LETTER TO THE EDITOR

 

Improving Health-Related Quality of Life Assessment in Chronic Hepatitis C

Aprimorar a avaliação da qualidade de vida relacionada com a saúde na hepatite C crónica

 

Andreia Rei^a, Marta Rocha^b, Isabel Pedroto^b

^aInstituto de Ciências Biomédicas Abel Salazar (ICBAS), Medical College, University of Porto (UP), Porto, Portugal; ^bGastroenterology Department, Hospital de Santo António (HSA), Centro Hospitalar do Porto (CHP), Porto, Portugal

^* Corresponding author.

 

Keywords: Health-related quality of life, Hepatitis C virus, Health surveys

Palavras-Chave: Qualidade de vida, Hepatite C crónica, Questionários de saúde

 

Dear Editor,

Alvarez, Urbina, and Tejada [1] comment on the importance of considering chronic hepatitis C patients with cognitive impairment in the evaluation of health-related quality of life (HRQoL) [2], bearing in mind that this is a usual comorbidity in this population. They argue that in patients with chronic disease and low cognitive status, the caregivers should be a valuable source of information of their quality of life, as demonstrated by studies with neurodegenerative disorders. They also propose the development of specific instruments for assessing quality of life in patients with both chronic diseases and cognitive impairment.

We appreciate the contribution of Alvarez, Urbina, and Tejada [1] and agree on the relevance of evaluating quality of life in chronic hepatitis C patients regardless of the severity of extrahepatic manifestations. Recent evidence suggests that one third of patients with chronic hepatitis C virus (HCV) can experience cognitive impairment even in the absence of cirrhosis, although greater fibrosis correlates significantly with poorer cognitive functioning [3, 4]. Attention, concentration, working memory processes, and mental flexibility are the most frequently affected cognitive abilities early in the course of disease [4, 5]. These impairments are reported to affect quality of life and performance in professional and personal settings [4].

In our study, we considered cognitive impairment as an exclusion criteria if the patient demonstrated very severe limitations that precluded a reliable understanding of the questions, including extremely low literacy level or illiteracy. We believe that this selection did not imply a low representability of this population, because the most frequently reported cognitive impairments, especially in the early stage of disease, are executive functions that do not tend to compromise self-awareness of health state. Also, most patients readily self-completed the questions, and the patients with limitations were supported by our trained interviewer to confirm full completion of questionnaires. We also followed the methodology proposed by the authors of the disease-specific instrument used in our study, the Chronic Liver Disease Questionnaire (CLDQ), developed by Younossi et al. [6].This instrument is useful in all etiologies of liver disease at any severity stage [7] and appears to provide a valuable measure of HRQoL in chronic liver disease across diverse cultures [7]. In developing the instrument, the authors excluded patients with psychiatric comorbidity and language or cognitive difficulties that prevented reliable completion of the questionnaire [6].

We also agree on the importance of valuing the contribution of caregivers in the evaluation of quality of life in chronic HCV patients with cognitive impairment. This could enable a more integrated approach to health care in this population. However, we should notice that in our study we used self-report instruments, for instance CLDQ domains (fatigue, activity, emotional function, abdominal symptoms, systemic symptoms, worry), including highly subjective items focused on emotional states and feelings [6], meaning that the interpretation given by the caregiver could induce some important bias.

 

References

1 Alvarez I, Urbina JC, Tejada RA: Chronic Hepatitis C and Health-Related Quality of Life in Patients with Cognitive Impairment. GE Port J Gastroenterol 2018, DOI: 10.1159/000488603.         [ Links ]

2 Rei A, Rocha M, Pedroto I: Health-Related Quality of Life in Portuguese Patients with Chronic Hepatitis C. GE Port J Gastroenterol 2017;24:68–78.         [ Links ]

3 Perry W, Hilsabeck RC, Hassanein TI: Cognitive Dysfunction in Chronic Hepatitis C: A Review. Dig Dis Sci 2008;53:307–321.         [ Links ]

4 Hilsabeck RC, Perry W, Hassanein TI: Neuropsychological impairment in patients with chronic hepatitis C. Hepatology 2002;35:440–446.         [ Links ]

5 Forton DM, Thomas HC, Murphy CA, Allsop JM, Foster GR, Main J, Wesnes KA, TaylorRobinson: Hepatitis C and cognitive impairment in a cohort of patients with mild liver disease. Hepatology 2002;35:433–439.         [ Links ]

6 Younossi ZM, Guyatt G, Kiwi M, Boparai N, King D: Development of a disease specific questionnaire to measure health related quality of life in patients with chronic liver disease. Gut 1999;45:295–300.         [ Links ]

7 Martin LM, Dan AA, Younossi ZM: Measurement of health-related quality of life in patients with chronic liver disease. Liver Transpl 2006;12:22–23.         [ Links ]

 

Disclosure Statement

Since the publication of their article, the authors have reported no further potential conflict of interest.

 

^* Corresponding author.

Dr. Andreia Rei

Instituto de Ciências Biomédicas Abel Salazar (ICBAS)

Medical College, University of Porto

Rua de Jorge Viterbo Ferreira 228, PT–4050-313 Porto (Portugal)

E-Mail aicrei@hotmail.com

 

Received: February 27, 2018; Accepted after revision: March 9, 2018