What does end-of-life care imply for cancer patients?
Medical testing and cancer treatment often come to an end when a person’s health care team determines that the cancer can no longer be controlled. However, the person’s care continues, with a focus on increasing their quality of life and that of their loved ones, as well as ensuring that they are comfortable in the coming weeks or months.
Pain and other symptoms such as constipation, nausea, and shortness of breath can be controlled using medicines and treatments given to people near the end of their lives. Some people receive these treatments at home, while others are admitted to a hospital or other facility. In either case, there are resources available to assist patients and their families with medical, psychological, social, and spiritual difficulties related to death. Hospice programs give the most complete and well-coordinated services.
Everyone’s end-of-life experience is unique. As people’s illnesses progress, their indications and symptoms may change, and each person’s information and support needs are different. As questions and concerns regarding the end of life arise, family members should discuss them with one other as well as with the health care staff.
Communication and decision-making about end-of-life care are critical in the final months of a person’s life. According to research, if a person with advanced cancer discusses their treatment options with a doctor early on, their stress level drops and their capacity to cope with illness improves. Patients prefer an open and honest dialogue with their doctor about end-of-life care options early in the course of their sickness, according to studies, and are better happy when they have this chat.
Experts highly advise patients to fill out advance directives, which are documents that state a person’s medical preferences. They also name who the patient wants to make decisions for them if they are unable to do so themselves. It’s critical for cancer patients to make these decisions before they become too sick to do so. However, if a person becomes too ill before completing an advance directive, family caregivers will benefit from knowing what type of care their loved one would want. In the Related Resources section of this fact sheet, you may learn more about advance directives.
How do doctors determine how long a person will live?
Patients and their families frequently want to know how much longer a cancer patient will live. It’s natural to want to be ready for the unexpected. However, forecasting how long someone will live is a difficult topic to answer. What happens depends on several circumstances, including the type of cancer, its location, and whether the patient has other ailments.
Even though doctors may be able to predict how long someone will live based on what they know about them, they may be unwilling to do so. They can be worried about overestimating or underestimating the person’s remaining life expectancy. They may also be afraid of instilling false hope or suffocating a person’s will to life.
When should someone who is caring for a cancer patient at home seek professional help?
Patients who are cared for at home should be asked if they are comfortable, if they are in pain, and if they have any other physical issues.
In end of life care, The caregiver may require assistance from the patient’s health care team at times. In any of the following scenarios, a caregiver can seek assistance from the patient’s doctor or nurse:
- The patient is experiencing pain that is not being eased by the pain medication given.
- The patient is developing new symptoms such nausea, vomiting, increased disorientation, anxiety, or restlessness.
- The patient is having trouble controlling symptoms that were previously under control.
- The patient expresses dissatisfaction by grimacing or moaning.
- The patient is having difficulty breathing and appears to be disturbed.
- The patient cannot urinate or empty his or her bowels.
- The sufferer has lost his balance.
- The patient is sad or contemplating suicide.
- The caregiver is having trouble administering medications to the patient.
- The caregiver feels overwhelmed by the patient’s care, is too sad or fearful to be with the patient; or the caregiver is unsure how to manage a particular situation.
Keep in mind that the patient’s physician can call in palliative care experts at any stage during the patient’s illness to assist with these difficulties. They’re becoming more common not only in hospitals, but also in outpatient settings.
When is it appropriate to seek hospice care?
Many individuals assume that hospice care should only be used in the final weeks or days of life. Medicare, on the other hand, stipulates that it can be utilized up to six months before death is expected. Those who have lost loved ones often express regret for not contacting hospice care sooner.
Patients and families who use hospice services have a higher quality of life than those who don’t, according to research. Medical treatment, counselling, and respite care are just a few of the services offered by hospice. Patients typically qualify for hospice when their doctor signs a statement stating that patients with their kind and stage of sickness are unlikely to live longer than six months on average. In the Related Resources section of this fact sheet, you’ll find more information about hospice.
What are some methods to offer emotional support to someone who is battling cancer and is about to die?
Everyone has individual requirements, yet most dying patients have the same concerns. Worry of desertion and fear of becoming a burden are two of these anxieties. People who are dying are often concerned about losing their dignity and power. The following are some ways caregivers can bring comfort to someone who is concerned about these issues:
- Keep the individual company. Talk to them, watch movies with them, read with them, or simply be with them.
- Allow the individual to share their fears and anxieties about dying, such as leaving behind family and friends. Be ready to pay attention.
- Be open to talking about the person’s past.
- Don’t hold back tough information. Most patients like to be engaged in talks about problems that are important to them.
- Assure the patient that advance directives, such as living wills, will be followed.
- Inquire if there is anything you can do to help.
- Be considerate of the individual’s demand for privacy.
