. 2022 Apr 21;10:801981. doi: 10.3389/fpubh.2022.801981

Table 4.

Characteristics of selected QoL studies.

Study	Region	Study design	Sample source	Sample size	Measure(s)	QoL data
Measures of QoL in Chinese patients
Hsu et al. (34)	Taiwan	Cross-sectional study	Hospital-based	300	MNA-LF, MNA-SF, EORTC QLQ-C30 V3.0	(1) Both the long-form and short-form of the MNA performed better than GQL and GFS in predicting quality of life and functional status of patients with HCC . (2)The MNA is suitable for identifying the risk of deteriorating quality of life or functional status, in addition to identifying the risk of malnutrition, in patients with HCC.
Li et al. (36)	Hong Kong	Prospective cohort study	Hospital-based	472	EORTC QLQ-C30, EORTC QLQ-HCC18, C30 and HCC18 index-scores	(1) In multivariate analysis, independent prognostic HRQOL variables for OS were QLQ-C30 pain (HR 1.346 [1.092–1.661], P = 0.0055), QLQ-C30 physical functioning (HR 0.652 [0.495–0.860), P = 0.0024); QLQ-HCC18 pain (HR 1.382 [1.089–1.754], P = 0.0077) and QLQ-HCC18 fatigue (HR 1.441 [1.132–1.833], P = 0.0030). (2)C30 index-score (HR 2.143 [1.616–2.841], P < 0.0001) and HCC18 index-score (HR 1.957 [1.411–2.715], P < 0.0001) were highly significant factors for OS. (3)The median OS of patients with C30 index-score of 0–20, 21–40, 41–60, 61–100 were 16.4, 7.3, 3.1, 1.8 months respectively (P < 0.0001); while for HCC18 index-score: 16.4, 6.0, 2.8, 1.8 months respectively (P < 0.0001).
Yang et al. (48)	Yunnan	Interrupted time series	Hospital-based	114	EORTC QLQ-HCC18, FACT-Hep	(1)The internal consistency Cronbach's α were > 0.60 for all domains (exception of Jaundice 0.38), and all test-retest reliability coefficients were > 0.80. (2)Four out of eight domains had statistically significant changes with effect size standardized response mean ranging from 0.31 to 0.73.
HCC compared with benign liver diseases and the general population
Fan et al. (32)	Taiwan	Cross-sectional study	Hospital-based	286	EORTC QLQ-C30, EORTC QLQ-HCC18, Brief IPQ, Jalowiec coping scale	(1) Patients with HCC had worse global QoL, physical, role, cognitive and social functioning, but better emotional functioning than the general population. (2)Cognitive representation was significant predictors of global QoL, physical functioning and emotional functioning. (3)Cognitive representation mediated the relationships between physical variables and global QoL, physical functioning and emotional functioning, but coping only mediated the relationship between cognitive representation and global QoL.
Wei et al. (45)	Guangxi	Cross-sectional study	Hospital-based	63	CD-RISC, EORTC QLQ-C30 V3.0, EORTC QLQ-HCC18	(1) The total health status score of QLQ-C30 was (56.61 ± 27.24) points, with lower quality of life scores and higher clinical symptoms scores. (2)Emotional functioning, social functioning, and general health status were positively correlated with the total score of psychological resilience (r = 0.382, P < 0.01; r = 0.324, P < 0.01; r = 0.383, P < 0.01). (3)Symptoms of fatigue, pain, fatigue, and nutritional changes were negatively correlated with the total score of psychological resilience (r = −0.303, P < 0.05; r = −0.286, P < 0.05; r = −0.360, P < 0.01; r = −0.259, P < 0.05).
Zhang et al. (50)	Hebei	Case-control study	Hospital-based	81 HCC 44 benign liver diseases	QOL-LC V2.0	(1) The scores of physical functioning (42 ± 10), symptom/side effect (41 ± 7), social functioning (28 ± 10) and total QoL (150 ± 24) of HCC group were lower than that of control group (P < 0.05). (2)The scores of physical functioning, symptom/side effect are negatively correlated with the way of case finding, TNM stage, Child-Pugh class, respectively. (3)The score of psychological functioning is positively correlated with age. (4)The score of social functioning is positively correlated with age, education level, income, and mode of payment, and negatively correlated with the way of case finding.
Physical factors and symptoms associated with QoL
Fielding et al. (33)	Hong Kong	Prospective cohort study	Hospital-based	176 liver cancer 358 lung cancer	FACT-G, Visual analog: eating ability, eating appetite, eating enjoyment, self-care ability, and current health perception	(1)No association between QoL and survival in patients with liver cancer. (2)Less advanced cancer stage and better appetite were associated significantly with longer survival in patients with liver cancer.
