Cancer symptoms and nutritional status are inversely associated with health-related quality of life in patients awaiting liver resection

Introduction: The purpose of this study was to determine associations between health-related quality of life (HRQoL) and functional capacity, body composition, cancer symptoms and nutritional status in patients upon enrolment to a surgical prehabilitation program. 

Methods: This is a sub-analysis of baseline measures from a prehabilitation study for patients with a suspected hepatobiliary cancer awaiting liver resection. All patients performed a six-minute walk test (6MWT) and underwent a full-body dual-energy X-ray absorptiometry scan. We calculated the appendicular skeletal muscle mass index (ASMI) for all patients. Patients completed the revised Edmonton Symptom Assessment System (ESAS-r) questionnaire to measure symptom burden. Patients also completed the abridged Patient-Generated Subjective Global Assessment (aPG-SGA) to determine nutritional status. Finally, patients completed the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire to determine HRQoL. Statistical methods included the Pearson's correlation coefficient and robust univariate regression analysis. 

Results: Thirty-five patients (male=26, age=63.6±11.9 y) were included in this analysis. Mean 6MWT distance was 506.2±100.8 m, ASMI was 6.82±1.09 kg/m2, ESAS-r total score was 13.6±10.6 and aPG-SGA score was 4.8±4.3. The mean FACT-G score was 82.5±13.8. Moderate negative associations with HRQoL were found for symptom burden (ESAS-r: r=-0.63, p<0.001) and nutritional status (aPG-SGA: r=-0.50, p<0.01). A 1.1 unit increase in ESAS-r and a 1.5 unit increase in aPG-SGA scores (denoting deterioration) were associated with a 1-unit deterioration in FACT-G score (R2=0.32 and R2=0.19 respectively). 

Conclusion: HRQoL is negatively affected by cancer symptoms and poor nutritional status in patients awaiting liver resection. Prehabilitation programs for these patients should include a dietary intervention and supportive medical management of cancer symptoms.