Cancer progresses in stages, each with its own set of challenges. The last stages of cancer can be particularly difficult -- both physically and emotionally -- for you and your family. Knowing what to expect can reduce the anxiety of saying goodbye to your loved one.
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.
One thing to expect in the very last stages of cancer is a gradual reduction in food and water intake. 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. 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. Your loved one may eventually stop taking fluids. This is sometimes referred to as "terminal dehydration." Toothettes may be used to swab around the patient's mouth once the dehydration process begins. These toothettes will keep the mouth area clean and help to place the tongue inside of the mouth if needed.
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.
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 -- a process 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.