Li et al. (37)	Hong Kong	Prospective cohort study	Hospital-based	445	EORTC QLQ-C30, EORTC QLQ-HCC18, C30 and HCC18 index-scores	(1)Significant correlations were found between IL-8 levels and EORTC QLQ-C30, QLQ-HCC18, C30, and HCC18 index-scores. (2)The strongest correlated factors were those reflective of constitutional symptoms, namely QLQ-C30 “appetite loss” (with Pearson's correlation coefficient, r = 0.322, P < 0.0001); QLQ-C30 “fatigue” (r = 0.311, P < 0.0001); QLQ-C30 “role functioning” (r = −0.305, P < 0.0001); QLQ-HCC18 “nutrition” (r = 0.317, P < 0.0001); and QLQ-HCC18 “fatigue” (r = 0.306, P < 0.0001). (3)Moderate but significant correlations were also observed with HCC18 index score (r = 0.321, P < 0.0001), and C30 index score (r = 0.306, P < 0.0001). (4)QoL factors were also significantly correlated with mIBI.
Li et al. (38)	Hong Kong	Prospective cohort study	Hospital-based	445	EORTC QLQ-C30, EORCT QLQ-HCC18, C30 and HCC18 index-scores	(1)Higher inflammatory states were significantly correlated with worse QoL. (2)For CRP and CRP/alb ratio, the QoL factors with higher correlations included C30 and HCC18 index-scores, certain QLQ-C30 domains and items (“physical functioning”, “role functioning”, “fatigue”, “pain”, “appetite loss”) and QLQ-HCC18 items (“fatigue”, “body image”, “nutrition” and “abdominal swelling”), where the Pearson's correlation coefficients were up to 0.416. (3)Multivariate analyses indicated that worse QoL factors were significantly correlated with worse scores in GPS, IBI and PI.
Li et al. (39)	Hong Kong	Prospective cohort study	Hospital-based	472	EORTC QLQ-C30, EORCT QLQ-HCC18, C30 and HCC18 index-scores	(1)After adjusting for clinical variables, significant correlations were found between QoL (QLQ-C30 and QLQ-HCC18) and dichotomized liver function variables (including Child-Pugh class, ALBI grade and the presence of ascites). (2)It was demonstrated that QoL had significant and potentially clinically important correlations with continuous liver function variables (albumin, bilirubin, ALP and albumin-to-ALP ratio), with the highest Spearman's rank correlation coefficient (rho) exceeding 0.4. (3)HCC18 and C30 index scores were also significantly correlated with these liver function variables. HCC18 index score, which had rho up to 0.37, generally performed better than C30 index score, which had rho up to 0.33.
Qiao et al. (42)	Shanghai	Cross-sectional study	Hospital-based	140	FACT-Hep	(1)The mean FACT-Hep scores were reduced significantly from TNM Stage I to Stage II, Stage IIIA, Stage IIIB group (687 ± 39.69 vs. 547 ± 42.57 vs. 387 ± 51.24 vs. 177 ± 71.44, P = 0.001). (2)Regarding the physical and emotional well-being subscales, scores decreased gradually from Stage I to Stage IIIB (P = 0.002 vs. Stage I; P = 0.032 vs. Stage II; P = 0.033 vs. Stage IIIA). (3)Mean FACT-Hep scores varied by Child-Pugh class, especially in the subscales of physical well-being, functional well-being and the hepatobiliary cancer (P = 0.001; P = 0.036; P = 0.032 vs. Child A). (4)For the social and family well-being subscale, only Child C scores were significantly lower as compared with Child A scores (P = 0.035). (5)For the subscales of functional well-being and hepatobiliary cancer, there were significant differences for Child A, B and C (P = 0.002 vs. Child A).
Wong et al. (46)	Hong Kong	Prospective cohort study	Hospital-based	253 liver cancer 334 lung cancer	FACT-G, MISS-Cog, ChPSQ-9, The single-item visual analog to assess eating appetite, optimism, and depression	(1)There were no differences in QoL, patient satisfaction, and psychosocial measures between the 2 cancer groups. (2)The patients' informational support from medical staff did not predict QoL, but all psychosocial factors emerged as a covariate of the satisfaction in predicting QoL; after controlling for sociodemographic and psychosocial variables, only satisfaction predicted QoL.
Wong et al. (47)	Hong Kong	Prospective cohort study	Hospital-based	253 liver cancer 250 breast cancer 334 lung cancer 242 nasopharyngeal cancer	FACT-G, Eating function: eating ability, eating appetite, eating enjoyment, Pain rating (visual analog), Depression (single item)	(1)Patients with liver cancer reported lower scores in total QoL, physical, functional, emotional, eating appetite, and depression than patients with nasopharyngeal cancer. (2)After controlling for sociodemographic and medical variables, pain, depression, and eating function significantly predicted overall QoL, physical, and functional well-being over time (all cancer). (3)Patients with liver cancer had a slightly decreased score in eating appetite, ability, and enjoyment.
