End-of-Life Care for Loved Ones with Cancer

What are things to watch for?

Everyone is different, so it can be hard to predict how long someone will live with cancer. Some factors involved are what type of cancer it is, where it’s located, and if there are other health problems.

Some common signs that someone is approaching the end of their life are:

• Fatigue. Feelings of weakness and tiredness are getting worse.

• Sleeping more. They spend most of the day in bed.

• Losing weight. They lose muscle mass and burn through food faster.

• Decreased appetite. As the body stops being able to use food correctly, they’ll need and want less food. It may also be hard for them to eat or swallow liquids.

• Being less able to talk or focus. They may have a shorter attention span and tire easily while talking.

• Loss of interest. They may not feel interested in the same things that brought them pleasure before.

What decisions can you help with?

You can help make some important decisions with your loved one. These include:

• Living arrangements. You may find an inpatient hospice center or a facility with assisted living. If your loved one chooses to live at home, a decision about who will be the primary caregiver will need to be made. You may also want to hire a home health aide or start hospice services. The hospice care team can visit your loved one, teach you how to care for them, and also be available by phone. Respite care services are also available to give you a break from caregiving, even for a few hours.

• Advance directives. These are legal documents that say what your loved one wants to happen in the future.

  • Living will. Your loved one can say how they’d like to be medically treated if they’re unable to make their own healthcare decisions.

  • Durable power of attorney for healthcare. This is also called a healthcare agent. Your loved one chooses someone they trust to carry out their wishes if they are unable to make decisions.

• Plans for remembrance. They may have requests for carrying out their memorial service and managing their physical remains.

What can you do to help when the end of life is near?

It can be scary and painful watching your loved one go through this final phase of life. Knowing what to expect and how you can give them comfort can help.

When they’re entering the last days of life, you might see:

• Breathing changes. Breathing can speed up or slow down. There may be long pauses between breaths. There could also be rattling sounds because of mucus in the throat. To provide relief:

  • Add humidity to the room with a cool mist humidifier.

  • Help them get into any position that makes breathing easier. This can be done using pillows or by raising the head of their bed.

  • Turn them to the side to help drain mucus from their mouth. And to clean their teeth and mouth with water and a soft toothbrush or foam swabs.

• Skin changes. Skin is colder in the arms and legs. It may turn blue or blotchy, especially in the hands and feet. To help:

  • Keep them warm with blankets or light bed coverings. Don’t use electric blankets.

  • Use gentle massage with lotion to improve blood circulation.

• Dehydration. The mouth and lips may be very dry. There may also be less urine, and the urine will be darker colored. To help:

  • Put a lip balm on the lips.

  • If they can swallow, give them ice chips or sips of liquid with a straw. Don’t force your loved one to drink fluids.

• Confusion. This could be about what time it is, where they are, and who people are. To give comfort:

  • Speak in a clear, calm, gentle voice. Remind them of the time, place, and people present.

  • Try to avoid sudden noises or movements so you don’t scare them.

• Loss of bladder and bowel control. This could be due to treatment, or loss of muscle function. To make them comfortable:

  • Have a healthcare provider insert a catheter to collect urine. Or put disposable waterproof pads under your loved one and change them often.

  • Give your loved one a sponge bath if they can tolerate it. Or wash certain areas.

  • Apply barrier creams to protect the skin from urine.

• Worsening pain. You may see them become restless. Or they may let you know their pain is getting worse. To give relief:

  • Help them take their pain medicine until the end of life.

  • Help them with breathing and meditation exercises to reduce pain. You may also use hot or cold packs, but don’t apply them directly to the skin.

  • Rub their hands and feet gently with lotion if it is relaxing for your loved one. There are special types of massage for people with cancer to reduce their pain.

• Weakness. If they can’t get out of bed and have trouble moving in bed, you can help by:

  • Turning and changing their position every 1 to 2 hours. Try to time any position changes to be 30 minutes after pain medicine is given.

When should you call for help?

There will be times when you need help from your loved one’s healthcare team. It’s OK if you don’t know how to handle a situation. You may also feel too sad or afraid to be with them and may need a break. You can also call for help if your loved one:

• Has fallen or has a seizure

• Has pain that isn’t helped by their prescribed medicine

• Has new symptoms or a flare-up of old symptoms that were under control in the past

• Has trouble breathing and looks upset

• Has a sudden change of consciousness

• Is unable to pee or poop

• Has trouble taking medicine from you

Remember to take care of your own health during this time. You’ll be better able to cope with your grief if you prepare yourself for the changes that they’ll go through. And if you do your best to comfort them during their final days.