End of Life Management - When a Loved One Has Cancer
Understanding cancer
Cancer is a disease in which some of the body's cells grow uncontrollably and spread to other parts of the body. Cancer can start almost anywhere in the human body, made up of trillions of cells. Typically, human cells grow and multiply (through cell division) to form new cells as the body needs them. When cells grow old or become damaged, they die, and new cells take their place. However, sometimes this orderly process breaks down, and abnormal or damaged cells grow and multiply when they shouldn't. These cells may form tumors, which are lumps of tissue. Cancerous tumors spread into or invade nearby tissues and can travel to distant places in the body to create new tumors (a process called metastasis). Cancerous tumors may also be called malignant tumors. Many cancers form solid tumors, but cancers of the blood, such as leukemias, generally do not.
Some expected symptoms
Symptoms of cancer in the final stages can include pain, nausea, constipation or diarrhea, anxiety, confusion, restlessness, and depression.
Cancer-specific final stages
Digestive System - food or waste may be blocked, causing bloating, nausea, constipation, or vomiting. The patient may also not be able to absorb nutrients leading to malnourishment. Lungs- if too little healthy tissue is left or parts of the lungs are blocked, the person may feel short of breath.
Bones - too much calcium may go into the bloodstream leading to unconsciousness. Bones are prone to fracture and not heal.
Liver - the liver removes toxins from blood, digests foods, and converts food into usable substances. If the liver is unhealthy, the body's chemical balance may be disrupted. This can lead to a change in mentation, even a coma.
Bone Marrow - the body may not be able to make enough healthy blood cells which leads to anemia. This may cause a decrease in oxygen in the blood. Disruption to white blood cell production makes it difficult to fight infection. Blood clots or excessive bleeding may occur.
Brain - may lead to memory problems, balance issues, bleeding to the brain, or loss of body function.
Sleep changes
May have drowsiness with increased sleep, confusion when they first wake up, or continual fatigue
Worries or concerns may keep a person up at night
Continue to talk openly about loved ones while they sleep
Your hospice nurse may suggest Trazadone or melatonin
Pain control
Provide pain medication regularly. Seek advice from a hospice nurse
Offer other methods for pain relief, such as massage and relaxation
Pain medication regimen may need to be adjusted frequently
Look for signs of pain like a grimace to the face, ridged body posture, moaning, restlessness, etc.
There are many options of narcotic and non-narcotic medications to try. The nurse may also suggest introducing small doses of morphine
Appetite changes
As the body naturally shuts down, the need or want for food often decreases. This may be caused by the body's need to conserve energy and decreased ability to digest
Let your loved one choose if, when, and what they would like to eat or drink
Because chewing may become complex, soft or blended foods may be appetizing
If the ability to swallow is compromised, offer moisture for the lips and mouth
Awareness
May be episodes of confusion or hallucinations near the end of life. Gently remind your loved one of their surroundings and who is with them
If agitation should occur, don't attempt to restrain the person. Reach out to the hospice nurse for guidance
In these instances, hospice nurses may suggest an anti-anxiety, such as Ativan. Haldol is often used for end-of-life hallucinations, agitation, or anxiety
Some people report seeing loved ones who have died. They may talk about things they are seeing that are not real. As long as these visions are not disturbing the person, it is okay to encourage the person to share these experiences
Withdrawal from family and friends
Focus turns inward. This doesn't always mean the person is depressed or angry. It may be caused by a lack of oxygen to the brain or mental preparation for dying
They may lose interest in things they previously enjoyed
Caregivers should offer continued support and love
Emotional Support
"How can I best support my loved one?"
Keep your loved one company- talk, watch movies, read, or JUST BE WITH them
Allow the person to express their fears and concerns- dying, leaving family, etc.
Reminisce about life
Avoid being secretive- talk openly about disease and symptoms with loved one
Include the person in decision making
Reassure your loved one that the advanced directives will be honored and clarify any concerns
Respect person's privacy and/or silence
Self-care
It is essential to take care of yourself
Get out, walk, breathe fresh air, cry, eat, and try to relax
Consult often with your hospice nurse
Explore options for respite, in-home care, home health aides, etc.
Accept the hospice support you need
You, or the patient, have selected Stillwater Hospice to support you during this journey to provide comfort and dignity to your loved one as they experience the end-of-life process. The treatment will generally focus on managing pain, education on nutrition, safety and fall prevention, skin health, and medication intervention for emotional components such as anxiety, agitation, sleep, or mood health. The Stillwater team of nursing, aides, social workers, and chaplain will work with the patient and family to help develop a plan of care and provide support so the "journey" will not be traveled alone. It is recommended that family also reach out to the American Cancer Society for any other information that may be helpful to you.
