Cancer at final days

Recognizing signs of approaching death

Death from cancer usually occurs after a person has gradually become weaker and more tired over several weeks or months. Although it is not always possible to predict how long someone will live, some common signs and symptoms show that a person is entering the final weeks and days of life. Knowing what to expect helps relieve anxiety and allows better planning. For instance, it allows loved ones to try to be together during the person’s last hours.

Signs and symptoms that suggest that a person with cancer may be entering the final weeks of life:

• Progressive weakness and exhaustion
• A need to sleep much of the time, often spending most of the day in bed or resting
• Weight loss and muscle thinning or loss
• Minimal or no appetite and difficulty eating or swallowing fluids
• Decreased ability to talk and concentrate
• Little interest in doing things that were previously important
• Loss of interest in the outside world, news, politics, entertainment, local events, gossip
• Wanting to have only a few people nearby (The person may want few visitors, may need to limit the time spent with visitors, or wish to have no visitors at all.)

As the last days of life approach, you may observe the following signs and symptoms:

• Breathing may slow, sometimes with very long pauses between breaths
• Noisy breathing, with congestion and gurgling or rattling sounds as the person becomes unable to clear fluids from the throat. (Typically, similar to loud snoring, these sounds may concern others, but the ill person has no awareness of them.)
• Cool skin that may turn a bluish, dusky color, especially in the person’s hands and feet
• Dryness of the person’s mouth and lips
• Decreased amount of urine
• Incontinence (loss of bladder and bowel control)
• Restlessness or repetitive, involuntary movements
• Being confused about time, place, and identity of people, including family members and close friends
• Seeing or hearing people present or things that are not there. Although this is a form of hallucination, it is normal and not a cause for concern unless they scare or upset the person who is ill. These dream-like experiences often reflect themes of travel, preparation for travel, or people who have died (including parents) who are welcoming the person who is sick.
• A tendency to drift in and out of consciousness and gradually becoming less and less responsive to touch or voice of time.

Of course, every person is different. The signs and symptoms that people experience vary, and the order in which signs and symptoms occur may differ.

Providing comfort

Family members and caregivers can help the person who is ill become more comfortable during these last days and hours of life. The person’s doctors and nurses can guide you through steps you can take based on the person’s specific condition and needs. Here are some general guidelines for providing comfort:

• Use an “eggshell” mattress or foam cushions to make beds and chairs more comfortable.
• Help the person change positions frequently.
• Change bedsheets at least twice a week or more often, as necessary.
• Elevate the person's head if doings so is comfortable, or turn the person onto his or her side to help make breathing easier.
• Use blankets to help keep the person warm. (However, do not use electric blankets because they can cause burns.) Or, gently rub the person's hands and feet or soak the hands and feet in warm water if doing so is comforting or pleasurable.
• Speak in a clear, calm voice, and remind the person of the time, place, and people present. This may help ease confusion and disorientation. However, such steps may not help if the person has delirium (mental confusion).
• If the person is withdrawn or unresponsive, say things that are supportive and reassuring and do not require the person to respond. Instead of saying, “How are you?” to someone who is unresponsive, consider saying things such as, “Everything is alright.” “We are here with you.” “We are supporting one another.” “We love you.”
• Offer sips of liquid through a straw or from a spoon, if the person can swallow, to help keep the mouth moist. Glycerin swabs and lip balm also help with dry mouth and lips.
• Massage the person’s body gently if it seems soothing. Massage can be comforting as well as helping with blood circulation. Using a moistening lotion can soothe and alleviate dry skin. (Avoid alcohol-based lotions which while cleansing can further dry the person’s skin.)
• Be there. Your presence can be a gift to the person who is ill. By being present you acknowledge the profound nature of this transition from life. Sometimes, the best ways to comfort and reassure include simply sitting with the person, talking, offering gentle touch, or holding the person’s hands. Such steps not only help ease loneliness, but can also be healthy expressions of love for the person who is dying.