Steel_edit.qxp 4/10/07 3:39 pm Page 89
Health-related Quality of Life in Patients Diagnosed with Hepatobiliary Carcinoma
have been found to be associated with fatigue.
28
Additional factors such
Figure 1: Cumulative Survival of Patients Diagnosed with
as weight loss and loss of appetite, stress, changes in metabolism,
Hepatobiliary Carcinoma with and without Vascular Invasion and a
decreased levels of hormones, sleep problems, inactivity, shortness of
Center for Epidemiological Studies—Depression Score ≥ and <16
breath, pain, and depression may also contribute to fatigue.
28
Vascular Invasion
Cumulative Survival
Two schools of thought exist with regard to the treatment of fatigue in
1.0
cancer. Energy conservation has been recommended for decades and
includes changing daily activities to conserve energy for activities that may
0.8
not be necessary but improve quality of life (e.g. attending grandson’s
baseball game). For example, a person could sit down while drying off
from a bath or shower or request assistance for shopping or cleaning his
0.6
or her house. In contrast, several recent studies have demonstrated that
people diagnosed with breast and colorectal cancer who participate in 0.4
moderate physical activity report lower levels of fatigue.
28
0.2
A large percentage of patients diagnosed with hepatobiliary carcinoma
present with pain at diagnosis, and many others will develop pain as the
0.0
disease progresses. Pain is often effectively managed with opioids;
0.0 20.0 40.0
however, the metabolism of these medications in a cirrhotic liver and/or
Survival
the consequences of opioids on a cirrhotic liver are unknown, but are
currently under study. Additional challenges exist when managing pain in No Vascular Invasion
an individual with a history of drug and/or alcohol use. Management of
Cumulative Survival
1.0
pain may be difficult due to the increased risk for abuse of the
prescription drugs, and neurophysiological changes as a result of past
drug or alcohol use may make it difficult to manage the pain on usual
0.8
doses.
29
Often, collaboration with a pain center and/or palliative care
physician is recommended if the individual has a history of drug and/or 0.6
alcohol abuse. Behavioral strategies are also available and can be
recommended in addition to pharmacological interventions for pain.
0.4
Increasing evidence suggests that people diagnosed with hepatobiliary
carcinomas may have higher levels of distress compared with patients
0.2
with other types of cancer. In a study of over 9,000 patients, people
diagnosed with liver cancer reported the highest levels of distress
0.0
0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0
compared with those with other cancer types.
30
Similar to patients with
Survival
colorectal or pancreatic cancer, depressive symptoms are sometimes
reported months to years prior to the diagnosis, suggesting that a
biological process related to the cancer may contribute to what may be associated with survival.
33
A mediational model linking depressive
considered depression.
31,32
symptoms and survival, with NK cell number as a mediator, was
preliminarily supported.
33
In a recent study, 37% of patients reported a Center for Epidemiological
Studies—Depression (CES-D) scale score >16 (clinical range) at the time Few studies have been conducted concerning sleep problems in people
of diagnosis.
33
Using Cox regression analysis, sociodemographic (e.g. diagnosed with cancer. Difficulties such as insomnia, sleep apnea, and
age, gender) and disease-specific (e.g. tumor size, number of lesions) hypersomnolence have been reported by a significant proportion of
variables and CES-D score significantly predicted survival.
34
However, only patients diagnosed with hepatobiliary carcinoma (80%; unpublished
vascular invasion and CES-D >16 were significant predictors of survival. data). Insomnia may be secondary to depression, anxiety, or cancer-
Patients who had vascular invasion and a CES-D score >16 survived for related symptoms such as fatigue, pain, and/or ascites. Comprehensive
5.2 months, whereas patients who reported a CES-D score <16 assessment and treatment of sleep problems and referral to a sleep
and vascular invasion survived for 11.2 months.
34
Those patients without disorder specialist may be recommended for those with difficulties
vascular invasion who reported a CES-D score >16 survived for 17.0 initiating or maintaining sleep or sleep apnea, respectively.
months, while patients without vascular invasion and those who
reported a CES-D score <16 survived for 26.6 months
33
(see Figure 1). Sexual problems have been studied in patients with cancer of the
reproductive organs and were found to be more prevalent than in the
In a subsample of patients, those who reported a CES-D >16 were found general population;
34–37
however, sexual dysfunction (SD) is rarely
to have significantly lower NK cell numbers than those who reported a addressed by clinicians in other cancer types. People diagnosed with HCC
CES-D score <16. A robust trend was found in which NK cell number was may be expected to report higher levels of SD secondary to: disease- or
US GASTROENTEROLOGY REVIEW 2007 89
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100