Cancer is the second-leading cause of death in the United States, reports the Centers for Disease Control and Prevention. For most people dying of cancer, the end of life will approach gradually over a period of weeks to months. While each person's death is different, just as their lives have been, there are common symptoms at the end of life. Knowing what to expect may help you prepare.
Markedly Increased Sleep
As people with cancer approach the end of life, the time spent sleeping progressively increases. In her book, "Gone from My Sight: The Dying Experience," hospice nurse Barbara Karnes points out that in the last week or two before death, people frequently spend much of the day and night asleep. Wakefulness becomes increasingly infrequent. In the last hours to days of life, sleep gives way to coma and the person dying can no longer be awakened.
Absence of Appetite
Often for weeks leading up to the end of life, the appetite is nearly absent. A few bites of food here and there are frequently all that is desired. In "Preparing to Say Goodbye," an end-of-life booklet written and published by the University of Hawaii Center on Aging, it is noted that psychologically, this symptom can be a difficult one for family and friends to accept, as it is a tangible manifestation of a loved one slipping away.
Disorientation and Hallucinations
In her book, "The Eleventh Hour," hospice educator Barbara Karnes advises that people with cancer who are approaching the end of life often experience disorientation and hallucinations. Disorientation is the loss of connection with current circumstances including time, place and persons. For example, a dying person may ask when a favorite relative is coming to visit--a relative that died long ago. Loved ones and caregivers often describe these periods of disorientation as their loved one "leaving" for a time and then returning to the present. Hallucinations usually take the form of seeing or hearing people who are not physically present. If frightening or anxiety-provoking hallucinations occur, medications can usually suppress these experiences.
Body Temperature Fluctuations
In the days leading up to death, the body temperature often fluctuates. In "The Eleventh Hour," Karnes notes that fever may be present at times, while the skin may feel cold at others.
Bluish Skin Appearance
The heart beats weakly as the end of life approaches causing the circulation in the extremities to shut down. The skin of the hands, legs and feet typically has a purple or bluish appearance. The extremities are cold to the touch, notes hospice educator Karnes.
Airway Congestion
As the body systems progressively shut down toward the end of life, fluid often accumulates in the lungs causing wet-sounding breathing. The National Cancer Institute notes that saliva also pools in the upper airways during the last hours of life when the dying person is no longer able to swallow or clear the throat. This accumulation of fluid causes a loud, raspy noise with each breath.
Shallow, Irregular Breathing
During the last hours of life, breathing becomes increasingly irregular and shallow. There may be periods wherein breathing stops for an extended time and then resumes. This breathing pattern typically heralds the end of life.
References
- Centers for Disease Control and Prevention: FastStats, Leading Causes of Death
- University of Hawaii School of Medicine, Center on Aging: Preparing to Say Goodbye
- National Cancer Institute: Last Days of Life, Symptom Management
- "Gone From My Sight: The Dying Experience"; Barbara Karnes, R.N.; 2001
- "The Eleventh Hour"; Barbara Karnes, R.N.; 2008
