Fatigue, Physical Fitness and Quality of Life in Patients with Hepatitis C Virus Infection during the Combination Therapy

Introduction: An increasing incidence of liver cancer mainly attributed to Hepatitis C Virus (HCV) infection has been observed in Taiwan over the last 20 years. The current mainstay of treatment for patients with chronic HCV infection is the combination therapy of peglated interferon α (peginterferon α) plus ribavirin. Most patients experience multiple symptoms along with the therapy and fatigue is the most distressed symptoms with decreasing physical function that might affect their quality of life. However, there is no study to examine the changes of fatigue, physical fitness, and their relations with quality of life during the treatment.

Objective.  The aims of the study were to (1) examine the changes of physical fitness component (e.g., muscular strength and cardiopulmonary fitness), fatigue, and quality of life, and (2) explore the significant factors related to QOL over the 24 weeks of combined treatment.

Methods.A prospective correlational and longitudinal design was used. Patients with chronic hepatitis C infection who are scheduled to receive the combined therapy were recruited from a medical center at outpatient settings in Northern Taiwan. Data were collected from patients through interviews using a set of structured questionnaires and measuring physical fitness by using 6-minute walk test, hand dynamometer, and hand-held dynamometer at four time points: baseline (before treatment, T0), and at 8 weeks (T1), 16 weeks (T2), and 24 weeks (T3) during treatment. Descriptive statistics and generalized estimating equations analysis were used to explore the changes of the measured variables.  

Results.A total of 139, 134, 131 and 122 patients have completed the procedures at T0, T1, T2, and T3, respectively. The majority of HCV gene type was type I (49.7%). Fatigue was the most distressed symptoms and its intensity reached the peak at T1 and decreased folowing the treatment and significant decreased in mental related quality of life. All the measures of physical fitness decreased during treatment but only hand grip and 6-minutes walking distance (6-MWD) were significantly decrease. The 6-MWD was positively related to change of physical related QOL. Lower level of the hip muscle strength was related to change of mental related QOL.

Conclusions: Decreasing the 6-MWD and the hip muscle strength were the factors associated with decreasing the level of QOL. During the treatment, exercise enhancement on hip muscle strength and walking distance are suggested to improve their quality of life during combined therapy.