Influence of transcatheter arterial embolization on symptom distress and fatigue in liver cancer patients

Abstract

BACKGROUND

Hepatocellular carcinoma (HCC) is a prevalent malignancy, and transcatheter arterial embolization (TAE) has emerged as a pivotal therapeutic modality. However, TAE may induce symptom distress and fatigue, adversely affecting the quality of life of patients.

AIM

To investigate symptom distress, fatigue, and associated factors in HCC patients undergoing TAE.

METHODS

We used a cross-sectional design and purposive sampling to enroll HCC patients who underwent TAE at our institution from January to December 2022. Questionnaires were utilized to collect data on symptom distress and fatigue scores from the first to the third day after TAE.

RESULTS

Our study revealed a significant reduction in fatigue and symptom distress among patients after TAE. Pain, fatigue, insomnia, fever and abdominal distension were the most common symptoms troubling patients during the first 3 d post-TAE. Marital status, presence of family support, physical functional status, age, and symptom distress were identified as predictors of fatigue in patients.

CONCLUSION

Healthcare professionals should educate HCC patients on symptom distress and fatigue, offering personalized relief strategies to lessen their psychological burden.

Key Words: Transcatheter arterial embolization, Fatigue, Symptom distress, Hepatocellular carcinoma, Influencing factors

Core Tip: Our study highlights the impact of transcatheter arterial embolization (TAE) on symptom distress and fatigue in liver cancer patients. TAE significantly reduced symptom distress and fatigue levels in the immediate postoperative period. The most commonly reported post-TAE symptoms included pain, fatigue, insomnia, fever and abdominal distension. Marital status, presence of family support, physical functional status, age, and symptom distress were identified as predictors of post-TAE fatigue. This research underscores the importance of patient education and personalized symptom management strategies in improving the overall wellbeing and quality of life for liver cancer patients undergoing TAE.

INTRODUCTION

Hepatocellular carcinoma (HCC) ranks as the fifth most prevalent cancer and the third leading cause of cancer-related mortality globally. Surgical intervention remains the cornerstone of HCC treatment; however, due to the challenges associated with early diagnosis and the lack of specific diagnostic markers, a considerable proportion of patients are diagnosed at advanced stages, rendering them ineligible for surgical interventions. Transcatheter arterial embolization (TAE) is an interventional therapeutic approach involving the insertion of a fine catheter via the femoral artery to reach the vasculature near the tumor site. TAE aims to obstruct the arterial supply to the tumor by deploying embolic agents, thereby inducing necrosis in cancer cells. This procedure is suitable for patients with good liver function and overall health, particularly those with large HCCs that have not invaded the portal vein[1,2].

Nonetheless, following TAE, hepatocytes incur variable degrees of damage, leading to the development of a constellation of symptoms reminiscent of acute hepatitis. These symptoms include fatigue and systemic discomfort, such as nausea, vomiting, fever, abdominal pain, as well as transient elevations in aspartate aminotransferase (AST) and alanine aminotransferase (ALT), collectively referred to as postembolization syndrome[3,4]. These symptoms may arise due to ischemia of the liver and gallbladder, temporary liver enlargement, and peritoneal irritation. While many studies have explored fatigue and symptom distress in cancer patients both nationally and internationally, with some focusing on symptom distress following transcatheter arterial chemoembolization, there has been limited in-depth investigation into the fatigue and symptom distress resulting from TAE treatment[5-8].

Fatigue and pain are both subjective experiences, typically arising from the gradual depletion of energy reserves during the course of illness[9]. Fatigue is particularly prevalent among cancer patients, with rates soaring as high as 90%. Despite extensive research exploring cancer-related fatigue and its influencing factors, a unanimous consensus remains elusive. Hence, the primary objective of this study was to investigate the symptom distress and fatigue experienced by liver cancer patients following TAE treatment and to analyze potential contributing factors.

