Factors Predicting Quality of Life of Hepatocellular Carcinoma Patients Undergoing Transarterial Chemoembolisation


  • อรุณ นิลเลิศ หอผู้ป่วยผะอบฯ5(พิเศษรวม) โรงพยาบาลศิริราช เลขที่ 2 ถนนวังหลัง แขวงศิริราช เขตบางกอกน้อย กรุงเทพมหานคร
  • ผ่องศรี ศรีมรกต
  • เกศศิริ วงษ์คงคำ
  • สมราช ธรรมธรวัฒน์


fatigue, anorexia, insomnia, quality of life, patients with hepatocellular carcinoma, transarterial chemoembolisation


     Objective: To study predictive correlations between fatigue, insomnia and anorexia,and the quality of life of hepatocellular carcinoma (HCC) patients during four to eight weeks after undergoing transarterial chemoembolisation (TACE).
     Design: Predictive correlational research.
     Methodology: The subjects were 77 HCC patients receiving monitoring check-ups in an out-patient ward during 4 to 8 weeks after undergoing transarterial chemoembolisation. Data were collected through a set of questionnaires: 1) a general information questionnaire; 2) the Fatigue Symptom Inventory; 3) the Insomnia Severity Index; 4) the Council on Nutrition Appetite Questionnaire; and 5) the Functional Assessment of Cancer Therapy-Hepatobiliary. The data were analysed using descriptive statistics and stepwise multiple regression analysis.
      Results: Based on the results, the participants displayed mild fatigue ( = 19.31,SD = 27.09), no insomnia ( = 6.39, SD = 7.74), moderate anorexia ( = 17.25, SD = 5.55)and good quality of life ( = 138.36, SD = 22.99). The most influential factor affecting the quality of life was fatigue (ß = -.49, p < .001), followed by anorexia (ß = -.38,p < .001) and insomnia (ß = -.18, p < .001). These three factors were capable of predicting the patients’ quality of life by up to 80% (R2 = .80, F = 96.03, p < .001).
     Recommendations: Thorough evaluation of the severity of fatigue, anorexia and insomnia in hepatocellular carcinoma patients after TACE treatment is instrumental in successfully controlling or alleviating their symptoms, or preventing such symptoms from escalating and affecting the patients’ quality of life.


Download data is not yet available.


