Analysis Reveals Negative Mental Health Among Those With HCC Diagnosis

Results of a score-matched analysis showed individuals with hepatocellular cancer reported poor mental health as time progressed after diagnosis.

A diagnosis of hepatocellular cancer (HCC) has a profound negative impact on patients’ health-related quality of life (HRQL) while individuals’ mental health components—recorded by the assessment—deteriorated significantly over time, according to study results published in Cancer Medicine.

HCC usually occurs when individuals have an underlying progressive chronic liver disease and is the second-leading cause of cancer-related deaths globally. In 2019, over 30,000 new cases of HCC were diagnosed in the United States—mostly among men— and estimates project over 56,000 cases will exist by 2030.

In addition, HCC “is the only cancer for which the incidence and mortality rates have continued to rise exponentially over the past 2 decades,” researchers wrote. The disease has a relative survival rate of under 30%.

Limited data currently exist as to which particular aspects of HRQL are affected by a diagnosis, and how these aspects change over time. To address this knowledge gap, researchers used Surveillance, Epidemiology, and End Results registries (SEER) data linked with Medicare Health Outcomes Survey (MHOS) data to conduct a propensity score-matched analysis.

MHOS is a yearly survey administered to a random sample of 1000 to 2000 beneficiaries, while SEER data is gleaned from newly diagnosed cancer patients throughout certain geographic regions. Fifteen MHOS cohorts who completed baseline assessments between 1998 and 2012 and follow-up assessments between 2000 and 2014 were included in the analysis.

The final study population included 365 controls matched with 62 patients diagnosed with HCC. “HRQL was assessed using the Medical Outcomes Study Short Form-36 (SF-36) from 1998 to 2005 and the Veterans RAND 12-Item (VR-12) from 2006 to 2014,” researchers wrote.

Mean (SD) age of the entire population was 72.57 (9.19) years, while the majority (57%) of individuals were white. Most participants (73%) had a history of hypertension and arthritis (60%), and around 1 quarter of patients had heart disease (26%).

Analyses revealed:

  • Compared to their baseline HRQL scores, after diagnosis of HCC, patients were more likely to report declines in scores related to the mental component of HRQL
  • When stratified by time since diagnosis, the mental component remained significantly lower as the disease advanced
  • In contrast, only general health aspects of physical health worsened after HCC diagnosis

Patients with American Joint Committee on Cancer stage >2 had a worse decline in physical and mental health, with a clinical and statistically significant decline in vitality scores

“In the first 12 months after diagnosis, physical health domains such as general health and physical function are impacted. However, after the first 12 months of diagnosis, these aspects of HRQL either improve or remain stable,” researchers wrote. “In contrast, most components of mental health seem to be less profoundly impacted in the first 12 months, but the trends continue to worsen over time.”

Results suggest more long-term strategies are needed to address mental health impairments after 1 year in these patients. Although holistic approaches like palliative care could be beneficial for these patients, these strategies are underused among those with HCC.

In addition, “HRQL is critically influenced by time since diagnosis, probably due to increased stress given limited treatment options and dismal prognosis; hence the needs may vary over time,” authors said.

HCC or liver-specific measures of HRQL were not available in the data resources used, marking a limitation to the current study. HRQL data may also have a reporter bias, while other social confounding cannot completely be controlled for. Findings may not be representative of patients in Medicare fee-for-service.

“Given the high incidence and mortality of HCC cases, the need to address HRQL issues is urgent. Future research needs to evaluate the value of HRQL scores in comparative effectiveness research involving therapeutic options and psychological interventions,” researchers concluded.


Verma M, Paik JM, Younossi I, Tan D, Abdelaal H, and Younossi ZM. The impact of hepatocellular carcinoma diagnosis on patients’ health-related quality of life. Cancer Med. Published online August 18, 2021. doi:10.1002/cam4.4166