What to Know About Telehealth for Liver Cancer

Telehealth involves the use of technology to give people access to medical appointments. For people living with liver cancer, telehealth provides access to members of their healthcare team in a variety of ways, including help with medications, nutrition tips, consultations about side effects, and discussions about lifestyle changes. 

While telehealth has been around for many years, it has gained popularity and significance due to the COVID-19 pandemic. It helps by increasing access to healthcare for people who live long distances from their doctor’s office or who are unable to leave their homes.

In this article, we will discuss how telehealth technologies can help you to reach out to your healthcare team, when to use telehealth, the benefits and challenges, preparing for telehealth visits, and more.

Telehealth - Woman video chatting with doctor

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When to Use Telehealth for Liver Cancer

Liver cancer is a type of cancer that starts in the cells of the liver, the football-sized organ located in the upper right side of the abdomen, just above the stomach and below the diaphragm.

Having liver cancer can be an overwhelming experience—with or without an ongoing pandemic. Having access to your medical team is important as you live and manage all the aspects of your cancer.

Telehealth can replace in-person visits with video and telephone conferencing between you and your doctor. This keeps the dialogue open and encourages social distancing to reduce the spread of the COVID-19 virus.

This is especially important for people living with liver cancer who have weakened immune systems that put them at a higher risk for contracting the virus.

While some visits with your oncology (cancer care) team should be done in person, there are other instances in which telehealth can be a vital tool to you and your doctor. This can include follow-up visits with your provider, a remote visit with urgent care, or a visit with members of your healthcare team that covers specific topics, including nutrition, mental health counseling, and how to administer medications.

Telehealth can also be used as a tool to meet with a new provider for a second opinion on your cancer care and treatment.

Follow-Up Telehealth Visits

Follow-up telehealth visits for people with liver cancer can be used to discuss treatments and any potential adverse side effects you may be experiencing from those treatments, including chemotherapy (medications to kill cancer cells).

Chemotherapy is an option for people whose liver cancer cannot be treated with surgery or who have not had an adequate response to local therapies such as ablation (destroying tissue with heat or cold) or embolization (cutting off blood supply to a tissue), or when targeted therapy (drugs that target cells with specific characteristics) is no longer an option.

You can also discuss whether you feel your treatment plan is working or if you think your treatment plan needs to be adjusted. You can ask your doctor about additional care options to manage side effects of treatment, such as nausea and fatigue.

Follow-up virtual visits can also be helpful to monitor cancer recurrences, evaluate long-term complications of your cancer treatment, and discuss preventive measures for conditions in which the risk becomes higher after cancer treatment, such as heart disease

According to a report from Eugene Storozynsky, a cardiology specialist in heart complications from cancer at the University of Rochester Medical Center in New York, heart damage from chemotherapy or radiation is common.

Dr. Storozynsky notes that between 5% and 15% of people with cancer will go on to develop heart failure after surviving cancer. Many others will develop high blood pressure or atrial fibrillation (rapid and chaotic heartbeat) from their cancer treatments, putting them at a higher risk for stroke (a blockage of blood flow in the brain).

Second Opinions

Telehealth is useful if you are seeking a second opinion or additional treatment recommendations. A health provider can receive your medical records electronically and then you can meet via telehealth video services to discuss their thoughts and recommendations of your diagnosis and treatment options.

According to a 2021 report in the Internal Journal of Cancer, getting second opinions via telehealth has become standard practice. That report further notes top institutes, including MD Anderson Cancer Center and Memorial Sloan Kettering Cancer Center, are starting to advertise these services.

A second opinion can be vital for people seeking additional feedback and advice on cancer care and treatment options. The report’s authors conclude these services should not “be used in lieu of, but in addition to, face-to-face cancer care.”

You May Need to Be Seen in Person

There are instances in which telehealth visits for your liver cancer are not an option. For example, if you are newly diagnosed with liver cancer, do not delay any appointments for evaluation.

