Health-related quality of life and anxiety and depression in patients diagnosed with cholangiocarcinoma: a prospective cohort study

Background: Cholangiocarcinoma (CCA) is a rare cancer associated with a poor prognosis. Psychosocial challenges may negatively affect daily functioning and health-related quality of life (HRQOL). The primary aim was to evaluate HRQOL, and to assess anxiety and depression in these patients.Material and methods: From 93 eligible patients diagnosed with CCA, 76 were included in a prospective cohort over a period of 15 months. Patients answered the European Organization for Research and Treatment of Cancer QLQ C30 (EORTC QLQ C30) and Hospital Anxiety and Depression Scale (HADS) questionnaires at baseline, one, three and six months after initial treatment; defined as radical operation, explorative laparotomy, chemotherapy or drainage of the bile ducts. Scores were compared between the radically operated patients (n=25) and palliative patients (n=51; 12 of these had explorative laparotomy), using repeated measures ANOVA and unpaired ANOVA.Results: The groups were similar in demographic characteristics, except for fewer radically operated men (p=0.015). There was no significant change over time in HRQOL in total or between groups. At baseline nausea and vomiting scores were higher in the palliative group (p=0.035), and at one month follow-up, the radical group had higher pain scores (p=0.009). The majority reported normal/mild anxiety and depression throughout the study; there were no differences between the groups.Conclusions: It was not possible to measure any differences between the groups, regarding HRQOL, anxiety or depression, despite the fact that one of the groups had the prospect of total cure. In clinical settings, observed mean changes in HRQOL scores are generally small; probably due to psychological adaptation by patients to changing health status over time.