Liver Cancer
Supportive Care
One of the most common fears people have about cancer treatment is the potential side effects. Although most cancer and its treatments cause side effects, you will be surrounded by a health care team who will help you manage the symptoms from the moment you receive your diagnosis. You are encouraged to talk with your medical team before treatment begins about possible side effects and what to do if they occur.
Communicating honestly about how you feel, both physically and emotionally, is an important step you can take. The sooner you share your concerns, the quicker they can be managed. It’s also important to be honest with your family and caregiver about the side effects you have and their level of severity.
The advances made in treating cancer also apply to managing the side effects that accompany the diagnosis. As a result, people facing cancer have access to services that are designed to help improve their overall well-being before, during and after treatment. These are known as supportive or palliative care services.
Designed to benefit anyone with a serious or life-threatening illness, these services are available through survivorship. Palliative care is often confused with hospice care, which is reserved for end-of-life. Think of the purpose of palliative care as “quality-of-life preservation” or “quality-of-life restoration.”
This assistance will be a valuable part of your care because if liver function decreases, toxins that are normally filtered by the liver can build up. This can cause cognitive decline and other conditions that may make it difficult to think clearly. You may need help understanding the prognosis and making important care-related decisions.
Your doctor can provide you with a referral. Together with a palliative care specialist, you will develop a plan to ease symptoms. A specialist may offer the following forms of support:
- Educating you about your illness and prognosis.
- Defining your terms for quality of life.
- Coordinating care among the health professionals.
- Providing support for decision-making and stress management.
- Referring you for psychosocial support to manage depression, sleep disturbances and other mental health challenges.
- Finding financial counseling through a social worker, nurse navigator or financial counselor.
- Helping with advance care planning and assisting caregivers. Advance care planning is recommended as early as possible after diagnosis so you can make decisions before the disease progresses and interferes with normal thinking and decision-making.
The palliative care team assisting you may include doctors and nurses, mental health professionals, pain specialists, pharmacists, nutritionists and social workers. This team will work with your doctor and provide an extra layer of support to your care.
Palliative care services are often covered by individual insurance plans, Medicare and Medicaid. To learn more, talk with the hospital’s social worker or financial counselor or your health insurance representative.
Potentially Severe Side Effects
Serious side effects are usually uncommon, but they can occur with certain treatments. Ask your doctor whether you are at risk for side effects from the therapies in your treatment plan, how to identify the symptoms and when to seek emergency care. Report symptoms immediately so they can be treated rapidly. Some potentially severe side effects include the following:
- Ascites is a condition in which an abnormal amount of fluid collects in the peritoneal (abdominal) cavity. Ascites can be malignant, meaning it is caused by cancer cells distributed throughout the abdominal cavity, or non-malignant, meaning it is caused by something other than cancer (such as cirrhosis). It can be treated with diet, diuretics (drugs that cause the kidneys to produce more urine, ridding the body of extra fluid and salt), paracentesis (procedure to drain the fluid), chemotherapy or surgery. Your doctor will discuss the option that is best for you.
- Fatigue is the most common symptom reported by patients with liver disease. It is a type of tiredness that is much stronger and harder to relieve than the fatigue an otherwise healthy person has. Contact your doctor immediately if fatigue prevents you from carrying out your daily activities.
- Hepatic encephalopathy occurs when the liver is unable to filter toxins in the blood sufficiently. The buildup of these toxins affects the brain and ability of the nervous system to function. Ask your doctor about symptoms to watch for and when to go to the emergency room.
- Infection can occur as a result of suppression of your immune system. Contact your doctor immediately – do not wait until the next day – if you have any of these symptoms: oral temperature over 100.4°F, chills or sweating; body aches, chills and fatigue with or without fever; coughing, shortness of breath or painful breathing; abdominal pain; sore throat; mouth sores; painful, swollen or reddened skin; pus or drainage from an open cut or sore; pain or burning during urination; pain or sores around the anus; or vaginal discharge or itching. If you cannot reach your doctor, go to the emergency room.
- Immune-related adverse events (irAEs) may occur with certain immunotherapy drugs if the immune system becomes overstimulated by treatment and causes inflammation in one or more organs or systems in the body. These may include the cardiovascular, endocrine, gastrointestinal, neurologic, pulmonary (lung), renal (kidneys), skin and neurologic systems. Some irAEs develop rapidly, becoming severe and even life-threatening without immediate medical attention.
