Despite advances in cancer treatment, the disease remains life threatening if therapy fails to cure the illness. When treatment can no longer control disease progression, cancer eventually advances to its final stage. The symptoms that occur during the last stage of cancer vary depending on the site of the cancer and spread to other organs or tissues. As the final weeks to days approach, however, a rather predictable course typically occurs with certain telltale signs and symptoms. Hospice care helps make the end-of-life transition as comfortable as possible for people in the last stage of cancer and their loved ones.
Organ-Specific Signs and Symptoms
Organ-specific symptoms frequently occur when cancer progresses to the final stage. These symptoms might arise from the original site of the cancer or an organ to which the cancer has spread. Examples of organ-specific signs and symptoms include:
- Lungs -- shortness of breath, cough, wheezing
- Liver -- yellowing of the skin, itchiness, upper abdominal pain
- Brain -- headache, poor balance, drowsiness, personality and/or behavioral changes
- Bone -- bone pain, fractures associated with trivial or no trauma
In the final stage of cancer, activity gradually decreases. Initially, normal activities continue but with extra effort. Over time, daily activites become too overwhelming. The ability to walk and move about independently also typically decreases. As the end of life approaches, profound fatigue and lack of energy set in and activity is very limited. Caregivers take on increasing amounts of required personal care, such as bathing, dressing, brushing the teeth, and aiding with toileting. Time is primarily spent in bed sleeping. In the last few days of life, consciousness is often limited with little to no responsiveness.
People in the final stage of cancer invariably experience a diminishing appetite. The timing of this symptom might occur earlier with liver or digestive cancer than with other types of cancer. Loss of appetite typically leads to weight loss. Both of these symptoms tend to provoke distress in family members who view feeding their loved one as an expression of deep affection. Although this desire arises from a loving place, insisting on eating often taxes the person who is ill beyond their physical capacity because the digestive system gradually shuts down as cancer progresses. In the final weeks of life, many people subsist primarily on liquids. This gradually decreases to a few sips at a time, at most, during the last few days of life.
Mental and Interpersonal Changes
People in the last stage of cancer often experience mental changes. Brief periods of confusion can occur, especially upon waking from sleep. The ill person might become confused about time and place, such as thinking they are in their childhood home rather than their current residence. A loved one might not be recognized or could be confused with someone else, which sometimes represents a visual hallucination. So-called waking dreams also frequently take place wherein the person seems to be awake but is actually in a state between wakefulness and sleep. Some people approaching the end of life due to cancer experience anxiety, fear or agitation. Medication helps calm these symptoms.
Men and women in the last stage of cancer often prioritize their interactions with others due to limited energy and awareness that their remaining time is short. Many people in this situation prefer to limit their visitors to only their closest loved one. As the final days of life approach, many people increasing withdraw from even their most beloved family members and friends. This is not an act of rejection but rather a common and normal response as a dying person turns increasingly inward while detaching from life as they have known it. Withdrawal from others might also represent lack of oxygen delivery to the brain.
Impending death, also known as active dying, refers to the physical and biological changes that inevitably occur in the last 1 to 3 days of life. Signs and symptoms of impending death include:
- Difficulty swallowing liquids
- Decreased consciousness or coma
- Pale or bluish, cold arms and legs
- Movement of the lower jaw when the person inhales
- Irregular, noisy breathing
- Grunting sounds
- Brief periods during which breathing stops
- National Cancer Institute: Last Days of Life (PDQ®)–Health Professional Version
- Palliative Care Nursing - Caring for Suffering Patients; Kathleen Ouimet Perrin
- Approaching Death: Improving Care at the End of Life; Committee on Care at the End of Life, Institute of Medicine
- Queens University Faculty of Sciences: The Palliative Performance Scale