Lung cancer is the most common cancer in the United States, and while often treatable, it frequently progresses and causes death. Knowing the signs of impending death in someone suffering from lung cancer can be helpful for family members, caretakers and health care professionals who encounter these patients. There are specific signs of approaching death due to lung cancer that affect mostly the lungs as opposed to organs to which cancer may have spread.
Progressing Toward Death
When treatment for lung cancer has failed to stop advancement of the disease, a few main symptoms are of most concern. Pain at the primary cancer site and in any place where it has spread is the first symptom that needs the attention of the treating health care providers and family members. Adequate pain management can usually be achieved with most kinds of cancer, and this becomes more important as death approaches. The second symptom of primary concern is shortness of breath, or "dyspnea." Dyspnea occurs as lung function further deteriorates due to the effects of cancer. Feelings of breathlessness and the coughing that happens with it can be helped with opioid pain medications and supplemental oxygen, and these are often provided in hospice care.
Dr. David Weissman and others have described a syndrome of "imminent death," in which a person is considered to be actively dying. In the early stages, increased time spent in bed sleeping, the development of delirium (a kind of acute confusion) and the inability or loss of interest in eating or drinking are common features. As the process continues, consciousness decreases and the dying person becomes increasingly hard to wake up or may appear to be in a stupor. During this time, it is still important to treat pain and anxiety in the dying person as he or she may have moments of wakefulness and be aware of imminent death.
The Late Phase and Clinical Death
The late phase of active dying can be thought of as those hours and minutes immediately before death occurs. Complete unconsciousness and irregular breathing are typical. People in this stage of dying may have periods of no breathing, or they may breathe quickly followed by periods of slow breathing. If they have developed pneumonia from being unable to clear the secretions from the airway, they may develop a fever. This could actually hasten their death and is not uncommon in patients with lung cancer. As respiratory function declines, skin color may start to change and the person may appear mottled or bluish in color. As the respiratory system fails further, the heart will start to fail as well, resulting in complete cardiac and respiratory arrest. Usually within just a few minutes of the cessation of breathing, all heart activity has stopped, and death will have occurred.
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- Old, J. L., & Swagerty, D. (Eds.). (2007). A Practical Guide to Palliative Care. Philadelphia, PA: Lippincott.
- Weissman, D. E. (2005). Syndrome of Imminent Death, 2nd ed. Medical College of Wisconsin.