Care Through the Final Days | Cancer.Net

Death from cancer usually occurs after a person has become weaker and more tired over several weeks or months. It is not always possible to predict how long ... SkiptoContent Español Search Menu YouarehereHome>NavigatingCancerCare>AdvancedCancer>CareThroughtheFinalDays RequestPermissions CareThroughtheFinalDays ApprovedbytheCancer.NetEditorialBoard,05/2019 Asapersonnearstheendofhisorherlife,itisdifficulttoknowwhattoexpect.Responsibilitiesofcaregiversmaydifferbasedonwherethepersonwithcancerisreceivingcare.Forexample,providingcareathomeinsteadofahospitalorhospicefacilitymayincludemoreresponsibilitiesforcaregivers.Regardlessofthesituation,thehealthcareteamwillprovidethebestcarepossiblethroughtheendoflife.And,theywilldoeverythingpossibletoensurethatthepersondyingiscomfortable. Signsofapproachingdeath Deathfromcancerusuallyoccursafterapersonhasbecomeweakerandmoretiredoverseveralweeksormonths.Itisnotalwayspossibletopredicthowlongsomeonewilllive.Butsomecommonsignsandsymptomsshowthatapersonisenteringthefinalweeksanddaysoflife.Knowingwhattoexpecthelpsrelieveanxietyandallowsbetterplanning. Thefollowingaresignsandsymptomsthatsuggestapersonwithcancermaybeenteringthefinalweeksoflife: Worseningweaknessandexhaustion. Aneedtosleepmuchofthetime,oftenspendingmostofthedayinbedorresting. Weightlossandmusclethinningorloss. Minimalornoappetiteanddifficultyeatingorswallowingfluids. Decreasedabilitytotalkandconcentrate. Littleinterestindoingthingsthatwerepreviouslyimportant. Lossofinterestintheoutsideworld,news,politics,entertainment,andlocalevents. Wantingtohaveonlyafewpeoplenearbyandlimitingtimespentwithvisitors. Asthelastdaysoflifeapproach,youmayseethefollowingsignsandsymptoms: Breathingmayslow,sometimeswithverylongpausesbetweenbreaths. Noisybreathing,withcongestionandgurglingorrattlingsoundsasthepersonbecomesunabletoclearfluidsfromthethroat.Thesesoundsmayconcernothers,butthepersonwhoisdyingisnotawareofthem. Coolskinthatmayturnabluish,duskycolor,especiallyintheperson’shandsandfeet. Drynessofmouthandlips. Decreasedamountofurine. Lossofbladderandbowelcontrol. Restlessnessorrepetitive,involuntarymovements. Confusionabouttime,place,andidentityofpeople,includingfamilymembersandclosefriends. Seeingorhearingpeopleorthingsthatarenotthere.Thisiscommonandusuallynormal.Itisnotacauseforconcernunlessthesehallucinationsscareorupsetthepersonwhoisill.Thesedream-likeexperiencesoftenincludetraveling,preparingfortravel,orbeingwelcomedbypeoplewhohavedied. Atendencytodriftinandoutofconsciousnessandgraduallybecominglessandlessresponsivetotouchorvoice. Ofcourse,everypersonisdifferent.Thesignsandsymptomsthatpeopleexperiencevary.Andtheorderinwhichsignsandsymptomsoccurmaydiffer. Providingcomfort Familymembersandcaregiverscanhelpthepersonwhoisillbecomemorecomfortableduringthistime.Theperson’sdoctorsandnursescanguideyouthroughstepsbasedontheperson’sspecificconditionandneeds.Herearesomegeneralguidelinesforprovidingcomfort: Usean“eggshell”mattressorfoamcushionstomakebedsandchairsmorecomfortable. Helpthepersonchangepositionsfrequently. Changebedsheetsatleasttwiceaweekormoreoften,asnecessary. Elevatetheperson'shead,ifdoingsoiscomfortable,orturnthepersonontohisorhersidetohelpmakebreathingeasier. Useblanketstohelpkeepthepersonwarm.Donotuseelectricblanketsbecausetheycancauseburns.Gentlyrubtheperson'shandsandfeetorsoaktheminwarmwaterifitiscomforting. Speakinaclear,calmvoice,andremindthepersonofthetime,place,andpeoplepresent.Thismayhelpeaseconfusionanddisorientation.Butsuchstepsmaynothelpifthepersonhasmentalconfusion. Ifthepersoniswithdrawnorunresponsive,saythingsthataresupportiveandreassuringbutthatdonotrequirearesponse.Insteadofsaying,“Howareyou?”considersayingthingssuchas: “Everythingisalright.” “Weareherewithyou.” “Wearesupportingoneanother.” “Weloveyou.” Offersipsofliquidthroughastraworfromaspoon,ifthepersoncanswallow.Thiswillhelptokeeptheperson’smouthmoist.Glycerinswabsandlipbalmalsohelpwithdrymouthandlips. Massagetheperson’sbodygentlyifitseemssoothing.Thiscanbecomfortingandimprovebloodcirculation.Useamoisteninglotiontosootheandalleviatedryskin.Avoidalcohol-basedlotions,whichcanfurtherdrytheperson’sskin. Bethere.Sometimes,thebestwaystocomfortandreassureincludesittingwiththeperson,talking,offeringgentletouch,orholdingtheperson’shands.Suchstepsnotonlyhelpeaselonelinessbutalsocanbehealthyexpressionsofloveforthepersonwhoisdying.  