In addition to initial assessments, your doctor may want to see you in person for the following:

  • To perform a physical examination
  • For an imaging study to check the size of a tumor, and determine if treatment is helping
  • A biopsy (taking a sample of possibly cancerous tissue) for a pathology workup (examination by technologists and a physician specializing in laboratory medicine)
  • To reassess treatment options

People who seek liver cancer treatment through a clinical trial require in-person evaluations and consent screenings. Treatments need to be administered in person at the site conducting the clinical trial.

These are sometimes clinical trial requirements by the Food and Drug Administration (FDA) and other government agencies, although some of this guidance on evaluation and screening may be reviewed and amended by these agencies in light of challenges raised by the COVID-19 pandemic.

COVID-19 should not prevent you from receiving your cancer therapies. If you need to go in for a chemotherapy or radiation treatment (the use of high-energy radiation to kill cancer cells), the healthcare facility responsible for your treatment is doing everything they can to keep you safe when you come in.

This includes limiting the number of people going in and out of their spaces, practicing masking and physical distancing, providing hand sanitizer for staff and patient use, disinfecting surfaces that are frequently touched, and screening for COVID-19 with different methods, including temperature checks and questionnaires.

Benefits and Challenges

Telehealth has become a vital tool for improving cancer care and reducing costs for oncology. But as with any medical service, it comes with benefits and challenges.

Benefits

Telehealth comes with some obvious benefits, including convenience, time savings, and reduced travel. This means less time away from your job, away from your family, a reduced need for childcare, and less time sitting in waiting rooms.

Additional benefits include:

Reduced Risk

A 2020 report looked at the use of telemedicine for chronic liver disease at a tertiary care center in Italy early in the COVID-19 pandemic, from March 9, 2020, to May 3, 2020. The research team looked at the response of video visits during the pandemic, the impact of extended hours for a helpline, and the effect of social distancing. 

In this study, telehealth visits were implemented for follow-up visits, patient screenings before hospital admission, and urgent care evaluations for complications. Here, medical professionals were able to conduct almost 400 visits for liver cancer patients using telehealth.

The only people admitted to urgent care for non-COVID-19 cases were those experiencing severe complications of liver disease. Of the nearly 1,700 people with chronic liver disease who needed a follow-up visit at the liver unit, none contracted COVID-19 and there was no need to alter medication schedules or treatment plans.

Normalcy

When you are diagnosed with liver cancer, life tends to become less normal. There are appointments for care and treatment, new treatments to stay on top of, dietary changes to adhere to, and feelings of sadness, worry, grief, and not knowing what life has in store.

Telehealth appointments can provide a unique opportunity to maintain some sense of normal as you manage your everyday life with liver cancer. Frequent doctor visits are time consuming, stressful, and put you at risk for acquiring infectious diseases like COVID-19. Any effort to reduce your stress can be vital to improving your outcomes and quality of life.

And with all the advancements in technology and care coordination, it is possible to receive treatment and care right in your home. This might include some types of chemotherapy, physical and occupational therapy, nursing care, and symptom management.

Reduced Hospital Admissions

Another potential benefit of telehealth is that it can reduce the number of hospital readmissions for people with cancer. Hospital readmission rates for people with cancer are as high as 27%, and readmission is more common in people with advanced-stage cancer.

By providing liver cancer patients with access to telehealth, they are given more opportunities to share symptoms and other concerns with their healthcare professional. Oftentimes, the lack of frequency or the unavailability of in-patient visits lead to missing critical symptoms, which can put people with cancer at risk.

Telehealth means the opportunity for more frequent interactions with medical professionals and the opportunity for people with cancer to bring up symptoms and not feel like they are taking up too much of the provider’s time. It also increases the chances that effective intervention will occur in a timely manner.

Education Tool

Liver cancer telehealth can be used as a patient-education tool. Studies have found many benefits linked to patient education of cancer treatment and care. These include increased satisfaction with treatments, decreased anxiety, increased decision-making in treatment care, and overall increases in positive coping.

Patient education on treatment and disease management is often a part of doctor visits. However, all this information can be hard to retain when someone is managing stress, pain, and other disease factors during their medical appointment.

