Depression and anxiety among patients with hepatocellular carcinoma evaluated for liver transplantation

Introduction

Hepatocellular carcinoma (HCC) mostly develops in a cirrhotic liver and represents a serious public health problem. Liver transplantation (LT) is a therapeutic option for HCC that offers to patients a long-term survival.

Aim

The aim is to investigate depression and anxiety in HCC patients evaluated for LT.

Materials and Methods

Retrospective study (N=179) at liver disease clinic on patients with a diagnosis of cirrhosis evaluated for LT. Inclusion criteria: completion of the psychological evaluation for eligibility to transplantation. The sample was divided in two groups: HCC (89/179; 49.7%) and no-HCC. Patients underwent a psychological evaluation with clinical interviews and psychological assessment with self-report questionnaires for depression (BDI-II), anxiety (BAI) and general psychological problems (SCL-90). Descriptive analyses and linear regression analyses were performed.

Results

Among the 179 patients, 84.9% were men, the mean age was 58 years. HCC group has lower depression (p< .01), anxiety (p< .05), SCL-Somatization, SCL-Depression, and SCL-Anxiety (p< .05) than no-HCC group. They also have a lower severty of liver disfunction (MELDNa) (p< .001). Univariate linear regression analysis highlighted a correlation between depression (BDI-II) and respectively: age, gender, HCC, MELDNa class and psychopathological anamnesis. Multivariate linear regression analysis [covariate: male gender OR -3.6 (95% CI -7.11– -0.21); psychopathological anamnesis OR 6.3 (95% CI 3.87 – 8.77), HCC OR -4.3 (95% CI -6.88 – -1.80); p< 0.05] highlighted that depression is positively associated with psychopathological history and inversely with HCC and male gender.

Conclusions

Counterintuitively, patients with HCC show less depression/anxiety than patients without HCC, probably because of multiple loco-regional or systemic oncologic therapies. HCC and male gender have a significant effect on depression. HCC patients may not perceive the severity of their liver disease and lack of insights on it, therefore it could be important to enhance their compliance to the transplant programs.