Referral to a Gastroenterologist/Hepatologist is indicated for patients with persistent abnormal liver function tests or evidence of hepatomegaly either by physical exam or by imaging [28]. Survivors with confirmed Hepatitis C need close medical monitoring and should also have psychological assistance available, as patients with Hepatitis C report feelings of depression, stigma and anger associated with their disease [55]. This may be confounded by a history of childhood cancer, which is also associated with psychosocial distress [56].

All survivors, regardless of past exposures, should be educated on the potential for liver damage from medications, both over-the-counter and prescription, as well as from supplements [57, 58]. Acetaminophen is a well-established hepatotoxin, and patients should be educated that acetaminophen comes in various forms in combination over-the-counter pain and cold remedies [59]. Alcohol intake should be limited or eliminated completely as it is a major contributor to accelerating liver damage. Survivors should also be educated that emerging research is showing tattooing to be a risk factor for Hepatitis C, even among those with no other risk factors and having tattoos done in licensed parlors [60].