When telehealth is used as an education tool, it allows you to visit from your home with a member of your healthcare team who has dedicated time without distractions. They can answer questions and help you to better understand the options available to you as you manage and live with liver cancer.

People with liver cancer who are informed are more likely to be involved in their own cancer care, which means better treatment outcomes and improved quality of life.

Access To Mental Health Services

Psychiatric services are vital for people living with liver cancer who are struggling to cope with the effects of their disease. A study reported in 2018 involved 38 patients undergoing cancer treatment who lived in areas with limited access to counseling. Here, five psychiatrists conducted virtual patient visits over a two-year period.

After two years, half of the patients completed questionnaires about their experience. Most of them (98%) reported that telepsychiatric visits gave them better access to care and that the quality of that care was equal to what they would have gotten in person.

Patients in the study also reported additional benefits of no travel, easier scheduling, and reduced appointment wait times. The researchers added the cancellation rate for telepsychiatric visits was drastically less than in-person visits.

Challenges

Telehealth also comes with challenges. For example, it may not be appropriate for every situation. If you need to undergo a procedure or to get imaging, these procedures cannot be done remotely. A physical examination usually requires an in-person appointment.

Additional challenges with telehealth might include:

Medical Professional Opinions

Research shows many oncology health professionals have different opinions on the benefits and challenges of video visits with patients. A qualitative study, reported in 2021 in JAMA Network Open, consisted of interviews of 29 oncology medical professionals before the start of the pandemic.

The findings showed the oncologists disagreed on whether the virtual physical examination could adequately replace an in-person exam. They also disagreed and whether the patients would feel the insurance copay was too high for a virtual visit and was difficult to predict.

Most of the oncologists recognized the value of reduced travel costs and the challenge of delivering serious and difficult news in a virtual visit. Many also noted their inability to console patients in virtual settings.

Insurance Obstacles

Insurance coverage for telehealth visits can be a big barrier. Many private insurance companies differ on rates and coverages for telehealth visits. You can find out what your insurance coverage covers telehealth by calling the number on the back of your insurance card or visiting the company's website.

Many public insurers like Medicaid and Medicare have loosened their restrictions on telehealth during the pandemic and allow for its use on various platforms. Your doctor and the medical staff might have more information on covered services.

Medical Licensing Requirements and Malpractice Coverage

Issues regarding state medical licensing and malpractice coverage can limit the ability of physicians to provide telehealth services. A benefit to telehealth that does not exist is the ability of medical providers to provide medical services across geographic borders. It may be beneficial, especially in instances in which shared expertise is necessary, but the lack of multistate licensing rules and regulations hinders this.

Before the pandemic, telehealth had not been used as expansively as it is now. Its wide use now raises questions of malpractice liability in a variety of areas, including informed consent, standards and protocols, supervision, and liability insurance coverage.

Many professional liability insurance policies may not cover liability that extends to telehealth. That means doctors need to pay special attention to a variety of possible liability issues, including preventing errors, maintaining privacy, interruption of service during a telehealth visit, and more.

Prescribing Restrictions

Liver cancer care sometimes requires chronic pain management and the prescribing of medications considered controlled substances. Many liver cancer patients experience severe pain from their primary tumors and from other areas where cancer has spread.

Telemedicine prescribing laws might limit a healthcare professional’s ability to prescribe pain medications for people living with liver cancer.

The Ryan Haight Online Pharmacy Consumer Protection Act, passed in 2008, places limits on online prescribing of controlled substances. Fortunately, the law does allow prescribing of controlled substances when all federal and state laws have been met.

There are perceived restrictions, as well. The Drug Enforcement Agency in 2016 issued new rules to allow prescribing some controlled substances via telehealth technologies, including those without face-to-face examination.

With all of these considerations in mind, medical providers need to consider the penalties they might face and not just assume their telehealth practices follow all the rules under the Ryan Haight Act and other laws pertaining to prescribing and telehealth.

Technological Barriers 

For telehealth services for liver cancer and other health conditions to be successful, the technology needs to be available to everyone. There also needs to be support for people who are not familiar with the technology.