Yeo et al. (49)	Hong Kong	Prospective cohort study	Hospital-based	233	EORTC QLQ-C30	(1)Significant independent predictors of shorter survival were advanced Okuda staging (P = 0.0030; HR = 2.058), high baseline total bilirubin (P = 0.0008; HR = 1.013) and worse QoL score in the appetite score domain (P = 0.0028; HR for 10 point increase = 1.070). (2)Patients who were entered into the chemotherapy trial (P = 0.0002; HR = 0.503), those who scored better in the physical functioning domain (P = 0.0034; HR for 10 point decrease = 0.911) and the role functioning domain (P = 0.0383; HR for 10 point decrease = 0.944) of the QoL questionnaire, were associated with longer survival.
Demographic characteristics and psychological factors associated with QoL
Fan et al. (31)	Taiwan	Cross-sectional study	Hospital-based	33	Semistructured interview	(1)The impact of disease: HCC was associated with physical symptoms and psychosocial stress, as well as positive changes. (2)Illness perceptions: patients perceived HCC as a long-term and chronic disease that could not be cured but might be controlled. (3)Coping strategies: these included focusing on managing HCC and its symptoms, emotional responses, and leading a normal life.
Huang et al. (35)	Taiwan	Cross-sectional study	Hospital-based	77	BFI-T, PSQI-Taiwan Form, Depression subscale of the HADS	(1)Fatigue, sleep disturbance, and depression are positively interrelated and co-occur in patients with HCC. (2)Depression completely mediates the effects of sleep disturbance on fatigue.
Jie et al. (40)	Chongqing	Prospective cohort study	Hospital-based	218	EORTC QLQ-C30, Brief IPQ	(1)When comparing the patients in the disclosed group with the patients who were uninformed, the patients in the disclosed group had higher scores for global QoL at discharge (P = 0.013) and higher scores on understanding of their illness regarding illness perceptions (P = 0.022). (2)When comparing the patients in the ‘autonomy-satisfied' group with the patients whose desire for disclosure was not satisfied, the patients in the autonomy-satisfied group had better emotional functioning and better global QoL at discharge (P < 0.001 and P = 0.001, respectively). (3)Additionally, the patients in the autonomy-satisfied group had higher scores for personal control (P = 0.009) and lower scores for emotional reaction (P = 0.007) regarding illness perceptions, even after controlling for other confounding factors.
Jie et al. (41)	Chongqing	Prospective cohort study	Hospital-based	300	PCL-C, PTGI, EORTC QLQ-C30	(1)Compared with the uninformed group, patients in the disclosed group had lower scores for PTSS (P < 0.001), higher scores for PTG (P < 0.001), better emotional functioning (P < 0.001), and better global QoL (P = 0.006) at 1 month after discharge.
Qiu et al. (43)	Chongqing	Cross-sectional study	Hospital-based	220	EROTC QLQ-C30, Brief IPQ, SCSQ, SSRS	(1)The mean score of quality of life was obviously higher in the male patients than the female patients (P < 0.001). (2)In regard to illness perceptions, personal control (β = 1.707, P = 0.003), identity of symptoms (β = −1.315, P = 0.016) and illness comprehensibility (β = 1.489, P = 0.014) were significantly correlated to the global QoL.
Shun et al. (44)	Taiwan	Prospective cohort study	Hospital-based	104	SDS, HADS, SCNS-SF34	(1)Overall symptom distress decreased monthly, with the highest level before discharge. Compared with the elderly group, the young group had a significantly higher level of symptom distress (P = 0.024) but had a lower level of this 2 months after discharge. (2)Patients in the young group who were male (β = −14.24, P = 0.012) and single/widowed (β = −19.17, P = 0.033) and with higher levels of education (β = 1.38, P = 0.020), stage C (β = 30.21, P = 0.006), good functional status (β = 0.78, P = 0.024), and higher levels of symptom distress (β = 2.67, P < 0.0001) and anxiety (β = 6.03, P < 0.0001) had higher levels of overall unmet supportive care needs. (3)For the elderly group, those patients with recent diagnosis status (β = −14.08, P = 0.008), portal vein thrombosis (β = 31.32, P = 0.011), and higher levels of symptom distress (β = 2.09, P = 0.003), anxiety (β = 4.60, P < 0.0001), and depression (β = 2.71, P = 0.007) had higher levels of overall unmet care needs.
Zheng et al. (51)	Jiangxi	Cross-sectional study	Hospital-based	166	EORTC QLQ-HCC18, HCC18 index-score, CES-D, RSES, LOT-R	(1)Scores of CES-D, RSES, and LOT-R were (17.34 ± 2.25), (29.59 ± 4.67), and (29.78 ± 3.14), respectively. (2)EORTC QLQ-HCC18, CES-D, RSES, and LOT-R were correlated with scores in various fields (P < 0. 05). (3)In the influence path of QoL on depressive symptoms, RSES regulation belonged to a complete mediation model and LOT-R regulation belonged to partial intermediary model.