What to Expect When a Person With Cancer is Nearing Death

The end of life is different for everyone. No one can predict how long the final stage of life will last or when death will happen. Sometimes death comes quickly. Other times the dying process takes longer and the person may linger.

It's hard to know exactly what will happen in the final stage of life and especially near death. There are some common symptoms that most often happen in people with cancer who are dying. All might not happen, but it may help you to know about them.

Changes in body function

• Extreme weakness. May have trouble moving around in the bed and might not be able to get out of bed.
• May not be able to do much for themselves. They may need help bathing, brushing their teeth, and dressing. They may need to use a bedpan or bedside toilet, if they can get up.
• Less interest in food, often eating or drinking very little
• Trouble swallowing pills and medicines
• Lips may appear to droop
• Might not be able to focus on what’s going on around them
• Might not be able to help with their own care
• Sudden movement of any muscle, jerking of hands, arms, legs, or face

What caregivers can do

• Help the patient turn and change positions every 1 to 2 hours. It's best to time any position changes to about 30 minutes after pain medicine is given.
• Speak in a calm, quiet voice and avoid sudden noises or movements to reduce the chances of startling the patient.
• If the patient has trouble swallowing pills, ask about getting liquid pain medicines or a pain patch.
• If the patient is having trouble swallowing, do not give them solid foods. Try ice chips or sips of liquid.
• Do not force them to drink. Near the end of life, some dehydration is normal.
• Apply cool, moist washcloths to head, face, and body for comfort.

Possible changes in consciousness

• More sleeping during the day
• Hard to wake from sleep
• Confusion about what time it is, where they are or who the people around them are
• Restless, might pick or pull at bed linen
• May talk about things unrelated to the events or people present
• May be more anxious, restless, afraid, and lonely at night.
• After a period of sleepiness and confusion, may have a short time when they are mentally clear before going back to sleep

What caregivers can do

• Plan to be with them when they are most alert or during the night when your presence may be comforting.
• Remind them who you are and what day and time it is.
• Continue pain medicines up to your loved one’s death.
• If your loved one is very restless, try to find out if they are having pain. If it appears they are, give breakthrough pain medicines as prescribed, or check with the doctor or nurse if needed.
• If your loved one is confused, use calm, confident,gentle tones so you don’t startle or frighten them.
• Gentle touching, caressing, holding, and rocking are usually helpful and comforting.

Changes in appetite

In the last stage of life, many people lose their desire to eat or drink. This is not unusual. People also don’t need to eat and drink as much. Loss of appetite can be caused by changes in the body happening now. Try not to get upset when they don’t feel like eating or aren’t eating as much as they used to.  

What caregivers can do

• Avoid family food battles
• Let them eat what and when they feel like it
• Try to keep their favorite foods and drinks around, but know their tastes can change day to day.
• If the smell of food bothers them, offer foods that are cold or at room temperature.
• If they have nausea or pain, help them take medicines given to them as directed
• Try not to get upset when they don’t feel like eating or aren’t eating as much as they used to  
• Let them know that your efforts to get them to eat more are because you love them
• Ask how you can best support them and spend time together in ways that don’t involve eating

Possible changes in metabolism

• Mouth may dry out
• Might no longer need some of their medicines ( such as vitamins, replacement hormones, blood pressure medicines, and diuretics), unless they help make them more comfortable.

What caregivers can do

• Put lip balm, lubricant, or petroleum jelly (Vaseline®) on your loved one’s lips.
• Try giving ice chips from a spoon, or sips of water or juice from a straw.
• Check with the doctor to see which medicines may be stopped. Medicines for pain, nausea, fever, seizures, or anxiety should be continued to keep your loved one comfortable.

Possible changes in secretions

• Mucus may collect in the back of the throat. This may cause a rattling sound with breathing that’s very distressing to hear. But know that this isn’t usually uncomfortable for your loved one.
• Secretions may thicken and build up due to less fluid intake and because your loved one can’t cough

What caregivers can do

• If mouth secretions increase, keep them loose by adding humidity to the room with a cool mist humidifier.
• If your loved one can swallow, give them ice chips or sips of liquid through a straw. This may help thin secretions.
• Change your loved one’s position – turning them to the side may help secretions drain from the mouth. Continue to clean your loved one’s teeth and mouth with water and a soft toothbrush or foam mouth swabs.
• Certain medicines may help. Ask your doctor or nurse about them.

Possible changes in circulation and temperature

• Arms and legs may feel cool to the touch as circulation slows down
• Skin on arms, legs, hands, and feet may darken and look blue or mottled (blotchy)
• Other areas of the body may become either darker or paler
• Skin may feel cold and either dry or damp
• Heart rate may become fast, faint, or irregular
• Blood pressure may get lower and become hard to hear

What caregivers can do

• Keep your loved one warm with blankets or light bed coverings.
• Don’t use electric blankets, heating pads, etc.

Possible changes in senses and perception

• Vision may become blurry or dim
• Pupils may not change size
• May have trouble closing eyelids
• Hearing may decrease, but most people can hear you even after they can no longer speak.

What caregivers can do

• Leave indirect lights on as vision decreases.
• Always assume your loved one can hear you.
• Continue to speak with and touch your loved one to reassure them of your presence. Your words of affection and support are likely to be understood.

Possible changes in breathing

• Breathing may speed up then slow down
• Your loved one may grunt while breathing
• Neck muscles may look tight to help breathe
• Mucus in the back of the throat may cause rattling or gurgling with each breath
• Your loved one may have periods up to 30 seconds when they don’t breathe, then start breathing again

What caregivers can do

• Put them on their back, or slightly to one side.
• Raising your loved one's head may give some relief.
• Use pillows to prop your loved one’s head and chest up or raise the head of the bed.
• Any position that seems to make breathing easier is OK, including sitting up with good support. If your loved one is a small person, they may be more comfortable in your arms.

Possible changes in elimination

• Urine may become darker and decrease in amount
• Your loved one may lose control of their urine and stool

What caregivers can do

• Pad the bed beneath your loved one with layers of disposable waterproof pads.
• If your loved one has a catheter to collect urine, the nurse will teach you to care for it.
• Bathe your loved one as they can tolerate it - this could be a sponge bath or simply washing certain parts of the body.

Signs that your loved one has died

• Breathing stops
• Blood pressure cannot be heard
• Pulse stops
• Eyes stop moving and may stay open
• Pupils of the eyes stay large, even in bright light
• May lose control of their bowels or bladder

What to do when you think your loved one has died  

Try to have a plan for what to do just following your loved one’s death. This can help caregivers and other people who are with the loved one when they die. If your loved one is in hospice, the hospice nurse and social worker can help you. If your loved one is not in hospice, talk with the doctor so that you will know exactly what to do at the time of death. 

If your loved one dies at home and is not under hospice care, caregivers are responsible for calling the right people. Regulations or laws about who must be notified and how the body should be moved differ from one community to another. Your doctor or nurse can get this information for you.

If a hospice or home care agency is involved, call them first. If you’ve completed funeral arrangements, calling the funeral director and doctor are usually all that you have to do.

It’s all right if you want to sit with your loved one for a while. There’s no rush to get anything done right away. Many families find this is an important time to pray,  talk together, and share their love for each other and for the person who has passed away.