Quality of Life in Hepatocellular Carcinoma Patients Treated with Transarterial Chemoembolization

Table 2

Impact of TACE on QoL in patients with HCC.

SN	Author	Study design and population	Intervention	Comparative groups or subset	Timing of questionnaire	Outcome
1	Kato et al.; 1990 [19]	Prospective study; Unresectable HCC	Patients with unresectable liver cancer: comparison of TAE, MMC microcapsule, and single shot intra-arterial doxorubicin	6: TAE; 6: MMC microcapsule; 4: single shot intra-arterial doxorubicin	Before TACE; 1 week after; 2 weeks after	Anorexia and depression worse in patients who underwent TACE with doxorubicin
2	Toyoda et al.; 1993 [9]	Retrospective study; Stage IVa HCC	Patients with stage IVa HCC who are unsuitable for surgery, PEIT, and TAE were selected for continuous intra-arterial chemotherapy	NA	Variable timing	Two patients in partial remission group had improvement in QoL
3	Tanabe et al.; 2001 [10]	Retrospective study; HCC recurrence after initial curative resection	Recurrence of HCC after HR: comparison of repeat HR versus HAI chemotherapy	13: HAI; 10: repeat HR	After TACE	Repeat HR provides good prognosis and favourable QoL compared to HAI in patients with resectable recurrence
4	Jianbo et al.; 2002 [20]	Prospective study; Primary HCC	TACE	NA	Before TACE; 1 month after; 3 months after	QoL is improved after TACE and can be maintained till 3 months after treatment in the physiology, psychology, and symptoms domain
5	Steel et al.; 2004 [21]	Prospective nonrandomized cohort study; Histology proven HCC	Patients with HCC: comparison of TACE and ^90Y radioembolization	14: TACE; 14: ^90Y radioembolization	Before TACE; 3 months after; 6 months after; 12 months after	Treatment with Yttrium has a modest advantage with regard to QoL when compared to HAI with cisplatin
6	Shun et al.; 2005 [22]	Prospective study; Primary HCC	TACE; 16 patients had 2–5 previous TACE procedures	NA	Before TACE; 2 days after; 4 days after; 6 days after	Patient fatigue levels peaked at day 2. Factors responsible for increased fatigue levels include greater symptom distress, anxiety, and depression, higher Adriamycin dosage, longer duration of previous fatigue; and less education levels
7	Wang et al.; 2007 [23]	Prospective randomized study; Histology proven HCC	Patients with HCC: comparison of TACE and TACE + RFA	40: TACE; 43: TACE + RFA	Before TACE; 3 months after 1st TACE	The overall QoL of HCC patients in TACE-RFA group was maintained at higher level than that of TACE group
8	Wible et al.; 2010 [24]	Prospective study; Primary HCC	TACE; 23 patients underwent 3 or more TACE procedures	NA	Before TACE; 4 months after; 8 months after; 12 months after	Patients with HCC are likely to perceive improved mental health during the first 4 months of primary TACE. If they undergo more than 2 procedures, they are likely to perceive improved mental health during the first 2 sessions. Patient-perceived vitality will likely worsen after initial procedure
9	Toro et al.; 2012 [25]	Prospective study; Primary HCC eligible for HR, RFA, TACE, or NT	Patients with HCC: comparison of HR, TACE, RFA, and NT	14: HR; 15: TACE; 9: RFA; 13: NT	Before TACE; 3 months after; 6 months after; 12 months after; 24 months after	RFA provides a worse QoL compared to HR but a higher QoL compared to TACE or NT
10	Shun et al.; 2012 [26]	Prospective study; Primary HCC patients receiving TACE	TACE	NA	3 days prior to discharge; 4 weeks after discharge; 8 weeks after discharge	Those at greatest risk for lower QoL include males and those who have higher levels of depression and anxiety after discharge
11	Eltawil et al.; 2012 [27]	Prospective study; Primary HCC not amenable to ablation or resection	TACE; 6 patients underwent 3 or more TACE procedures	NA	Data collected every 3-4 months	QoL remained stable for almost a year and only started to decline after the 3rd TACE which coincided with progression of tumour; concluded that majority of patients were able to tolerate several TACE sessions without significant deterioration of QoL
12	Salem et al.; 2013 [2]	Prospective study; Primary HCC	Patients with HCC: comparison of TACE versus ^90Y radioembolization	29: ^90Y radioembolization; 27: TACE	Before TACE; 2 weeks after; 4 weeks after	QoL difference did not reach statistical significance; change in EES score was most pronounced; ^90Y radioembolization is better able to maintain health-related QoL.
13	Xie et al.; 2015 [28]	Retrospective study; Primary intermediate stage HCC	Patients with HCC: comparison of TACE versus HR	58: HR; 44: TACE	Before TACE; 1 month after; 3 months after; 6 months after; 12 months after; 24 months after	QoL was lower in the 1st month after procedure but recovered in the 3rd and 6th months but dropped again in the 12th month with lowest scores in the 24th month
14	Xing et al.; 2015 [29]	Prospective study; Unresectable HCC	TACE	NA	Before TACE; 3 months after; 6 months after; 12 months after	QoL was preserved for up to 12 months after TACE

5-FU: 5-Fluorouracil; CDDP: cisplatin; HAI: hepatic artery infusion; HR: hepatic resection; MMC: mitomycin C; NA: not applicable; NS: not specified; NT: no treatment; QoL: quality of life; RFA: radiofrequency ablation; SD: standard deviation; TACE: transarterial chemoembolization; TAE: transarterial embolization.