The American Cancer Society projected approximately 562,340 cancer deaths in the United States for 2009. Cancer has long been a focus of end-of-life care and hospice. Although symptoms vary widely at the end of life, many signs and symptoms are common in the dying person. The Hospice Foundation of American calls this time at the end of life the dying process.
Decreased Intake
The Core Curriculum of Oncology Nursing states that terminally ill cancer patients typically lose appetite and food/fluid intake decreases. This natural dehydration process is considered normal in the dying person. At end of life food and fluid make patients more uncomfortable. Patients are encouraged to eat for pleasure when they feel like eating. Considerations that decrease the cancer patient's appetite include nausea, taste changes, inability to swallow and mouth sores. As a result of lowered fluid and food intake, decreased urine production is common.
Breathing Changes
Several breathing conditions present in the cancer patient at the end of life. Shortness of breath occurs often with cancers that have spread to the lung or put pressure on the diaphragm or lungs. As a patient nears the end of life they may have periods of apnea where they stop breathing for short periods of time. This breathing pattern is known as Cheyne Stokes respiration. Breathing may sound congested or wet. This is due to the inability to swallow saliva, but is not thought to cause discomfort. Shallow breathing also commonly occurs.
Circulation Changes
The Core Curriculum of Oncology Nursing reports that decreased circulation occurs at the end of life. Often patients show signs of mottling, purple blotchy patches usually on the legs. Nails and lips often turn bluish in color due to decreased circulation of oxygen in the blood. Hands and feet cool as the body's circulation slows.
Mental Status Changes
Several changes in mental status and consciousness are noted by the Hospice Foundation of America. At the end of life patients become more withdrawn, speaking less and sleeping more. They often exhibit a faraway look and have difficulty focusing on the things around them. The Hospice Foundation reports that patients occasionally experience hallucinations, such as seeing those who have died before them. Near the end of life most patients are in a nonresponsive, coma-like state.
Other Symptoms
Symptoms at the end of life vary greatly for cancer patients depending on the location of the tumor and the type of cancer. Many cancer patients have pain associated with their disease process. Other symptoms include but are not limited to jaundice, swelling, seizures, nausea, bleeding, temperature fluctuations and infection.
References
- American Cancer Society: Cancer Facts and Figures for 2009
- "Core Cirriculum for Oncology Nursing"; Itano, J. Ph.D, Taoka, K. MSN; 2005
- Hospice Foundation of America: The Dying Process