MATERIALS AND METHODS

Study population and procedures

This study used a cross-sectional design and purposive sampling approach, enrolling patients with liver cancer who underwent TAE at the Department of General Surgery, Shanghai Fourth People’s Hospital, between January and December 2022. Inclusion criteria encompassed histologically confirmed liver cancer, patient awareness of their condition, inpatient admission for TAE treatment, and age ≥ 18 yr. After explaining the research objectives and obtaining patient consent, the research team administered three questionnaires – assessing fatigue, symptom distress, and basic demographic information – on the first day post-TAE (T1), second day post-TAE (T2), and third day post-TAE (T3). Basic demographic information was collected only on the first day, while the remaining questionnaires were filled out on the second and third days through face-to-face interviews conducted by the researchers. In cases where patients had difficulty understanding certain questionnaire items, the researchers provided explanations and collected data through verbal interviews. Other disease-related data, such as the number of embolization treatments, tumor size, medication usage, embolization dosage, and patient’s physical functional status (PST), were collected by the researchers based on medical record data with approval from our ethics committee.

Fatigue assessment scale

The cancer fatigue scale (CFS) was used, consisting of 15 items categorized into three dimensions: physical fatigue (items 1, 2, 3, 6, 9, 12 and 15), emotional fatigue (items 5, 8, 11 and 14), and cognitive fatigue (items 4, 7, 10 and 13). Each item was scored on a scale ranging from 1 (no fatigue) to 5 (severe fatigue)[10]. According to the scoring method outlined by Okuyama et al[11] for CFS, the score range for physical fatigue dimension was 0 to 28, while the score ranges for emotional and cognitive dimensions were both 0 to 16. The total scale score ranged from 0 to 60, with higher scores indicating greater fatigue severity.

Symptom distress scale

We utilized the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire[12]. Given considerations for patient age and education levels, some patients were unable to respond to questions regarding nausea frequency and intensity, future perspectives, and changes in sexual activity. Therefore, we adjusted the original questionnaire content to include 22 common symptoms experienced by patients. Patients were asked to rate the severity of each symptom based on their self-perception using a five-point scoring system: 1, absence of the symptom; 2, presence of mild symptoms; 3, moderate symptoms; 4, severe symptoms; and 5, very severe symptoms.

Statistical analysis

Data processing was performed using SPSS 23.0 software (IBM, Armonk, NY, United States). Initially, we conducted descriptive analyses for patient demographic data, disease characteristics, analgesic medication usage, embolization frequency and dosage, patient PST, and serum levels of AST, ALT and cortisol on the first and third days post-TAE. We computed mean values and standard deviations for questionnaire scores related to symptom distress and post-TAE fatigue over the 3 d. To analyze changes in fatigue and symptom distress among liver cancer patients following TAE treatment, we utilized one-way repeated-measures analysis of variance (ANOVA). If overall F tests indicated significant differences, Bonferroni post hoc tests were used to compare differences between individual days. Finally, to explore factors associated with post-TAE fatigue among liver cancer patients, we used generalized estimating equation (GEE) models. Given the collection of data over 3 d post-TAE, and considering the correlation between measurements within the same patients at different time points, we selected an autoregressive first-order working correlation matrix (AR1) to control for the effect of time. Robust standard errors were calculated for significance testing[13].

RESULTS

General characteristics

This study included 100 liver cancer patients, comprising 75 males and 25 females, with an average age of 64.3 ± 4.5 yr (Table 1). Nineteen patients received embolization for the first time, while 44 had undergone embolization ≥ 4 times. On the first day after the procedure, serum ALT and AST levels were 288.5 ± 24.1 U/L and 206.8 ± 19.7 U/L, respectively, and on the third day, the average values for ALT and AST were 126.4 ± 10.8 U/L and 162.3 ± 19.5 U/L, respectively.

Table 1 General characteristics of liver cancer patients.

Characteristics	Values
Gender (male/female)	75/25
Age (yr)	64.3 ± 4.5
Education level (primary or below/high school or vocational/university or above)	19/37/44
Occupation (yes/no)	71/29
Marital status (single/married)	19/81
Presence of family support (no/yes)	8/92
No. of embolization procedures (1/2/3/4 or more)	19/19/18/44
Tumor size (cm)	4.9 ± 1.8
Embolization agent volume (mL)	7.6 ± 2.5
Performance status (PST) (0/1/2)	63/32/5
Biochemical results on day 1 post-TAE
AST (U/L)	288.5 ± 24.1
ALT (U/L)	206.8 ± 19.7
Total bilirubin (μmol/L)	26.7 ± 4.2
Cortisol (nmol/L)	491.8 ± 98.1
Biochemical results on day 3 post-TAE
AST (U/L)	126.4 ± 10.8
ALT (U/L)	162.3 ± 19.5
Total bilirubin (μmol/L)	26.6 ± 3.4
Cortisol (nmol/L)	487.9 ± 54.3

Physical functional status refers to the Eastern Cooperative Oncology Group (ECOG) Performance Status Scale. 0: Fully active, able to carry on all pre-disease performance without restriction; 1: Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light housework or office work; 2: Ambulatory and capable of all self-care but unable to carry out any work activities. Up and about more than 50% of waking hours; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; TAE: Transcatheter arterial embolization.