- Encourage a person’s spirituality. Allow them to talk about what matters to them, pray with them if they like, and schedule visits from spiritual leaders and church members as needed. Objects that are meaningful to the person should be kept close by.
What are some other concerns that caregivers should be aware of?
Currently, it’s just as crucial for caregivers to look after their own health. Family and caregivers are more affected than they know by their loved one’s health. Caring for a sick person can result in physical and emotional exhaustion, stress, sadness, and anxiety. As a result, it’s critical for caregivers to look after their own bodies, minds, and spirits. As a result of helping themselves, they will have more energy, be able to manage with stress, and be better caregivers.
Caregivers can also benefit from enlisting the help of friends and family members. Such assistance is critical in reducing the numerous tasks involved in caring for a sick or dying loved one.
What are some issues that patients and their families can discuss?
It’s difficult for many individuals to know what to say to someone who is nearing the end of their life. It’s natural to choose to be bright and optimistic rather than discuss death. Nonetheless, it’s critical to be realistic about the extent of the person’s illness. Caregivers can bolster their loved one’s spirits without instilling false optimism. While the end of life can be a time for mourning and embracing loss, it can also be a moment for searching for meaning and reconsidering what is important.
Many people ponder on their lives, legacies left behind, and loved ones who will be left behind during this time.
- What are the happiest and saddest times we’ve had together as a couple?
- What are the defining or pivotal occasions in our relationship?
- What do we take pride in the most?
- What have we learned from each other?
Patients with life-threatening illnesses have expressed that being cheerful or adding humor is a vital outlet for them. Laughter may still be the best medicine, even in this trying time.
When it comes to a family member’s severe cancer, how should caretakers approach children?
Children have a right to know the truth about a family member’s prognosis so that they can be ready if their loved one passes away. It’s critical to respond to all their queries softly and honestly so that kids don’t envision things that aren’t true. Caregivers must be prepared to address difficult inquiries and reassure them that they will be taken care of no matter what occurs. They must first understand their own sentiments and opinions about the circumstance to do so. They must be able to teach children how to hope for the best while anticipating and embracing the possibility that their loved one will pass away.
What causes death because of cancer?
Every patient is unique, and cancer kills people in different ways. The procedure varies depending on the type of cancer, its location in the body, and its rate of growth.
Cancer can no longer be controlled in certain patients, and it spreads to healthy tissues and organs. Cancer cells take up space and nutrients that would otherwise be used by healthy organs. As a result, the healthy organs are rendered useless. Complications from treatment can lead to death in some persons.
Problems in several sections of the body may emerge during the last stages of cancer.
- Digestive system: If cancer is present in the digestive system (e.g., the stomach, pancreas, or colon), food or waste may be unable to pass through, resulting in bloating, nausea, or vomiting. Patients can become malnourished if their cancer inhibits them from digesting or absorbing food.
- Lungs: A person may have problems breathing and obtaining enough oxygen if there isn’t enough healthy lung tissue remaining, or if cancer has blocked off part of the lung. If the lung collapses, it may get infected, which a person with advanced cancer may find difficult to treat.
- Bones: If cancer is found in the bones, an excessive amount of calcium may enter the bloodstream, resulting in unconsciousness and death. Tumor-affected bones may potentially shatter and fail to mend.
- Liver: The liver filters pollutants from the blood, aids in digestion, and turns food into nutrients. The chemical equilibrium of the body is disrupted if there isn’t enough healthy liver tissue. The individual may eventually go into a coma.
- Bone marrow: Cancer in the bone marrow prevents the body from producing enough healthy blood cells. Anemia is caused by a low red blood cell count, and the body does not receive enough oxygen in the blood. It will be difficult to fight infection if your white blood cell count is low. Furthermore, a decrease in platelets prevents blood from clotting, making abnormal bleeding difficult to manage.
- Brain: A large tumor in the brain can cause memory loss, balance issues, brain bleeding, or loss of function in another body area, all of which can lead to a coma.
In some cases, the actual cause is unknown, and people gradually deteriorate, becoming weaker and weaker until they succumb to cancer.
Again, each patient is unique, and all processes progress at different times and at varying speeds. There are other treatments for some illnesses that can help delay the progression or make the patient more comfortable. It’s critical to maintain contact with the patient’s medical team.
What are the signals that death is on the way, and what can the caretaker do to make the individual as comfortable as possible?
Certain indications and symptoms can alert a caregiver that death is approaching. They’re explained below, along with advice on how to deal with them. Each person’s experience near the end of life, however, is unique. What occurs to one individual may not occur to another. Furthermore, the existence of one or more of these symptoms does not always imply that the patient is dying. A member of the health-care team can provide further information to family members and caregivers.
Withdrawal from family and friends:
- During the final weeks of life, people tend to focus inward. This isn’t to say that patients are irritable or depressed, or that they don’t care about their caregivers. It could be due to a lack of oxygen in the brain, a reduction in blood flow, or mental preparation for death.
