Association Between Illness Perceptions And Quality Of Life In Chinese Patients With Early And Intermediate Stage Primary Hepatocellular Carcinoma

The annual number of new cases of primary hepatocellular carcinoma(HCC)is over one million globally,with approximately 55% of the new cases occurring in China.The HCC is regarded as �incurable disease� in Chinese culture,although the prognosis has been significantly improved for early and intermediate stage HCC because of the improvement of screening and therapeutic techniques.Many studies have demonstrated the relationship between cancer patient's illness perceptions and the health-related quality of life(HRQOL).Illness perceptions are used to describe a range of cognitive processes underlying attention,interpretation,and behavior in response to illness-related information.There are few studies on Chinese patients for their illness perceptions(i.e.,beliefs,ideas,thoughts and emotional responses)related with HCC.Therefore,we conducted this study to explore the association between illness perceptions and HRQOL in Chinese patients with early and intermediate stage HCC.MethodsPatients with HCC who were admitted for potentially curative treatments in the first teaching hospital of Third Military Medical University were recruited from January to December 2015.At admission,the patients were interviewed for demographic characteristics.Then patients' illness perceptions were evaluated by the Brief Illness Perception Questionnaire(BIPQ),and quality of life was evaluated by the Chinese version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire(EORTC QLQ-C30).The Simplified Coping Style Questionnaire(SCSQ)was used to assess the coping strategies that the participants often used to manage the stressful life events they experienced,and the Social Support Rating Scale(SSRS)was adopted to evaluate the social support that patients have received.Correlation analysis was performed to determine the variables that were significantly related with the global HRQOL.Then the independent variables related with global HRQOL in the univariate analysis were entered into the multiple linear regression models,to demonstrate the association between illness perceptions and HRQOL after controlling for the other related factors.Results1.There were 220 patients recruited.The male: female ratio was 3.1:1(166: 54),and the mean age of the patients was 50.5�10.3 years(range: 22�80 years).2.Correlation analysis of demographic data and global HRQOL showed that gender,educational level and history of Hepatitis B virus(HBV)infection were significantly related to the global HRQOL,with correlation coefficient(r)of-0.271,0.159 and 0.192,respectively.Specifically,the scores of global HRQOL were higher for male patients comparing with the female patients(scores were 55.74�22.03 versus 41.36�24.06,P<0.001).Secondly,the scores of global HRQOL were higher for patients with college education relative to patients with primary education(scores were 57.52�19.95 versus 47.45�25.94,P=0.023).The higher score of global HRQOL was also found in patients with history of HBV infection relative to patients without infection(scores were 54.09�23.46 versus 42.54�20.94,P=0.006).3.Correlation analysis of subscales of EORTC QLQ-C30 and global HRQOL showed that physical functioning,role functioning,emotional functioning and symptom of fatigue were significantly related with the global HRQOL(r: 0.290,0.277,0.192 and-0.349,respectively;P value: <0.001,<0.001,=0.007,<0.001,respectively).4.Regarding illness perceptions,it showed that perceptions of consequences of disease,identity of symptoms and emotional response were negatively associated with global HRQOL(r:-0.209,-0.321,and-0.414,respectively;P value: 0.003,<0.001,<0.001,respectively),whereas the personal control and illness comprehensibility were positively related with the global HRQOL(r: 0.242 and 0.159,respectively;P value: 0.001 and 0.025,respectively).5.Regarding illness perceptions about the cause of their disease,the patients listed unhealthy life style(such as smoking,alcohol drinking,insufficient sleep and exercise),HBV infection,lack of awareness and psychological distress/mental stress as the four leading causes.6.Correlation analysis of coping style and global HRQOL showed that active coping style was significantly related with the global HRQOL(r=0.202,P=0.005),but passive coping style was not significantly associated with global HRQOL(P=0.851).7.Regarding social support,it showed that both of the objective social support and subjective social support were significantly related with the global HRQOL(r:0.221,0.164,respectively;P value: 0.002,0.022,respectively),but the use of support was not significantly associated with global HRQOL(P=0.114).8.The Independent variables that were significantly associated with global HRQOL in the univariate analysis were entered into the multiple linear regression model.The results of the regression showed that personal control,identity of symptoms,illness comprehensibility and gender were significantly associated with the global HRQOL(P=0.003,0.026,0.014 and 0.009,respectively).Conclusions of this study based on the study findings:1.The positive illness perceptions(i.e.,personal control and illness comprehensibility)were positively related with the health-related quality of life(HRQOL),whereas the negative illness perceptions(i.e.,perceptions of consequences of disease,identity of symptoms and emotional response)were negatively associated with HRQOL.2.There were other factors related with HRQOL,including the gender,educational level,history of HBV infection,active coping style,objective and subjective social support.3.Patient's illness perceptions of personal control,illness comprehensibility and identity of symptoms were independent variables significantly associated with HRQOL after controlling for the other related factors.4.Regarding illness perceptions about the cause of their disease,the patients explained their illness on both internal causes and external causes.Specifically,the unhealthy life style,HBV infection,lack of awareness and psychological distress/mental stress were the four leading causes listed by the patients.5.The study findings suggest that the healthcare providers should care about the patients' illness perceptions,and respond to them by managing symptoms,provide adequate information of their illness and treatment,and encourage their sense of personal control.To the best of our knowledge,this is the first study to evaluate the association between illness perceptions and health-related quality of life in patients with HCC in mainland China.The study findings provided a new variable(i.e.,illness perceptions)which was significantly related with qualify of life in patients with HCC,and also provided theoretical basis for improving the quality of life by psychological support and cognitive behavioral therapy directed to illness perceptions in these patients.There are limitations to our study.First is the geographic limitation because the 220 participants were from one single hospital in southwest China.Secondly,all participants were with early or intermediate stage HCC.It needs further studies in patients with late stage HCC considering that the illness perceptions might be different in such patients.