Symptom distress and fatigue on day 3 post-TAE

The average scores on the symptom distress scale ranged from 1.1 to 3.2, with most distress scores falling within the category of mild distress (≤ 2 points). Among the top three most distressing symptoms on the first day post-procedure were pain (3.1 ± 0.5), fatigue (2.8 ± 0.9) and fever (2.6 ± 0.5). On the second day, the top three distressing symptoms were fever (2.8 ± 0.7), pain (2.3 ± 0.5) and fatigue (2.3 ± 0.3). On the third day, the top three distressing symptoms were fever (1.9 ± 0.2), fatigue (1.8 ± 0.4) and pain (1.7 ± 0.6). Among the 22 symptoms assessed, 13 exhibited significant differences during the 3-d treatment period (P < 0.05), including pain, fatigue, fever, insomnia, abdominal distension, loss of appetite, nausea, vomiting, changes in bowel habits, dry mouth, chills, chest tightness, and gastric burning sensation (Table 2).

Table 2 Scores on symptom distress subscales at postoperative day 3 following transcatheter arterial embolization.

Subscale	T1	T2	T3	F	P value	Post hoc Bonferroni comparisons
Pain	3.1 ± 0.5	2.3 ± 0.5	1.7 ± 0.6	47.21	0.001	T1 > T2 > T3
Fatigue	2.8 ± 0.9	2.3 ± 0.3	1.8 ± 0.4	22.72	0.004	T1 > T2 > T3
Fever	2.6 ± 0.5	2.8 ± 0.7	1.9 ± 0.2	7.55	0.032	T2, T1 > T3
Insomnia	2.3 ± 0.6	1.8 ± 0.4	1.5 ± 0.3	15.88	0.009	T1 > T2 > T3
Abdominal distension	2.4 ± 1.1	2.1 ± 0.9	1.5 ± 0.7	19.45	0.006	T1 > T2 > T3
Anorexia	2.2 ± 0.3	1.7 ± 0.4	1.5 ± 0.4	12.64	0.012	T1 > T2 > T3
Nausea	1.9 ± 0.4	1.4 ± 0.5	1.1 ± 0.3	23.00	0.004	T1 > T2 > T3
Vomiting	1.6 ± 0.4	1.2 ± 0.2	1.1 ± 0.4	14 97	0.009	T1 > T2 > T3
Bowel movement	1.8 ± 0.9	1.4 ± 0.4	1.2 ± 0.3	8.58	0.027	T1 > T2 > T3
Dry mouth	1.8 ± 0.5	1.5 ± 0.6	1.4 ± 0.2	7.29	0.035	T1 > T2 > T3
Chills	1.9 ± 1.2	1.6 ± 0.3	1.3 ± 0.2	7.05	0.041	T1 > T2 > T3
Chest tightness	1.6 ± 0.2	1.3 ± 0.4	1.1 ± 0.5	6.26	0.043	T1 > T2 > T3
Gastric burning sensation	1.9 ± 0.6	1.5 ± 0.4	1.3 ± 0.4	16.61	0.008	T1 > T2 > T3
Urination	1.3 ± 0.7	1.2 ± 0.5	1.1 ± 0.2	2.58	0.598
Dyspnea	1.3 ± 0.5	1.2 ± 0.4	1.2 ± 0.5	1.82	0.611
Cough	1.3 ± 0.2	1.2 ± 0.5	1.1 ± 0.4	1.63	0.724
Oral esophageal pain	1.1 ± 0.3	1.0 ± 0.2	1.1 ± 0.3	0.40	0.921
Restlessness	1.5 ± 0.8	1.3 ± 0.6	1.3 ± 0.6	2.10	0.372
Concentration	1.4 ± 0.6	1.2 ± 0.4	1.3 ± 0.2	0.86	0.728
Appearance	1.3 ± 0.5	1.1 ± 0.5	1.2 ± 0.6	1.12	0.827
Bleeding	1.1 ± 0.4	1.1 ± 0.3	1.3 ± 0.1	1.48	0.782
Numbness	1.2 ± 0.5	1.2 ± 0.4	1.1 ± 0.3	0.89	0.709

T1, T2, and T3 represent different time points following transcatheter arterial embolization for liver cancer. F denotes the results of the analysis of variance, P indicates the level of statistical significance, and Bonferroni signifies the post-hoc comparison method.