Easingpain Severepainoftenmakesithardforapersontofeelcomfortableandatpeaceasheorshedies.Cancercausespaininmanydifferentways,buttherearewaystotreatthepain.Uncontrolledpainoftenworsensothersymptoms,suchasfatigueandconfusion.Thesesymptomsmakeitmoredifficulttoconcentrateontimespentwithfamilymembersandfriends.  Talkwithamemberofyourhealthcareteamwhospecializesinpaincontrolorpalliativecare.Heorshecanhelpfindaneffectivepain-reliefstrategy.Thismayrequirecarefulplanningandcommunicationwithseveralmembersofthehealthcareteam. Learnmoreabouttreatingpainwithmedicationandadditionalwaystomanagepain. Callingforhelp Thepersonwithcancerandthecaregiversmustknowwhomtocallwithquestionsaboutpainandiftheyneedurgenthelp.Ifyouarecaringforsomeonewithcancerathome,asktheperson’sdoctor(s)orthehospiceorhomecarestaffwhenandwhomtocallforhelp.Somesituationsthatrequireassistancefromprofessionalsandahealthcareteaminclude: Thepersonhaspainthatisdifficulttomanageorrelieve. Thepersonisunabletotakeprescribedmedications. Thepersonshowssignsofdistress,suchasbreathingproblemsoragitation. Thepersonhasasuddenchangeinconsciousness,becominglessresponsiveorconfused,orhasaseizure. Caregiversathomeareoverwhelmedbytheperson’sconditionandneeds. Respectingpersonalchoices Findoutaheadoftimeifthepersonyouarecaringforcreatedanadvancedirective.Thereare2typesofadvancedirectives: Ahealthcarepowerofattorneyisapersonthepatientselectstomakehealthcaredecisionsifheorsheisunableto.Thispersonmayalsobecalledahealthcareproxy,agent,orsurrogate. Alivingwillisadocumentthatliststhetypeofmedicaltreatmentsthepatientdoesordoesnotwantattheendoflife.Forexample,somepeoplenearingtheendoflifechoosetorefuseartificiallifesupport,suchasmechanicalrespiratorsorafeedingtube.Or,theyrequestadonotresuscitate(DNR)order.ThisorderstatesthatthepersonshouldnothaveCPRperformedifhisorherbreathingorheartbeatstops. Caregiversandotherswhocareaboutthepersonmaynotalwaysagreewiththedecisionsinanadvancedirective.Butpeoplewithanadvancedillnessneedtoknowtheirfinalwisheswillberespected.Asacaregiver,followingtheadvancedirectiveisoneofthemostimportantthingsyoucandotohelpthepersondiewithdignityandpeaceofmind. IfthepersonhasaDNRorder,informanyemergencypersonnelifyouneedtocall911oranotheremergencyline.LearnmoreaboutDNRordersandCPR. Organizingpracticalmatters Organizingpracticalmattersinadvancelowerssomeofthestressofcaregiving.Italsohelpscaregiversconcentrateonspendingtimewiththepersonwhoisdying.Thefollowingaresometipsthatmayhelpyouorganizeyourtimeandfocusyourefforts: Compilealistofimportantpapersthatmaybeneededandwheretheyare.Thesecouldincludebankaccounts,realestate,stockholdings,andpasswordstoaccountsandonlinebanking. Makealistofpeoplethepersonwouldliketoseeinthefinalweeks. Considerwhoshouldbepresentatoraroundthetimeofdeath.Forexample,decidewhetheraclergymemberorotherspiritualleadershouldbeatthebedsidetoprovidecomfortorperformimportantrituals. Makealistofpeopletocallafterdeathoccurs.Andaskafriendorrelativetohelpmakethosecalls. Chooseafuneralhomeandnotifythefacilitythatadeathisexpectedinthenearfuture.Mosthospiceswillcallthefuneralhomeforyou. Makesureyouunderstandtheperson’swishesforfuneralandburialservices,suchascremation. Notifyhospitalorhospicestaffofculturalorreligiouscustomsaboutdeathsothattheycanaccommodatethem.Thismayincludepeoplewhoshouldbepresentbeforeandafterthetimeofdeath.Or,itmayincludespecialcustomsregardingwashing,dressing,orcaringforthebodyafterdeath. Understandingwhathappensimmediatelyafterdeath Whendeathoccurs,theperson'smuscleswillrelax,breathingwillstop,theheartwillstopbeating,andtherewillbenopulse. Evenwhendeathisexpected,itiscommon—andnormal—forcaregiverstofeelasenseofshockanddisbelief.Althoughhomehealthorhospicestaffandtheperson'sdoctorshouldbenotified,anaturaldeathisnotanemergency.Thereisusuallynoneedtocallmedicalpersonnelimmediately.Manypeoplefinditcomfortingtotakesometimetositwiththeirlovedone,perhapstalkingquietly,holdinghands,orwatchingtheirlovedoneatpeace. RelatedResources CompletingYourLife CaringforaLovedOne GriefandLoss MoreInformation NationalCancerInstitute:End-of-LifeCareforPeopleWhoHaveCancer Español f t k e P Moreinthissection Timely.Trusted.Compassionate. Comprehensiveinformationforpeoplewithcancer,families,andcaregivers,fromtheAmericanSocietyofClinicalOncology(ASCO),thevoiceoftheworld'soncologyprofessionals. FindaCancerDoctor