What To Expect When A Person With Cancer Is Nearing Death
This information has been written for the caregiver, but many patients want this same information for themselves. It gives some signs that death may be close and gives the caregivers some ideas about ways they may be able to help.
The signs of death being near can be different for each person. No one can really predict what may happen at the end of life, how long the final stage of life will last, or when death will actually happen. Sometimes death comes quickly due to an unexpected event or problem. Other times the dying process moves slowly and the patient seems to linger.
If possible, its important to have a plan for what to do just following a death, so that the caregivers and other people who are with the patient know what to do during this very emotional time. If the patient is in hospice, the hospice nurse and social worker will help you. If the patient is not in hospice, talk with the doctor so that you will know exactly what to do at the time of death.
Just like the timing of the dying process cannot be predicted, it’s also hard to predict what exactly will happen in the final stage of life and especially near death. The following symptoms are examples of what may happen in some people with cancer who are dying. While not all may happen, it may help you to know about them.
But Don’t Abandon Chemotherapy Quite Yet
While we have discovered that chemotherapy does not always deliver desired outcomes, it should be pointed out that most chemotherapeutic drugs are not customized or matched to patient-specific cancer/tumor or biopsy. Instead, pharmaceutical drugs are developed to fit a model that promotes certain drug regimens for certain cancer types. Sadly, these Chemo-regimens are constructed through pharmaceutical sponsorship in partnership with prestigious cancer doctors and hospitals working together to politically position protocols as standards of care. The end result means such protocols are moved through the FDA with quantities of sales pre-approved and guaranteed by Medicare.
As a result, chemotherapy drugs are often miss-matched to the patient’s actual tumor. Amazingly, we have found this to be true for more than 75 percent of our patients, determined through molecular and genetic testing. For example, if someone has colon cancer, it is entirely possible that their specific biopsy or tumor would respond best to a chemotherapy drug typically used for breast cancer. These observations become increasingly important for those with advanced and stage 4 cancers.
Prostate Cancer Survival Rates Are Favorable Overall
Thinking about survival rates for prostate cancer takes a little mental stretching. Keep in mind that most men are around 70 when diagnosed with prostate cancer. Over, say, five years, many of these men will die from other medical problems unrelated to prostate cancer.
To determine the prostate cancer survival rate, these men are subtracted out of the calculations. Counting only the men who are left provides whats called the relative survival rate for prostate cancer.
Taking that into consideration, the relative survival rates for most kinds of prostate cancer are actually pretty good. Remember, were not counting men with prostate cancer who die of other causes:
- 92% of all prostate cancers are found when they are in the early stage, called local or regional. Almost 100% of men who have local or regional prostate cancer will survive more than five years after diagnosis.
- Fewer men have more advanced prostate cancer at the time of diagnosis. Once prostate cancer has spread beyond the prostate, survival rates fall. For men with distant spread of prostate cancer, about one-third will survive for five years after diagnosis.
Many men with prostate cancer actually will live much longer than five years after diagnosis. What about longer-term survival rates? According to the American Society of Clinical Oncology, for men with local or regional prostate cancer:
- the relative 10-year survival rate is 98%
- the relative 15-year survival rate is 95%
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Gleason Score Vs Grade Groups
The International Society of Urological Pathology released a revised prostate cancer grading system in 2014. The grade group system seeks to simplify Gleason scores and give a more accurate diagnosis.
One of the major problems with the Gleason score is that some scores can be made up in different ways. For example, a score of 7 can mean:
- 3 + 4. The 3 pattern is the most common in the biopsy and 4 is the second most common. This pattern is considered favorable intermediate risk.
- 4 + 3. The 4 pattern is the most common in the biopsy and 3 is the second most common. This pattern is considered unfavorable and may mean local or metastatic spread.
So, although both situations give a Gleason score of 7, they actually have very different prognoses.
Heres an overview of how the two grading systems compare:
|grade group 5||910|
Not all hospitals have switched to the grade group system. Many hospitals give both grade group and Gleason scores to avoid confusion until grade groups become more widely used.
When Is The Right Time To Use Hospice Care
Many people believe that hospice care is only appropriate in the last days or weeks of life. Yet Medicare states that it can be used as much as 6 months before death is anticipated. And those who have lost loved ones say that they wish they had called in hospice care sooner.
Research has shown that patients and families who use hospice services report a higher quality of life than those who dont. Hospice care offers many helpful services, including medical care, counseling, and respite care. People usually qualify for hospice when their doctor signs a statement saying that patients with their type and stage of disease, on average, arent likely to survive beyond 6 months. More information about hospice can be found below in the Related Resources section of this fact sheet.