The average scores on the fatigue scale ranged from 1.2 to 4.7. Among the 15 items assessing fatigue, seven exhibited significant differences over the 3-d treatment period (P < 0.05), including easy fatigue, desire to lie down, feeling utterly exhausted, bodily fatigue, feeling bored, feeling unable to make an effort, and feeling a need to perk up (Table 3).

Table 3 Fatigue scores on various subscales at postoperative day 3 following transcatheter arterial embolization.

Subscale	T1	T2	T3	F	P value	Post hoc Bonferroni comparisons
Easily fatigued	2.7 ± 0.5	2.2 ± 0.4	1.7 ± 0.5	18.45	0.007	T1 > T2 > T3
Want to lie down	2.9 ± 1.0	2.3 ± 0.6	1.8 ± 0.7	21.33	0.005	T1 > T2 > T3
Feel exhausted	2.6 ± 0.8	1.9 ± 0.5	1.6 ± 0.3	21.36	0.005	T1 > T2 > T3
Feel distracted	1.7 ± 0.4	1.4 ± 0.6	1.5 ± 0.6	2.26	0.064
Feel energetic	4.6 ± 1.9	4.6 ± 1.2	4.7 ± 1.3	0.13	0.857
Feel physically tired	2.4 ± 1.1	2.1 ± 0.8	1.6 ± 0.7	12.67	0.013	T1 > T2 > T3
Feel talkative	1.2 ± 0.3	1.2 ± 0.4	1.5 ± 0.6	0.92	0.694
Interest in things	4.5 ± 1.6	4.5 ± 1.4	4.4 ± 1.0	0.39	0.921
Feel irritable	1.7 ± 0.4	1.6 ± 0.8	1.4 ± 0.5	3.39	0.043	T1 > T2 > T3
Feel forgetful	1.5 ± 0.8	1.3 ± 0.2	1.3 ± 0.3	1.15	0.624
Able to concentrate	2.0 ± 0.8	1.8 ± 0.7	1.9 ± 0.7	0.65	0.829
Feel unable to get going	2.4 ± 1.0	1.7 ± 0.3	1.5 ± 0.9	6.51	0.039	T1 > T2 > T3
Feel slower thinking	1.6 ± 1.0	1.49 ± 0.9	1.4 ± 0.90	0.75	0.721
Feel like making effort	1.9 ± 0.3	1.7 ± 0.2	1.3 ± 0.2	4.00	0.032	T1 > T2 > T3
Feel overwhelming fatigue	1.6 ± 0.7	1.4 ± 0.3	1.4 ± 0.4	2.31	0.067

T1, T2, and T3 represent different time points following transcatheter arterial embolization for liver cancer. F denotes the results of the analysis of variance, P value indicates the level of statistical significance, and Bonferroni signifies the post-hoc comparison method.

The total symptom distress scores in the patients within the first 3 d post-procedure were 38.9 ± 10.4 on the first day, 33.1 ± 10.1 on the second day, and 29.6 ± 9.2 on the third day. The total fatigue scores were 28.9 ± 9.2 on the first day, 24.9 ± 9.9 on the second day, and 23.3 ± 6.4 on the third day. Repeated-measures ANOVA indicated significant differences in the mean scores for both symptom distress and fatigue (P < 0.001), suggesting that they decreased over time.

Predictors of fatigue

Since the symptom distress scale includes the assessment of fatigue, this study incorporated fatigue scores into the overall symptom distress score when analyzing predictors of fatigue. The results of GEE multivariate regression analysis revealed that marital status, presence of family support, PST, age, and modified total symptom distress score were predictors of fatigue (P < 0.05; Table 4). Married patients had lower levels of fatigue compared to single patients (β = 3.05); patients with family support experienced higher levels of fatigue than those without family support (β = 5.62); patients with a PST score of 1 had lower levels of fatigue compared to those with a score of 0 (β = 2.54); older patients experienced lower levels of fatigue (β = 0.20); and higher modified total symptom distress scores were associated with higher levels of fatigue (β = 0.53).

