A typical Hepatitis B patient’s encounter with the doctor consists of a series of medical tests and discussions geared solely toward a patient’s physical health.
Yet a recent study, which appears in this month’s issue of the journal Hepatology, has shown that other aspects such as psychological and social health may play a surprisingly significant part in a patient’s overall well-being.
The study, which lasted from January to October 2006, was headed by UCLA and Veterans Affairs Hospital researchers. Scientists and doctors developed and tested a questionnaire that was given to 138 Hepatitis B patients across the nation to qualitatively and quantitatively assess their quality of life.
The assessment consisted of 32 questions that targeted six specific areas of a patient’s life: psychological well-being, anxiety, vitality, disease stigma, vulnerability and transmissibility, said Fasiha Kanwal, the principal health-related quality of life specialist for the UCLA/VA Center for Outcomes, Research and Education.
“We found that a lot of them had anticipation anxiety, thinking (the disease) could flare up and lead to liver cancer,” Kanwal said. “Others felt ashamed and stigmatized.”
Many patients exhibited signs of depression, lack of energy and reduced physical functions such as memory problems and joint pains, said Brennan Spiegel, the principal investigator and an assistant professor of medicine at UCLA.
Affecting 1.25 million people in the United States a year and having a particularly high incidence among Asians, Hepatitis B is a viral infection of the liver that may lead to chronic diseases such as liver tissue scarring or liver cancer.
Though one of most common causes of Hepatitis B is the passing on of the disease from parent to child at birth, transmission can occur via use of contaminated needles or unprotected sexual contact.
As a result of these perceptions of transmission, a high percentage of patients said they felt the stigma attached to sexually transmitted diseases, said Steven Han, one of the authors of the study and the director of the Hepatology Clinical Research Center at UCLA.
“It was like HIV. Some were afraid of getting married or even dating,” Han said.
The results of the survey were compiled and the following conclusion was drawn: patients with chronic Hepatitis B attributed negative psychological, social and even physical symptoms to the disease, even when they were not experiencing complications.
“Doctors should follow not just the biological endpoints but the psychosocial endpoints as well,” Spiegel said. “Sometimes there’s a disconnect between what the doctors are asking about and what the patients care about.”
This study, the first one to take a look beyond the physical symptoms, will alert physicians to the fact that quality of life is a key component of treatment, said Eric Esrailian, one of the authors of the study and the section head for General Gastroenterology in the Division of Digestive Diseases at UCLA.
“Previously, the emphasis has been on physical manifestations, but I think physicians are recognizing more and more that a patient’s health status consists of more than just the physical symptoms,” he said.
Not only has the study shown the impact of the disease on a patient’s quality of life, but it has also resulted in the development of an assessment tool in the form of a questionnaire that doctors can use to measure quality of life.
Currently, the tool is being used and refined in clinical trials as an integral part of a patient’s visit.
The ultimate goal is to have quality of life become one of the key factors doctors look at in treating their Hepatitis B patients.
“We hope to use this as a vital sign, just like heart rate or breathing rate,” Spiegel said. “(Psychosocial factors) affect how patients get through the day and how they interact with others. … This study validates the importance.”