- They may lose interest in previously enjoyed activities, such as beloved TV shows, friends, or pets.
- Caregivers can let the patient know that they are available to help. Even if they are unable to answer, the individual may be awake and able to hear. Giving them permission to “let go,” according to experts, may be beneficial. If they do want to talk, they could want to reminisce about their joys and losses, or they might want to tie up loose ends.
- When people first wake up, they may experience tiredness, increased sleep, inconsistent sleep, or bewilderment.
- Patients’ worries or fears may keep them awake at night. Caregivers can ask them whether they want to sit in the same room with them while they sleep.
- As time passes, patients may sleep more and more. Even if the patient is unconscious, caregivers should continue to speak to them because the patient may still hear them.
- Discomfort that is difficult to manage: As the cancer progresses, it may become more difficult to manage pain. It is critical to deliver pain medicine on a regular basis. Caregivers should seek advice on the proper drugs and dosages from a palliative care doctor or a pain expert. Other pain-relieving approaches, such as massage and relaxation techniques, may be beneficial.
- Weakness and weariness will become more prevalent over time. • Caregivers can help patients save energy for the things that are most important to them, as the patient may have good days and bad days and require more assistance with daily personal care and going around.
- As the body naturally closes, a person with cancer may generally require and desire less meals. The body’s urge to preserve energy and its reduced capacity to use food and water properly produce a lack of appetite.
- Patients should be able to decide when and if they want to eat or drink. Caregivers can serve tiny portions of the patient’s favorite foods. They may prefer milkshakes, ice cream, or pudding because chewing requires energy. Offer sips of fluids if the patient isn’t having difficulties swallowing, and if they can’t sit up, use a flexible straw. Offer ice chips if a person can no longer swallow. Lip balm will keep their lips moisturized, and a soft, damp towel will keep their mouth clean.
- People often have moments of bewilderment or waking dreams near the end of their lives. They could get mixed up regarding time, place, and who their loved ones are. Patients can be gently reminded where they are and who is with them by caregivers. They should be reassuring and peaceful. If the patient is agitated, however, they should not be restrained. If you experience severe agitation, tell your doctor since there are medicines that can help you control or reverse it.
- Patients have reported seeing or chatting with loved ones who have passed away. They might talk about going on a journey, seeing lights, butterflies, or other intangible indicators of reality. Caregivers can ask the patient to say more if these things aren’t bothering them. They should allow them to communicate their visions and dreams rather than trying to persuade them otherwise.
The dying procedure is as follows:
- The muscles in the pelvis may relax, resulting in a lack of bladder or bowel control. Clean, dry bedding and gentle personal care should continue to be provided by caregivers. They can place disposable pads under the patient on the bed and remove them as they become dirty. There may also be a decrease in urine volume due to a decrease in fluid intake or a slowdown of kidney function. It could be dark and stinky.
- Breathing patterns may change in cycles, becoming slower or faster. Although the patient may not notice the changes, caregivers should notify the doctor if they are concerned. The accumulation of saliva and fluids in the throat and upper airways can generate rattling or gurgling sounds. Although this can be upsetting for caregivers, the patient is usually not in any distress at this point. If a person’s torso is rotated to the side and pillows are placed behind the back and beneath the head, breathing may be easier. If the patient is short of breath, caregivers can also ask the health care team about using a humidifier or an external supply of oxygen to make it easier for the patient to breathe.
- As blood flow slows, skin may turn bluish in hue and feel chilly. The patient does not experience any pain or discomfort because of this procedure. Electric blankets or heating pads should not be used to warm the patient because they can cause burns. They may, however, cover the patient with a light blanket.
What are the indicators that the person has passed away?
- The person has stopped breathing and no longer has a pulse.
- Their pupils are dilated, and their eyes do not move or blink (enlarged).
- The eyes may be slightly open; the jaw is relaxed; and the mouth is slightly open.
- The bowel and bladder contents are released.
- When touched or spoken to, the person does not reply.
- The skin of the individual is very pale and chilly to the touch.
What should be done when the person has passed away?
There is no need to rush the arrangements once the deceased has passed away. Family members and caregivers may want to sit with the body, talk with it, or pray with it. The following measures can be taken once the family is ready.
- Lie down on your back with one pillow under your head. Caregivers or family members may choose to place the person’s dentures or other artificial pieces in place if necessary.
- If the person is enrolled in a hospice program, follow the program’s guidelines. A caregiver or family member might ask for the death to be confirmed by a hospice nurse.
- In accordance with local regulations, contact the appropriate authorities. Contact the person’s physician and funeral home.
- Call other family members, friends, and clergy when the patient’s family members are ready.
- Assist family members and friends in coping with their loss by providing or obtaining emotional support.