- Infusion-related reactions most frequently occur with treatment given intravenously (IV) through a vein in your arm, usually soon after exposure to the drug. Reactions are generally mild, such as itching, rash or fever. More serious symptoms, such as shaking, chills, low blood pressure, dizziness, breathing difficulties or irregular heartbeat, can be serious or even fatal without medical intervention.
Common Physical Side Effects
Managing side effects allows you to stay on treatment without interruption, makes it easier for your body to handle treatment and generally improves your well-being. It may comfort you to know that people often respond differently to the same treatments, so it is important to discuss with your doctor which side effects you may experience (see Table 1).
Also, watch for possible late effects. These are side effects that develop weeks, months or even years after treatment ends. They typically are hard to predict so knowing what to do if one occurs is key.
Keeping track of your side effects helps your doctor to better manage them. The sooner side effects are addressed, the sooner you will feel better.
Table 1. Some Common Side Effects
| Side Effects | Symptoms |
| Abdominal pain | Cramping and dull aches in the abdominal area |
| Ascites | Abdominal swelling from fluid accumulation in the abdomen |
| Bleeding problems | Hemorrhaging and bruising |
| Chemo brain (cognitive dysfunction) | Brain fog, confusion and/or memory problems |
| Constipation | Difficulty passing stools or less frequent bowel movements compared to your usual bowel habits |
| Decreased appetite | Eating less than usual, feeling full after minimal eating, not feeling hungry |
| Diarrhea | Frequent loose or watery bowel movements that are commonly an inconvenience but can become serious if left untreated |
| Difficulty swallowing | Also called dysphagia; may include painful swallowing |
| Fever | Raised body temperature that could signal an infection |
| Hair loss (alopecia) | Hair loss on the head, face and/or body |
| Hand-foot syndrome | Also known as Palmar-Plantar Erythrodysesthesia; may include pain, swelling, tightness and redness on the palms of the hands or soles of the feet; or blisters and calluses |
| Headache | Pain or discomfort in the head |
| Hypertension | Abnormally high blood pressure |
| Lymphedema | Swelling of the extremities |
| Nausea and vomiting | The feeling of needing to throw up and/or throwing up |
| Neuropathy | Numbness, pain, burning sensations and tingling, usually in the hands or feet at first |
| Pain | Musculoskeletal pain and aches that occur in the muscles, joints, bones, tendons, ligaments or nerves |
| Proteinuria | High levels of protein in urine |
| Respiratory problems | Shortness of breath (dyspnea) with or without cough, upper respiratory infections |
| Skin reactions | Rash, redness and irritation or dry, flaky or peeling skin that may itch |
| Taste changes | Foods may taste different or bland, or your ability to handle spicy, sweet or bitter foods changes |
| Thrombocytopenia | Low number of platelets in the blood, which can lead to bruising and bleeding |
| Voice changes | Also known as dysphonia, difficulty speaking or swallowing, hoarseness, raspy voice, soft voice, no voice or swelling in the throat |
| Weight changes | Unintentionally gaining or losing weight |
Caring for your emotional health
Many people rely on supportive care to manage physical side effects, but it can also be used to help you manage the emotional challenges associated with cancer. Your family members, caregivers and others close to you can also benefit from this support.
It is common to experience a range of emotions when you receive a cancer diagnosis: sadness, anger, anxiety, depression, loneliness and even regret. It is normal to be concerned about how cancer treatments will affect your health, family and daily life.
Taking care of your emotional well-being will help you better cope with cancer-related issues, including managing physical side effects. It is important to recognize the effect that physical changes from treatment can have on your mental and emotional well-being. Supportive care services can connect you with resources to help manage these feelings.
Support is available from online and in-person support groups, counselors, psychologists, psychiatrists and other specialists. Some organizations offer one-on-one buddy programs that pair you with another person who has the same type of cancer as you. Sharing your feelings with people who can relate because they have been through something similar can be very satisfying.
Watch for scanxiety, which is a mixture of anxiety and stress that can happen when you are awaiting results from imaging scans, laboratory tests or exams you have as part of your treatment plan. That is a lot of stress to put on your mind and your body, and it may help to find ways to manage it. Set expectations with your doctor or nurse about when and how you will receive the results so you are not left waiting and wondering.
Notify your health care team if you are unable to follow treatment due to extreme emotional distress; have excessive crying or continued feelings of hopelessness or despair; are unusually angry or irritable; are withdrawing and isolating yourself from family and friends; and feeling worthless. Get immediate medical attention for thoughts of suicide or death.
Mental Health Services: American Psychosocial Oncology Society Helpline: 866-276-7443
