According to the International Association for the Study of Pain, or IASP, approximately 6.6 million people worldwide die each year from cancer. Symptoms vary widely depending on the type of cancer, extent of spread and location of the cancer. Although symptoms of individual cancers vary, certain symptoms are shared among cancer patients at the end of life.
Pain
Up to 75 percent of patients with advanced cancer experience pain at some point during their disease, according to the IASP. Cancers most likely to cause pain include head, neck, prostate, uterine, breast, pancreatic and genitourinary cancers. Although pain remains prevalent in late cancer disease, healthcare professionals successfully treat pain at the end of life. The body's process of shutting down at the end of life is not believed to be painful.
Breathing Changes
As the cancer patient reaches the final stages of life, breathing patterns change. Some breathe more rapidly or slowly. The Hospice Foundation of America reports that congested breathing commonly occurs at the end of life. This is known as the "death rattle," caused by the pooling of saliva in the back of the throat. It does not make the patient uncomfortable. Breathing also typically becomes shallower, and eventually short pauses in breathing occur.
Circulation Changes
The body no longer functions at normal speed, and circulation of blood begins to slow. As a result, the National Cancer Institute reports that skin of the hands, feet and other body parts begin to feel cool. Discoloration of the skin also commonly occurs. Pink skin and nail beds turn gray, bluish or purple. Often a blotchy pattern, similar to bruising, occurs over the legs and/or arms. This condition, known as mottling, commonly occurs when the end of life draws near.
Changes in Mental Status
Several mental changes happen at the end of life with cancer. The "Core Curriculum of Oncology Nursing" lists these as withdrawal from social interaction, seeing persons who have died, and talking about going on a trip or going back home. Patients often experience some confusion or restlessness at the end of life. Eventually most will become increasingly sleepy and fall into a coma-like state from which they may not wake.
Other End-of-Life Indications
At the end of life, cancer patients often lose their appetite and stop drinking and eating. Although families find this disturbing, the body's slowed metabolism no longer needs the same nutrition to function. Forcing food and fluid at the end of life often precipitates more discomfort. Muscles also begin to relax in the final stages of life with cancer. This causes the inability to control bowel and bladder functions. Urination occurs less frequently, and urine becomes darker and more concentrated.
References
- "Core Curriculum for Oncology Nursing"; Joanne Itano PhD, Karen Taoka MSN; 2005
- Hospice Foundation of American: What to Expect Before Death
- National Cancer Institute: End-of-Life Care: Questions and Answers
- International Association for the Study of Pain: Epidemology of Cancer Pain