Table 4 Generalized estimating equation multivariate regression analysis of factors influencing fatigue in patients following transcatheter arterial embolization.

Variables	Regression coefficient	SE	Wald χ2	P value
Gender (male vs female)	0.36	1.38	0.07	0.793
Marital status (married vs single)	-3.05	1.46	4.35	0.037
Marital status (married vs single)	-0.93	1.60	0.34	0.558
Family accompaniment (yes vs no)	5.62	1.64	11.69	0.001
Educational level
Junior high school or below vs high school/vocational	0.97	2.02	0.23	0.631
Junior high school or below vs college or above	0.52	2.03	0.07	0.796
Days after embolization
Day 2 vs day 1	-1.01	0.79	1.64	0.200
Day 3 vs day 1	-1.05	0.93	1.28	0.258
PST
1 vs 0	-2.54	1.17	4.70	0.030
2 vs 0	2.69	5.13	0.27	0.601
Continuous variables
Age	-0.20	0.07	7.29	0.007
Tumor size	0.18	0.21	0.79	0.373
Number of TAE procedures	0.16	0.19	0.74	0.390
TAE dose	-0.09	0.17	0.31	0.576
AST on post-TAE day 1	-0.003	0.005	0.46	0.498
ALT on post-TAE day 1	0.003	0.015	0.41	0.523
Total bilirubin on post-TAE day 1	-0.70	1.12	0.39	0.532
Cortisol on post-TAE day 1	0.01	0.07	0.02	0.880
Total symptom distress score	0.53	0.06	79.89	0.001

TAE: Transcatheter arterial embolization; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; PST: Physical functional status.

DISCUSSION

The present investigation delineates the symptomatology experienced by liver cancer patients undergoing TAE, emphasizing distressing manifestations such as pain, fever, fatigue, insomnia and abdominal distension. With the exception of fever, these symptoms peak on the first day post-TAE (T1) and exhibit a gradual attenuation throughout the treatment trajectory, aligning with antecedent research outcomes[8,14]. The temporal dynamics of symptom distress underscored in this observation are pivotal for healthcare teams, facilitating a comprehensive comprehension of postoperative comfort and pain management imperatives. A notable escalation in fever symptoms on the second day post-TAE is discerned, potentially ascribable to tumor necrosis and the concomitant release of thermal energy, thereby enriching our insights into the physiological mechanisms governing post-treatment symptomatology[15,16]. In comparative juxtaposition, our findings align with those of Yenjai et al[8], demonstrating a congruent trend of pain, fatigue and insomnia peaking on the first day post-TAE. The post-TAE fever symptoms may be associated with tumor necrosis and the release of thermal energy. This subtle distinction, contrasting with existing literature, underscores the unique contributions of our study and its relevance in advancing the understanding of underlying physiological mechanisms.

Further multivariate regression analysis has elucidated pivotal factors influencing fatigue in liver cancer patients post-TAE, including marital status, presence of family members, and age[17,18]. Consistent with prior research, our study reveals that younger patients are more susceptible to experiencing fatigue. Intriguingly, our investigation highlights that patients with the accompaniment of family members manifest elevated levels of fatigue. This observation underscores the potential mitigating impact of social support on fatigue, emphasizing the critical role of familial support during the treatment process. This not only underlines the multifactorial nature of fatigue within this patient cohort but also advocates for a holistic approach to patient care that incorporates psychosocial factors. For instance, recognizing the vulnerability of younger patients to fatigue may prompt healthcare providers to proactively address and manage fatigue within this demographic group[8,19]. Similarly, the observed influence of family member presence on fatigue emphasizes the potential benefits of integrating family-oriented interventions into the supportive care framework for liver cancer patients undergoing TAE.

Our research findings indicate that patients’ PST scores and the modified Symptom Distress Total Scores can independently predict post-TAE fatigue, irrespective of tumor size and embolization drug dose[20,21]. This suggests a close relationship between fatigue and symptom distress, where an increase in symptom distress may exacerbate fatigue. However, further investigation is needed to delve into the mechanisms underlying this relationship. It is noteworthy that the pharmacological properties of iodized oil may have enduring effects on patients during the treatment process. The ability of iodized oil to adhere to tumor cells may prolong the biological half-life of the drug, thereby rendering its inhibitory effects on tumor vascular growth more persistent[22]. This may also contribute to a more pronounced post-treatment fatigue, as patients may experience the biological effects of the drug over an extended period. When used in conjunction with gel, it effectively inhibits the development of new tumor blood vessels, achieving therapeutic efficacy[23,24]. Consequently, patients with larger tumor diameters may receive higher embolization doses, leading to transient liver and gallbladder ischemia, hepatomegaly, and peritoneal stimulation-induced pain. This phenomenon could potentially explain the significantly higher pain symptom scores observed in our patient cohort compared to other symptoms.

