Relationships Between Insomnia and Quality of Life in Patients With Advanced Liver Cancer: A Secondary Analysis of a Multicenter Cross‐Sectional Study

ABSTRACT Background This study aims to evaluate the symptom burden of advanced liver cancer, explore factors related to quality of life (QoL), and investigate the relationship between insomnia and QoL. Methods This is a secondary analysis of a multicenter cross‐sectional study that included data from patients with advanced liver cancer ( n = 364) recruited from 10 cancer centers across China. Participants were required to complete Patient Health Questionnaire‐9 (PHQ‐9), MD Anderson Symptom Inventory (MDASI), Insomnia Severity Index (ISI), 5‐level EQ‐5D (EQ‐5D‐5L). Factors associated with QoL were identified through a multiple stepwise linear regression model and the LASSO regression approach. The mediating effect between insomnia and quality of life was tested using the bootstrap method. Results The three most prevalent symptoms were fatigue (17.0%), sleep disturbance (16.2%), and pain (15.8%). Insomnia, depression, and the 13 core symptoms in the MDASI were strongly correlated with reduced QoL (all p < 0.001). The mediating effect analysis showed that depression, dry mouth, pain, forgetfulness and fatigue were partial mediating variables between insomnia and QoL. Conclusion Various physical and psychological symptoms could affect the QoL in patients with advanced liver cancer. Insomnia and related symptoms such as depression, dry mouth, pain, forgetfulness and fatigue should be identified and appropriately addressed to improve QoL for this population.