1. Global Burden of Disease Cancer C, Fitzmaurice C, Dicker D, Pain A, Hamavid H, Moradi-Lakeh M,
et al. The Global Burden of Cancer 2013. JAMA Oncol. 2015;1(4):505-27.
2. Information and Technology Division, National Cancer Institute. Hospital-based Cancer Registry Annual Report 2014. Bangkok: Pornsup Printing; 2016. (in Thai)
3. Strategy and Planning Division. Public Health Statistics A.D. 2015. Offce of the Permanent Secretary Ministry of Public Health, editor. Bangkok: Samcharoen Panich; 2015. (in Thai)
4. Shun S-C, Chen C-H, Sheu J-C, Liang J-D, Yang J-C, Lai Y-H. Quality of life and its associated factors in patients with hepatocellular carcinoma receiving one course of transarterial chemoembolization
treatment: a longitudinal study. The Oncologist. 2012;17(5):732-9.
5. Division of Academic Support, National Cancer Institute. Guidelines for the diagnosis and treatment of hepatocellular carcinoma (HCC).2nd ed. Bangkok:National offce of Buddhism publisher; 2011. (in Thai)
6. Cao W, Li J, Hu C, Shen J, Liu X, Xu Y, et al. Symptom clusters and symptom interference of HCC patients undergoing TACE: a cross-sectional study in China. Support Care Cancer. 2013;21(2):475-83.
7. Fan SY, Eiser C, Ho MC. Health-related quality of life in patients with hepatocellular carcinoma: a systematic review. Clin Gastroenterol H. 2010;8(7):559-64
8. Gupta D, Lis CG, Grutsch JF. The relationship between cancer-related fatigue and patient satisfaction with
quality of life in cancer. J Pain Symptom Manage. 2007;34(1):40-7.
9. Lis CG, Gupta D, Grutsch JF. The relationship between insomnia and patient satisfaction with quality of life in cancer. Support Care Cancer. 2008;16(3):261-6.
10. Ravasco P, Monteiro-Grillo I, Camilo ME. Does nutrition influence quality of life in cancer patients undergoing radiotherapy? Radiother Oncol. 2003; 67(2):213-20.
11. Dodd M, Janson S, Facione N, Faucett J, Froelicher ES, Humphreys J, et al. Advancing the science of symptom
management. J Adv Nurs. 2001;33(5): 668-76.
12. Polit D, Beck C. Designing and conducting quantitative studies to generate evidence for nursing. Nurs research.
13. Hann D, Jacobsen P, Azzarello L, Martin S, Curran S, Fields K, et al. Measurement of fatigue in cancer patients: development and validation of the Fatigue Symptom Inventory. Quality Life Research 1998;7(4):301-10.
14. Buranaruangrote S. Experience and self management for fatigue in breast cancer patients receiving chemotherapy.
Nakornpathom: Mahidol Univ; 2006.
15. Morin CM. Insomnia: Psychological assessment and management. New York: Guilford Press; 1993.
16. Supornpattra Boongnam, Orapan Thosingha, Wallada Chanruangvanit, Parunut Itthimethin. Factors affecting the adjustment process of surgically critical patients’ relatives. Journal of Thai Nursing Council. 2016;30(4):72-83. (in Thai)
17. Wilson M-MG, Thomas DR, Rubenstein LZ, Chibnall JT, Anderson S, Baxi A, et al. Appetite assessment: simple appetite questionnaire predicts weight loss in community-dwelling adults and nursing home residents. Am J Clin Nutr. 2005;82(5):1074-81.
18. Panpae K, Sriyuktasuth A, Chawanasuntorapoj R. Anorexia experience, management strategies, and functional status in chronic kidney disease patients undergoing hemodialysis. Journal of Nursing Science. 2011;29(3):59-66.(in Thai)
19. Heffernan N, Cella D, Webster K, Odom L, Martone M, Passik S, et al. Measuring health-related quality of life in patients with hepatobiliary cancers: the Functional Assessment of Cancer Therapy–Hepatobiliary Questionnaire. J Clin Oncol. 2002;20(9): 2229-39.
20. Ryu E, Kim K, Cho MS, Kwon IG, Kim HS, Fu MR. Symptom clusters and quality of life in Korean patients with hepatocellular carcinoma. Cancer Nurs.2010;33(1):3-10.
21. Surachai Maninet, Chanokporn Jitpanya. Relationships among Symptoms, Symptom Management, Sense of Coherence, and Quality of Life in Patients with Hepatobiliary Carcinoma. Kuakarun Journal of Nursing. 2014;21(1):161-77. (in Thai)
22. Bower JE. Cancer-related fatigue [mdash] mechanisms, risk factors, and treatments. Nat Rev Clin Oncol. 2014;11(10):597-609.
23. Wible BC, Rilling WS, Drescher P, Hieb RA, Saeian K, Frangakis C, et al. Longitudinal quality of life assessment of patients with hepatocellular carcinoma after primary transarterial chemoembolization. J Vasc Interv Radiol. 2010;21(7):1024-30.
24. Toro A, Pulvirenti E, Palermo F, Di Carlo I. Healthrelated quality of life in patients with hepatocellular carcinoma after hepatic resection, transcatheter arterial chemoembolization, radiofrequency ablation or no treatment. Surg Oncol. 2012;21(1):E23-E30.
25. Shun S-C, Lai Y-H, Jing T-T, Jeng C, Lee F-Y,Hu L-S, et al. Fatigue patterns and correlates in male liver cancer patients receiving transcatheter hepatic arterial chemoembolization. Support Care Cancer.2005;13(5):311-7.
26. White BN, Waddell JA, Solimando Jr DA. Mitomycin and fluorouracil with concurrent radiation (FUMIR) regimen for anal cancer. Hosp Pharm. 2013;48(6):464-9.
27. Manni R, Cremascoli R, Terzaghi M. Pain, Cancer, Fibromyalgia and Gastrointestinal disorders. Sleepiness and Human Impact Assessment. Milan: Springer; 2014. p. 279-85.
28. Kotronoulas G, Wengström Y, Kearney N. A critical review of women's sleep–wake patterns in the context of neo-/adjuvant chemotherapy for early-stage breast cancer. The Breast. 2012;21(2):128-41.
29. O'Donnell JF. Insomnia in cancer patients. Clin Cornerstone. 2004;6(1):S6-S14.140
30. Swain MG. Fatigue in liver disease: pathophysiology and clinical management. Can J Gastroenterol Hepatol.
31. Wilkes GM, Barton-Burke M. 2017 Oncology Nursing Drug Handbook. Burlington: Jones & bartlett learning; 2011.
32. Tachi T, Teramachi H, Tanaka K, Asano S, Osawa T,Kawashima A, et al. The impact of outpatient chemotherapy-related adverse events on the quality of life of breast cancer patients. PloS One.2015;10(4):15.



How to Cite

นิลเลิศ อ, ศรีมรกต ผ, วงษ์คงคำ เ, ธรรมธรวัฒน์ ส. Factors Predicting Quality of Life of Hepatocellular Carcinoma Patients Undergoing Transarterial Chemoembolisation. TJNC [Internet]. 2019 Apr. 23 [cited 2022 Nov. 28];34(2):127-40. Available from: https://he02.tci-thaijo.org/index.php/TJONC/article/view/160724