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Other Ways To Help Cancer Pain
With certain types of pain, doctors can do special procedures such as nerve blocks, targeted radiation treatments, or even surgical procedures to control pain. Sometimes physical therapy may help. If your pain isnt well controlled, your doctor might also refer you to an expert in pain management. The pain specialist might have some different options to help you.
Medicines and medical procedures are not the only ways to help lessen your pain. There are other things you can do. Some people find distractions like music, movies, conversation, or games help. Using heat, cold, or massage on a painful area can help. Relaxation exercises and meditation can help lessen the pain and lower anxiety for some people. Keep in mind that for most people with cancer pain these measures alone are not enough to control pain. But, they may help improve comfort when used along with pain medicines.
You can learn more in Cancer Pain.
When Prostate Cancer Spreads Where It Goes Matters A Lot
And if the cancer progresses or spreads beyond his prostate? We can treat it then, Callaghan said.
The study shows that you have no business treating low-grade prostate cancer in someone with a life expectancy of less than 15 years because the side effects outweigh any benefits, said urological surgeon Dr. Peter Albertsen of the University of Connecticut Health. The Oxford scientists reported that 46 percent of men who had their prostate removed were using adult diapers six months later . Similarly, only 12 percent of men who got surgery and 22 percent who had radiation could sustain an erection, compared to 52 percent of the monitoring group.
An estimated 180,890 men in the US will be diagnosed with prostate cancer this year, according to the American Cancer Society. Some 26,120 will die of it in 2016, almost always because it has spread to a vital organ.
In an editorial accompanying the study, radiation oncologist Dr. Anthony DAmico of Brigham and Womens Hospital focused on the finding that men who opted for monitoring were more than twice as likely to develop metastatic prostate cancer. That is, malignant cells reached the bones, lung, liver, or brain.
Garnick agreed: The intermediate-risk men we would never assign to active monitoring. If the increased metastases came from these patients, it would explain those differences and even more strongly encourage the role of active management in truly low-risk prostate cancer.
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Signs Of Approaching Death
Death from cancer usually occurs after a person has become weaker and more tired over several weeks or months. It is not always possible to predict how long someone will live. But some common signs and symptoms show that a person is entering the final weeks and days of life. Knowing what to expect helps relieve anxiety and allows better planning.
The following are signs and symptoms that suggest a person with cancer may be entering the final weeks of life:
Worsening weakness and exhaustion.
A need to sleep much of the time, often spending most of the day in bed or resting.
Weight loss and muscle thinning or loss.
Minimal or no appetite and difficulty eating or swallowing fluids.
Little interest in doing things that were previously important.
Loss of interest in the outside world, news, politics, entertainment, and local events.
Wanting to have only a few people nearby and limiting time spent with visitors.
As the last days of life approach, you may see the following signs and symptoms:
Of course, every person is different. The signs and symptoms that people experience vary. And the order in which signs and symptoms occur may differ.
What Are Some Ways To Provide Emotional Support To A Person Who Is Living With And Dying Of Cancer
Everyone has different needs, but some worries are common to most dying patients. Two of these concerns are fear of abandonment and fear of being a burden. People who are dying also have concerns about loss of dignity and loss of control. Some ways caregivers can provide comfort to a person with these worries are listed below:
- Keep the person company. Talk, watch movies, read, or just be with them.
- Allow the person to express fears and concerns about dying, such as leaving family and friends behind. Be prepared to listen.
- Be willing to reminisce about the person’s life.
- Avoid withholding difficult information. Most patients prefer to be included in discussions about issues that concern them.
- Reassure the patient that you will honor advance directives, such as living wills.
- Ask if there is anything you can do.
- Respect the person’s need for privacy.
- Support the persons spirituality. Let them talk about what has meaning for them, pray with them if theyd like, and arrange visits by spiritual leaders and church members, if appropriate. Keep objects that are meaningful to the person close at hand.
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How Is Pancreatic Cancer Diagnosed
Pancreatic cancer is diagnosed with a patient history and physical exam, along with tests such as:
- Multiphase CT scan or a pancreatic protocol CT scan
- CT-guided needle biopsy
Stage 4 Cancer Symptoms
The symptoms of metastatic cancer depend on the type of cancer. In some cases, there are no symptoms at all, so it’s possible to have stage 4 cancer and not know it.
Most of the time, a cancer that reaches stage 4 affects not only the part of the body where it originated, but the areas where it has spread to as well.
|Common Symptoms of Metastatic Cancer|
|When cancer spreads to:|
Stage 4 cancer also can cause more general symptoms, such as extreme fatigue and lack of energy. Some people become so tired and weak they have trouble doing everyday things. They may even need help with getting dressed or other routine tasks.
