As a person nears the end of his or her life, it is difficult to know what to expect. Caregivers’ responsibilities may differ, based on where the person with cancer is receiving care. For example, providing care at home instead of a hospital or hospice facility may include more responsibilities for caregivers. Regardless of the situation, the health care team will provide the best care possible through the end of life. And, they will do everything possible to ensure that the person dying is comfortable.
Signs of approaching death
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 someone will live. But 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.
- Worsening 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, and local events
- Wanting to have only a few people nearby and limiting time spent with visitors
- 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. These sounds may concern others, but the person who is dying is not aware of them.
- Cool skin that may turn a bluish, dusky color, especially in the person’s hands and feet
- Dryness of mouth and lips
- Decreased amount of urine
- 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
Family members and caregivers can help the person who is ill become more comfortable during this time. The person’s doctors and nurses can guide you through steps 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 doing 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. Do not use electric blankets because they can cause burns. Gently rub the person’s hands and feet, or soak them in warm water if it is comforting.
- 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 mental confusion.
- If the person is withdrawn or unresponsive, say things that are supportive and reassuring but that do not require a response. Instead of saying, “How are you?” 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. This can be comforting and improve blood circulation. Use a moistening lotion to soothe and alleviate dry skin. Avoid alcohol-based lotions, which can further dry the person’s skin.
- Be there. Sometimes, the best ways to comfort and reassure include sitting with the person, talking, offering gentle touch, or holding the person’s hands. Such steps not only help ease loneliness but also can be healthy expressions of love for the person who is dying.
Severe pain often makes it hard for a person to feel comfortable and at peace as he or she dies. Cancer causes pain in many different ways, but there are ways to treat these different types of pain. Uncontrolled pain often worsens other symptoms, such as fatigue and confusion. These symptoms make it more difficult to concentrate on time spent with family members and friends.
Talk with a doctor or other health care professional who specializes in pain control or palliative care. He or she can help find an effective pain-relief strategy. This may require careful planning and communication with several members of the health care team.