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Multimodality treatment for cancer of the liver, bile duct, gallbladder, and pancreas requires administration of chemotherapy before and/or after surgery along with/without radiation therapy. Multimodality treatment of cancer is a marathon rather than a sprint. Sometimes, treatment with chemotherapy can lead to side effects. Some side effects can be minor, while some can be severe enough that it may delay the next round of chemotherapy. The most important factor for successful completion of all treatment is the patient’s performance status, i.e., how active a patient is. Also important is your ability to be able to eat and drink to maintain adequate nutrition and stay hydrated.
Palliative and supportive care physicians are doctors who not only help care for patients during end of life events, but are also doctors who are trained in specifically managing symptoms. Symptoms from cancer, such as pain and loss of appetite, can reduce function and result in weight loss, respectively. Symptoms from chemotherapy, such as nausea and vomiting, can result in lack of food and drink by mouth, and in turn result in severe weight loss, dehydration and inability to administer chemotherapy. Certain chemo medications can cause neuropathy or tingling in hands or feet, and this can cause pain or discomfort with day-to-day activity such as walking, or performing the activities of daily living. This can result in functional decline, which in turn can hinder administration of chemotherapy or result in prolonged recovery after major surgery. Palliative and supportive care physicians help manage these symptoms by treating them early, rather than playing catch up. As a result, a patient is able to tolerate chemotherapy better, maintain or improve nutrition and tolerate major surgery well. It is recommended to seek a palliative care consult early on in treatment.