Brenda Spriggs, MD, MPH, MBA
Terminal liver cancer occurs when the cancer has spread outside of the liver to other vital organs in the body. It can be hard for the friends, family and caretakers to deal with the death of someone who is in the final stages of liver cancer. There is generally a lot of things going on leading up to the death, such as friends and family members visiting and a hospice care team coming and going throughout the day. Those caring for a terminally ill patient should know the signs to look for as the patient begins to transition from life to death.
When a patient is approaching death because of terminal liver cancer, his body temperature likely will spike. This is the body's natural way of shutting down. In some cases, the fever can climb higher than 104 degrees F. The patient will feel warm to the touch. He may sweat or appear uncomfortable. This is a normal function, and no acetaminophen or ibuprofen should be given. The hospice nurse may decide to administer a strong narcotic, such as oxycodone, to relax the patient and help him feel more comfortable.
Another sign of dying from liver cancer is a change in the patient's breathing. A faint rattle or gurgling sound may be heard as the patient tries to breathe in and out. This is because of the weakening of the muscles in the chest, which keeps them from moving phlegm and mucous through the lungs properly. The patient is not choking. The hospice nurse will likely administer medication to help the patient relax and make breathing easier. The patient may also be on oxygen at this time to make her more comfortable.
Terminal restlessness occurs in the final stages of life. The patient may be completely aware of his surroundings and feel uncomfortable in bed. He may thrash or complain or appear in distress or pain. Morphine or a Duragesic pain patch may help with restlessness. Some patients may also feel the need to moan or yell. Providing physical comfort to the patient by hand holding or companionship may help him remain calm.
In the final stages of liver cancer, the patient may experience changes in her vision. The muscles in the eyes may not work as well as they used to, so she may have trouble recognizing visitors and family members. Some patients may also talk about seeing loved ones who have already passed away. These are common signs of approaching and impending death.
All caregivers should be educated in how to read vital signs to know when their loved one has passed away. The patient's breathing may go from rapid, short gasps to minimal respirations, in which he takes only two to four breaths a minute until the chest stops rising and falling. The patient's jaw may relax, and his mouth may be open slightly. His eyes may remain open, but his pupils will be fixed and dilated. The patient may also lose control of his bowels and urine at the time of death. If the patient has signed a "do not resuscitate" order, 911 or an ambulance does not have to be called. The hospice nurse should be contacted immediately she can pronounce the patient's time and date of death.