A study reported in 2021 by Pew Research Center found up to 7% of Americans do not use the Internet, and 25% of them are adults over age 65. Even for people who use and have access to the Internet, telehealth only works if they have access to a good Wi-Fi connection.

Depending on where a person lives or other factors, they might have a slower connection or lose connection, which leads to a longer or canceled visit.

Telehealth also requires the use of devices that support its use. Some people do not own a smartphone, tablet, or computer because they can’t afford these technologies, or they don’t know how to use them. If you don’t own an appropriate device, you can’t access telehealth.

How to Prepare for a Telehealth Visit

Just like an in-person visit with your healthcare professional, you will want to prepare to ensure your telehealth visit is a productive one. There are some things you want to do in advance of your visit, including:

Jot down your concerns. Write down any questions and you might have and any new symptoms or medication side effects. This will help to ensure you don’t forget anything important you want to discuss with your healthcare provider.

Complete electronic paperwork. Many providers require you to update your information through some type of patient portal. You can verify and update personal details, medications, and insurance information days before your visit.

Download necessary apps. Before the appointment, download the application ("app") you need on the device you plan to use and make sure you understand how to use and access the app. Your doctor’s office will let you know what type of app they use, or they may provide you a link to use at your appointment time.

Check your technology, Before your visit, you will want to make sure your device is charged and you have a strong Wi-Fi connection. A higher Internet speed means a high-quality video and audio call for your virtual visit. Also make sure your audio, video, microphone, and headphones are all working before you start the telehealth visit.

Set the stage. Just as you would for a video call on the job, you should find a quiet, private, and well-lit space for your visit. Make sure you don’t have any background noise or distracting visuals that might appear on the screen while you are on the call.

Remember to look into the camera so your doctor can have a more engaged conversation with you. You might consider using headphones or a headset if you have them, so it is easier to hear your provider.

Will Insurance Cover Telehealth for Liver Cancer?

You will want to check with your insurance company to make sure your plan covers the cost of telehealth services as part of your cancer care. You will also want to ask what telehealth services are covered and what your out-of-pocket costs might be. For people on Medicare, you can find a 2021 list of telehealth-covered services at the Centers for Medicare & Medicaid Services website.

What Happens During the Telehealth Visit?

Your telehealth visit takes as long as an in-person appointment and your doctor will treat it as such. You may need to provide consent to the use telehealth services or some other type of agreement before the appointment starts. You may need to wait for a short time before your provider joins the call.

Your healthcare professional will ask you questions about new symptoms and treatment side effects, if you feel treatments are helping, and for any new concerns you might have.

Ask questions and share concerns with your healthcare professional, just as you would at an in-person visit. If you have had previous treatments, including chemotherapy and surgery, your doctor will want to know how you did afterward, including pain levels and side effects, including nausea.

Toward the end of your telehealth visit, your healthcare professional will share information about follow-ups, referrals, prescriptions, future telehealth or in-person visits, imaging studies, and any blood work you might need.

Sometimes, things do not go as planned and you lose connection during the video call with your doctor. If, for example, your doctor loses connection, and you can still see you are connected, don’t close out the call. Just wait for your doctor to rejoin.

If you lose connection, restart the video call and wait to see if your doctor can restart your call. If your video call cannot be restarted, your doctor or the medical staff will likely reach out by telephone, so stay close to your phone.

Summary

Telehealth has become more common for cancer care, including care for liver cancer. It can be used for appointments with many of the professionals on your care team. although in-person appointments will be needed for some care.

A Word From Verywell

Telehealth visits can reduce some of the stress and fatigue of in-person visits for people with liver cancer. They can also reduce your exposure to others who might be sick.

Try not to let the technology overwhelm you and keep you from getting the care you need. Your doctor, their staff, or a loved one can help you to figure out what technology you might need and how to connect for a virtual visit.

And remember, telehealth is not your only option. You still have the option of visiting your doctor in person for your liver cancer care. Your doctor’s staff is doing everything they can to keep their offices safe for you and others who visit them.

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12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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