In the context of biochemical markers, changes in liver function on the first- and third-days following embolization were found to be unrelated to fatigue, aligning with prior research findings[25]. The elevation of AST and ALT levels appears to be a consequence of transient hepatic cell ischemia induced by the treatment, rather than indicative of sustained liver injury. The physiological responses triggered by the treatment, such as inflammation and cellular stress, may exert short-term effects on liver function markers but do not necessarily correlate directly with the patients’ subjective experience of fatigue. Other factors, including overall patient health, medication history, and the pre-existing hepatic condition before treatment, may also influence the relationship between liver function markers and fatigue. Therefore, while AST and ALT levels may rise post-embolization, they do not directly reflect ongoing liver damage and cannot singularly explain the post-treatment fatigue reported by patients. This intricate relationship necessitates further in-depth investigation for a comprehensive understanding of the physiological and subjective responses post-treatment.

In conclusion, the results of this study contribute to a more comprehensive understanding of fatigue and symptom distress in liver cancer patients undergoing TAE. These findings not only provide a basis for clinicians to predict the likelihood of fatigue in patients but also underscore the significance of social support in alleviating fatigue. Nevertheless, this study had limitations, including the assessment of fatigue and symptom distress scores only within 1–3 d post-TAE, the absence of preoperative scores as baseline references, and the lack of longer-term follow-up data. Future research can expand the patient population to enhance the generalizability of findings and delve deeper into the impact of various treatment modalities on fatigue in liver cancer patients, offering a more comprehensive insight and guidance for clinical practice.

CONCLUSION

Healthcare professionals should bolster patient education efforts, enabling liver cancer patients to develop a clear understanding of the potential symptom distress and fatigue associated with treatment, as well as the potential post-treatment scenarios. They should provide tailored and efficacious strategies for symptom alleviation and fatigue management, thus alleviating the psychological burden on patients. This comprehensive approach to patient care is indispensable in ensuring that liver cancer patients receive the highest level of support and personalized assistance throughout their treatment journey.

ARTICLE HIGHLIGHTS

Research background

Hepatocellular carcinoma (HCC) ranks as the fifth most common cancer globally and is a major contributor to cancer-related mortality. Surgical treatment remains pivotal, but late-stage diagnosis limits its applicability. Transcatheter arterial embolization (TAE) is an essential intervention for unresectable HCC, yet its impact on patient well-being requires further exploration.

Research motivation

Despite the significance of TAE in HCC management, the associated symptom distress and fatigue remain inadequately understood. A comprehensive investigation of symptom distress and fatigue following TAE is essential to enhance patient care and outcomes.

Research objectives

To assess symptom distress and fatigue in liver cancer patients undergoing TAE. To identify factors influencing post-TAE fatigue. To contribute evidence-based insights for personalized symptom management strategies.

Research methods

We used a cross-sectional design and purposive sampling to enroll liver cancer patients who underwent TAE. We used questionnaires to collect data on symptom distress and fatigue. We analyzed the data using statistical methods to reveal correlations and predictors.

Research results

TAE significantly reduced symptom distress and fatigue levels post-treatment. Commonly reported symptoms included pain, fatigue, insomnia, fever and abdominal discomfort. Marital status, family support, physical function, age, and symptom distress were identified as predictors of post-TAE fatigue.

Research conclusions

TAE plays a crucial role in managing unresectable HCC, with notable benefits in symptom distress and fatigue reduction. Personalized symptom management strategies should be tailored to individual patient profiles. Patient education is vital to prepare them for post-TAE symptoms and optimize their wellbeing.

Research perspectives

Future studies should focus on long-term follow-up to evaluate the sustained effects of TAE on symptom distress and fatigue. Exploring interventions to further mitigate symptom distress and fatigue in post-TAE patients. Continual research will enhance the understanding and management of symptom-related issues in liver cancer patients, improving their overall quality of life.