Brenda Spriggs, MD, MPH, MBA
The world often seems suddenly strange and unfamiliar when a loved one is dying of cancer. In addition to a flood of emotions and practical concerns, uncertainty about what to expect in the final few days causes more anxiety. While everyone's experience is different, the body organs and systems shut down during the dying process, leading to predicable signs and behaviors that reflect the mind, body and spirit undergoing transition from life to death.
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Pain associated with terminal cancer may worsen or become harder to control near the end of life. It is distressing to see a loved one suffer, but pain can usually be effectively relieved with medication and simple measures like changing position, massage and music. Body language can be telling even when someone is no longer able to verbally communicate pain. Nonverbal indications of pain include restlessness, grimacing, moaning and guarding a specific area of the body.
Loss of Appetite
People nearing death usually have little interest in eating or drinking. While this is often upsetting to witness, there is typically no hunger involved. Eating or drinking during this final stage of life causes discomfort because the digestive system becomes inactive. The lack of intake leads to decreased urination and bowel movements. However, there is often loss of control over the bladder and/or bowels in the final hours of life.
Sleepiness and Unresponsiveness
Drowsiness, with more time spent sleeping than awake, is a sign that a person may be moving into the active phase of dying. The dying process is divided into preactive and active phases. While there is individual variability, the preactive phase usually lasts about 2 weeks and the active phase approximately 3 days. The inability to arouse someone from sleep or only with great effort, followed by a quick return to sleep, is considered part of the active phase of dying.
Appearance and Function
Progressive weakness and relaxation of the muscles throughout the body affect appearance and function. You may notice that your loved one's face looks droopy or less expressive and that he needs help to sit up or turn in bed. The inability to independently move is a significant sign of declining function as a person approaches her final days.
Mental, Emotional and Behavioral Changes
Toward the end of life, there are notable changes in consciousness beyond sleepiness. An inward focus is part of the preparation for death. You may notice your loved one is no longer concerned about former interests and converses less. Periods of disorientation, confusion and even agitation frequently emerge, and it may seem as if the dying person is in "another world." Hallucinations wherein the person sees or hears someone who has already died are not unusual and are generally comforting.
Breathing and Circulation
Erratic breathing mixed with periods when breathing temporarily stops is common in the final hours of life. Mucus that collects in the back of the throat often produces a rattling sound that can be alarming to family but is not bothersome to the dying person. The skin turns a dusky color, and arms and legs cool as oxygen levels fall from low blood pressure and a fluctuating heart rate. A number of individual factors, such as other medical problems a person may have, influence how long the body can maintain life under these conditions.
REFERENCES & RESOURCES
- Hospice Patients Alliance: Signs and Symptoms of Approaching Death
- Palliative Care Perspectives; James L. Hallenbeck, et al.
- International Association for Near-Death Studies: Nearing Death Awareness in the Terminally Ill
- Cancer: Bedside Clinical Signs Associated With Impending Death in Patients With Advanced Cancer: Preliminary Findings of a Prospective, Longitudinal Cohort Study
- Encyclopedia of Death and Dying, First Edition; Glennys Howarth and Oliver Leaman
- American Cancer Society: Physical Symptoms in the Last 2 to 3 Months of Life
- Hospice Foundation of America: Signs of Approaching Death
- National Cancer Institute: What Are the Signs That Death Is Approaching, and What Can the Caregiver Do to Make the Person Comfortable During This Time?
- National Institutes of Health: End of Life: Addressing Other Signs and Symptoms