How many tests and treatments have you had since you were diagnosed with cancer? All of this was done to control the cancer in your body. When a treatment was successful, we continued it. But when it stopped working, you and your medical team worked together to consider other options and perhaps start a new treatment. It's a long, tiring journey. But sometimes we reach a point where cancer treatments no longer work. Or, you may feel like all these tests and treatments are over. This is a very difficult and sensitive topic to talk about. But being aware of this can be a great strength for you and your loved ones to face this challenging time.
What happens at this stage?
Approaching the end of life means that there may be no more ways to control the cancer. Or you may decide to get rid of all these treatments and live out the rest of your life in comfort.
The important thing is that the care you receive does not stop when treatment stops. What happens here is that our focus shifts from curing the cancer to helping you live the rest of your life as comfortably and well as possible.
What physical changes can you expect?
At first, you may not feel much difference. Many people who fight cancer remain physically healthy for a long time, but as they approach the end of their lives, their bodies gradually begin to lose function. Cancer causes the body's organs to slowly stop working. This can affect you in many ways.
Fatigue
This is the main and most common symptom seen at this stage. You will feel extremely tired. This is not just the tiredness we feel after a day of work. Even if you are just lying in bed, the cancer itself is sucking the energy out of your body. Day by day, you may feel sleepy and weak.
Appetite
Cancer can make it difficult for your body to use food and water properly. This means that even if you eat, it won’t provide you with the energy and nutrition you used to. If you feel like eating or drinking, it means your body is still ready to accept those things. But sometimes, your body may tell you, “I don’t want food or water right now.”
This can be difficult for your loved ones to understand. In our culture, food is a major way of showing love and care. So it's normal for your family to feel sad and upset when you don't eat. When everyone understands that this is normal at this stage, it will be a great relief for you and them.
Confusion and Delirium
You may feel disoriented and confused at times. This can happen when the brain doesn't get enough blood, oxygen , and nutrients. It can also be a side effect of some medications or an imbalance that occurs when you stop taking a medication. While some confusion is normal, your medical team may be able to manage this condition by giving you fluids or changing your medication dosage .
Pain
Pain can occur when cancer cells destroy tissue, press on bones, nerves, or organs. Some cancer cells release chemicals that cause pain. But remember, pain can be controlled. Pain management is an important part of palliative care and hospice care. It is important to tell your loved ones and your medical team what you are feeling and what the pain is like. There are ways to relieve that pain .
Difficulty swallowing
You may have difficulty swallowing because your body is weak. It can also happen because the message from your brain telling you to “swallow” is not getting through to your esophagus properly. If you are unable to swallow painkillers , they can be given under the tongue, by injection, or through a skin patch.
How are you feeling mentally and emotionally?
This is an emotional time for you and your loved ones. Sometimes you may feel a great sense of peace and readiness to move on. Other times you may feel sad, angry, afraid, or lonely. You may feel sorry for the loved ones you are leaving behind, or you may have good or bad feelings about your own life.
Whatever you feel is okay. Whatever you feel at that moment is exactly what you need to feel.
During this stage, you may feel like you're losing a lot of things. It's normal to feel sad about your body's function, your independence, your hope for recovery, the way you thought your life would be.
What is hospice care and how can it help?
Hospice is a philosophy on the one hand, and a system of care on the other. Its philosophy is to provide you with the best possible quality of life during the final stages of life. As a system of care, hospice is a team of doctors, nurses, social workers, home health aides, and spiritual counselors. They support all of your physical, spiritual, and emotional needs.
| Services provided by hospice care | |
|---|---|
| Service | Description |
| Medication and pain management | Providing necessary medications for your symptoms and pain. |
| Medical equipment and supplies | Providing necessary equipment such as special beds and oxygen to the home. |
| Occupational therapies | Physical therapy, occupational therapy and speech therapy services. |
| Nutritional counseling | Advice on eating patterns that suit you. |
| Final stage decision making | Helping make decisions about things like feeding tubes and cardiopulmonary resuscitation (CPR). |
| Support for the family | Providing emotional support to the family throughout this process and even after your death. |
Most of the time (over 80%) hospice care is provided at home. Hospice care can also be provided in a hospital or specialized facility. Generally, hospice care is available if a doctor can reasonably predict that a person will have 6 months or less to live if the disease progresses naturally.
Advance Directives
These are legal documents. If you are in a situation where you are unable to make decisions, you can write down in advance what medical care you should or should not receive, and who will make those decisions. It is very important to discuss this with your doctor and make a decision.
The last few days of life
Although everyone is different, there are some common physical signs that the body is preparing for death.
- Loss of urinary or bowel control.
- Changes in breathing patterns (rapid, deep breaths and short periods of not breathing).
- Snoring-like sounds caused by the accumulation of saliva and other fluids in the throat and respiratory tract.
- Skin turning blue and/or feeling cold to the touch.
Even at this time, there are ways to make you as comfortable as possible. The care team can use disposable pads to keep clothes and bedding clean. Adjusting pillows, using a humidifier, or giving oxygen can help relieve breathing difficulties. As blood circulation slows, blankets can keep you warm.
Be kind to yourself. No one knows how they will feel until they have gone through this experience. It is different for each person. As long as you can talk, you always have the right to ask for what you need to feel comfortable, and to make sure that there is someone to speak for you if you cannot.
Take-Home Message
- In the final stages of cancer, the focus of care shifts from curing the disease to providing you with the best possible comfort and quality of life.
- Physical changes such as extreme fatigue and loss of appetite are common during this time. Talk to your doctor about these.
- It is normal to feel any emotion, whether it is sadness, anger, fear, or peace. There is no such thing as a “wrong” feeling.
- Don't put up with the pain. It can be controlled. Be sure to tell your medical team about the pain you are feeling.
- Hospice care is a specialized service that supports you and your family physically, mentally, and emotionally.
- Never be afraid to ask for what you need to feel comfortable. It is your right to express your needs.
Cancer, End-of-Life Care, Hospice Care, Pain Management, Palliative Care, Palliative Care
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