyslipidemia, and insulin resistance compared with
cancer and HIV/AIDS; the association between psychological factors, immunity, and disease
progression in virally related cancers; and health and psychological sequelae of trauma.
patients with HCC of viral or alcohol etiology.
14,15
Dr Steel completed her graduate training at Washington State University, her residency at
Rush-Presbyterian St Luke’s, and her fellowship at Columbia University.
Less common types of hepatobiliary carcinoma include gallbladder and
cholangiocarcinoma. Risk factors for gallbladder carcinoma include
Brian I Carr, MD, PhD, FRCP, is a Professor and Co-Director of the Liver Cancer Center at the
University of Pittsburgh. His major interest is hepatocellular carcinoma (HCC), and his research
gallstones, chronic cholecystitis, calcified gallbladder, gallbladder polyps,
and academic interests include novel treatments for HCC, K vitamin antagonists of tyrosine
typhoid, and carcinogens such as azotoluene and nitrosamines.
16
phosphatases, psychological factors in cancer prognosis, and patient coping mechanisms. Dr Carr
Cholangiocarcinomas are often classified as intrahaptic hepatic, which is
received his MD and a PhD in molecular biology from the University of London, before carrying
out an oncology fellowship at the University of Wisconsin, Madison.
when a lesion arises in the small bile duct radicals, or extrahepatic, which
occurs within the bile ducts outside the liver, including the major hepatic
Marion C Olek, MSc, MPH, is a Data Analyst at the Liver Cancer Center at the University of
ducts, the junction of the right and left hepatic ducts, and the common
Pittsburgh Medical Center. She holds a Master degree in both microbiology and epidemiology.
hepatic and bile ducts.
16
The etiology of cholangiocarcinoma is unknown; Her interests include the study of psychosocial, immune, and clinical risk factors and survival in
however, risk factors may include hepatolithiasis, ulcerative colitis,
hepatobiliary cancers. She is a member of the Society for Epidemiologic Research (SER).
schlerosing cholangitis, choledochal cysts, liver fluke infections, or
T Clark Gamblin, MD, is an Assistant Professor of Surgery in the Division of Surgical Oncology and
chemical exposure to nitrosamines.
16
Transplantation at the University of Pittsburgh. His clinical focus is liver and pancreatic cancer, and his
research interests are directed toward hepatobiliary clinical trials and isolation of liver cancer stem
At diagnosis, approximately 80% of patients diagnosed with
cells. He also leads the sction of liver-directed therapy at the Liver Cancer Center, utilizing hepatic
artery chemoembolization or 90-Yttrium internal radiation for primary and metastatic liver cancer.
hepatobiliary carcinoma present to a physician with unresectable lesions
or do not meet the criteria for orthotropic liver transplantation.
2,8
Non-
© TOUCH BRIEFINGS 2007
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