Hearing your doctor call a liver tumor “breast cancer” may sound strange. But stage 4 cancer is diagnosed based on where the original cancer is located, not where it has spread. So, breast cancer that has spread to the liver will be called stage 4 breast cancer with liver metastasisnot stage 4 liver cancer.
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What Are The Signs That Death Is Approaching And What Can The Caregiver Do To Make The Person Comfortable During This Time
Certain signs and symptoms can help a caregiver anticipate when death is near. They are described below, along with suggestions for managing them. However, each persons experience at the end of life is different. What may happen to one person may not happen for another. Also, the presence of one or more of these symptoms doesnt necessarily mean that the patient is close to death. A member of the health care team can give family members and caregivers more information about what to expect.
Withdrawal from friends and family:
- People often focus inward during the last weeks of life. This doesnt necessarily mean that patients are angry or depressed or that they dont love their caregivers. It could be caused by decreased oxygen to the brain, decreased blood flow, or mental preparation for dying.
- They may lose interest in things they used to enjoy, such as favorite TV shows, friends, or pets.
- Caregivers can let the patient know they are there for support. The person may be aware and able to hear, even if they are unable to respond. Experts advise that giving them permission to let go may be helpful. If they do feel like talking, they may want to reminisce about joys and sorrows, or tie up loose ends.
The dying process:
What Are Some Topics Patients And Family Members Can Talk About
For many people, its hard to know what to say to someone at the end of life. Its normal to want to be upbeat and positive, rather than talk about death. And yet, its important to be realistic about how sick the person may be. Caregivers can encourage their loved one without giving false hope. Although it can be a time for grieving and accepting loss, the end of life can also be a time for looking for meaning and rethinking whats important.
During this period, many people tend to look back and reflect on life, legacies created, and loved ones who will be left behind. Some questions to explore with a patient at the end of life are the following:
- What are the happiest and saddest times we have shared together?
- What are the defining or most important moments of our life together?
- What are we most proud of?
- What have we taught each other?
Patients with serious, life-threatening illness have stated that being positive or adding humor remains an important outlet for them. Even at this challenging moment, laughter may still be the best medicine.
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Survival Rates By Tnm Stage
The first approach is based on the TNM stage. Statistical survival times are matched to the stage of the disease.
|TNM Lung Cancer Stage|
By contrast, the one-year survival rate for stage 4 lung cancer was reported in one study to be between 15% and 19%. This means this portion of patients with metastatic disease lived for at least a year.
Survival Of Prostate Cancer
Survival depends on many factors. No one can tell you exactly how long you will live.
Below are general statistics based on large groups of people. Remember, they cant tell you what will happen in your individual case.
Survival for prostate cancer is generally good, particularly if you are diagnosed early.
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What You Can Do
Its important that you learn all you can about advanced prostate cancer so you can make informed decisions. Be open with your doctors and others on your healthcare team. Express your concerns and feel free to advocate for yourself and your quality of life. Get another medical opinion if you feel its necessary.
Some complementary therapies may prove helpful in coping with advanced cancer. For example:
- tai chi, yoga, or other movement therapy
- meditation, breathing exercises, or other relaxation techniques
A variety of services can help you with everything from lodging while youre getting treatment to getting some help around the house. Communicating with online or in-person groups are a good way to share information and lend mutual support.
How To Make The Right Treatment Decision
Current expert guidelines for treatment of localized prostate carcinoma recommend potentially curative therapy for patients whose life expectancy is at least 10 years.12,14 Patients with limited life expectancy are more likely to die from health conditions other than prostate cancer. Men with a life expectancy of more than 10 years are more likely to die from progressive prostate cancer.14 This 10-year rule enjoys broad acceptance among urologists and radiation oncologists.15,16
Conservative management proved to be an acceptable treatment option for men with low-grade Gleason scores, clinically localized disease, and life expectancies of less than 10 years. Increasing age was described as a risk factor for receiving inadequate treatment for prostate cancer.17 Thus, older men have been shown to receive potentially curative therapy less often than younger men.18,19 Radical prostatectomy is preferred treatment in men younger than 70 years, whereas radiation therapy is applied predominantly in patients older than 70 years. Conservative therapy such as watchful waiting or androgen deprivation by luteinizing hormone-releasing hormone analogs is preferentially applied in men older than 80 years. Watchful waiting or hormonal therapy is used to treat 82% of men older than 80 years.
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