With cancer, most people associate death. While there are many cancers that can be treated if caught early, there are also some that cannot be treated or cured. The result is the diagnosis of a terminal cancer illness. This means that some medical but mostly palliative care is established to help patients cope and remain comfortable during their last weeks or months of life.
Hospice Care Team
One of the first things to expect with a terminal cancer diagnosis is the introduction of the hospice care team. This is a direct referral from the patient's primary care physician. The hospice care team consists of a registered nurse, home health aide, social worker, medical director and spiritual care adviser. Each person on the care team will assist in the care of the patient and determine what is best for her needs. They will visit the home or hospice inpatient facility as needed by the patient. They will administer medication, clean the patient, help her and her family with coping mechanisms and make her comfortable. Most importantly, they are there to answer important questions that the patient and the family may have.
Reduction of Solid Foods
One thing to expect in the very last stages of cancer is a reduction of solid foods and eventually no food at all. This is the body's natural way of shutting down. It needs to be understood that if food is forced on the patient, it will only prolong death and may cause more pain for the patient. The reason for this is that most major organs are beginning to shut down, and as they do, they are no longer able to easily function as before---this includes the digestive system, bowels, kidneys and intestines.
Elimination of Fluids
A very difficult thing for families and caregivers to do is to eliminate all fluid intake with the cancer patient. It may be something that the patient begins to do on her own---resisting fluids and foods. This is sometimes referred to as "terminal dehydration." Generally, the hospice care team will know when to stop giving the patient fluids. Toothettes may be used to swab around the patient's mouth once the dehydration process begins. The toothettes will keep the mouth area clean and help to place the tongue inside of the mouth if needed.
Bed-bound or Comatose
When most cancer patients are in their final stages of their disease, they will likely become completely bed-bound or even comatose. They can remain bed-bound for several days or weeks---this is where the benefits of the hospice care team come in. The team will help move, clean and change the patient's clothes, bed pads, catheter and diapers as needed. They can also administer medications and oxygen to help the patient remain comfortable while she is in bed. Durable medical equipment such as a hospital bed, an egg crate mattress and over-the-bed table may be brought in to assist with care. In the last few hours of life, the patient may become comatose or completely unresponsive; this is a normal stage of the dying process.
Physical Changes
Once the disease has overtaken the body and the organs are affected, physical changes may begin to appear and happen rapidly. One of the first noticeable signs may be the patient's skin changing to a bluish, grayish color on the toes, lips and fingertips---this is called "mottling." This is due to the restriction of oxygen throughout the body. The patient may also spike a very high fever of up to 104 degrees---this is also a normal sign of the body shutting down. The patient will likely begin irregular breathing patterns at this time---sometimes going several minutes between breaths. Eventually the breathing will stop completely, and the patient's heart will also stop, resulting in death.
