Liver Cancer
Supportive Care
Facing a liver cancer diagnosis may feel overwhelming emotionally and physically. But you will not face it alone. Preventing, minimizing and managing the side effects of any underlying conditions, the cancer and its treatment are a primary focus of your multidisciplinary health care team. They will work together to make you more comfortable and enhance your quality of life. Knowing the side effects that may occur – and setting expectations for how to manage them if they do – will help you feel more prepared for treatment.
Today, people with cancer have access to services that are designed to help improve their overall well-being before, during and after treatment. These services are known as supportive care and include assistance with nutrition, fitness, mental health and physical/occupational therapy. They also address the practical, spiritual, financial and family-related challenges associated with cancer. Because your diagnosis also affects your loved ones, your family members, caregivers and others close to you can access this support.
As you discuss treatment options with your doctor, ask about the potential side effects of each. Keep in mind that how you respond to those side effects will depend on many factors, including your specific diagnosis, health history, age and other characteristics. People often respond differently to the same treatments, so you cannot expect your experience to be like that of anyone else.
Lean on your health care team to help you navigate your journey. Their help will be invaluable throughout your experience, but they can only be effective if you communicate openly and honestly with them. The sooner your team knows about any concerns you have, the more quickly they can be addressed. Keeping track of your side effects helps you provide the most complete information. Ask whether telehealth appointments or an online portal are available for reporting symptoms or complications between follow-up visits.
Common Physical Side Effects
Some physical side effects can be disruptive while others are merely an annoyance (see Table 1). Ask your doctor how to recognize symptoms, when they might occur and ways you can help manage them. 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.
Stay alert to the possibility of late effects. These are side effects that develop weeks, months or even years after treatment ends. They are typically hard to predict so knowing what to do if one occurs is key.
Potentially Severe Side Effects
Serious side effects are usually uncommon, but they can occur with some treatments. Ask your doctor whether any therapies in your treatment plan could cause them, and find out how to identify the symptoms. Report them immediately if they occur. Prompt medical attention can be lifesaving.
- 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 experienced by an otherwise healthy person. Contact your doctor immediately if fatigue prevents you from carrying out your daily activities.
- Hepatic encephalopathy (HE) occurs when the liver is unable to filter toxins in the blood sufficiently. The buildup of these toxins affects the brain and its ability to function normally. Ask your doctor about symptoms to watch for and when to go to the emergency room. These signs are often noticed by caregivers first.
- Infection can occur as a result of a low white blood cell count (neutropenia) or other factors. 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; 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. Some irAEs can develop rapidly, becoming severe and even life-threatening without immediate medical attention. Common symptoms of irAEs may include fever, joint aches, skin rash, cough and diarrhea. Discuss with your doctor how to recognize signs of irAEs.
- Infusion-related reactions most frequently occur with treatments given intravenously (IV) through a vein in the arm and usually happen 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.
Both patients and caregivers need emotional support
A cancer diagnosis can bring up a range of emotions, whether you are the patient or the caregiver.
Both parties will immediately face the fear of this new reality. A person diagnosed with liver cancer will experience the direct stress of treatment and the caretaker will often take on added responsibilities for a loved one. Keep in mind that flexibility, patience and compassion will be key for everyone.
In fact, research supports the idea that improving a patient’s emotional well-being can help them better cope with cancer-related issues. The same is true for caregivers who can face burnout and exhaustion both physically and emotionally. Monitor each other for mental and emotional health and watching for signs of distress.
Common emotions of both patients and caregivers include fear, stress, anxiety, sadness, depression, anger, loneliness and guilt. These feelings may come and go and sometimes be much worse than others. Give yourself permission to move through these emotions and know that all of them are normal.
Following are some ideas for maintaining and improving emotional health for people who are diagnosed with liver cancer and their loved ones and caregivers:
- Express your feelings. Don’t keep them bottled up.
- Don’t try to be upbeat when you are not. It is okay to have bad days.
- Find ways to relax, such as meditation, yoga, walking, guided imagery, reading, journaling and spending time in nature.
- Be as active as possible. Even a 10-minute walk can do wonders for your mental well-being.
- Find new hobbies and activities you enjoy.
- Think about what you can control to help bring your mind some peace.
- Breathe deeply to calm anxiety or try other relaxation methods.
- Call a friend or family member.
Consider reaching out to support groups. Many are available online or in person for anyone affected by liver cancer, and they have sessions for caregivers and patients to attend independently. A caregiver may be afraid to share their feelings of fear with their loved one facing cancer. An opportunity to open up with other caregivers can help manage these emotions to allow for easier caregiving and remind them to care for themself as well.
People facing liver cancer can learn a lot by connecting directly with others who are in the same situation and receiving similar treatments. Sharing experiences and feelings with others living through liver cancer can provide hope and encouragement while also validating their emotions.
Both patients and caregivers will need to practice self-care and be empathetic to each other. If it feels that the strategies you are using are not working, don’t be afraid to ask your health care team to provide a referral for professional help.
Mental Health Services: American Psychological Oncology Helpline: 866-276-7443
Table 1. Some Common Side Effects
