It’s hard to ask the question, “What can I expect in the final stages of lung cancer?” I agonized before asking this question of my father’s oncologist. Yet many of us want some idea of what to expect at this stage of the journey for our loved one or for ourselves.
We are all different. Some people will have pain, some won’t. Some people will need oxygen to control shortness of breath; others may breathe comfortably on room air. Some people decline rapidly at the end of their journey with cancer, and others seem to live on despite all odds.
Just as physical symptoms in the final stages of lung cancer vary for different people, our loved one’s emotional response is hard to predict. Some people hold on, wanting to “fight” their cancer to the end. Others appear to accept death more readily. But despite our differences, there are common changes that occur for many people.
Physical ChangesPhysical changes during the final stages of lung cancer can be related to the tumor in the lungs or the spread of the cancer to other parts of the body, or due to the terminal stages of cancer in general. By definition, the final stage of lung cancer implies that treatment options have been exhausted; a cure is not possible. But palliative treatments, treatments used to minimize symptoms or improve comfort, may still be used. Some common physical changes include:
- Fluid build-up around the lungs
Fluid containing cancer cells (malignant pleural effusion) may build up in the space surrounding the lungs, resulting in shortness of breath. To improve breathing and make someone more comfortable, physicians often drain this fluid. If the fluid continues to build up, a procedure called pleurodesis may be recommended to prevent fluid from accumulating again.
- Obstruction or bleeding from the large airways
With lung cancers that grow near the airways, spread of tumor into the airway can cause obstruction and bleeding. Doctors may recommend a procedure or radiation to decrease the obstruction or control bleeding.
- Bone pain
Lung cancer frequently spreads to bones in the chest and spine. Pain medications can be used to control pain, but sometimes radiation therapy is also used to decrease pain or help prevent fractures.
- Symptoms due to brain metastases
When lung cancer spreads to the brain, people may experience headaches, seizures, and other neurological symptoms like weakness or speech problems. Radiation therapy may be recommended to slow the growth of these tumors and ease symptoms.
- Symptoms of terminal cancer
Profound fatigue is very common in the late stages of lung cancer. Weight loss is also almost universal, and it occurs even when people are eating a diet with adequate calories.
Emotional ChangesBeginning in the last few months before death, your loved one may begin to withdraw and appear less interested in visiting with family and friends. Activities that once excited him may no longer capture his interest. He may appear lost in thought, and as one woman I met remarked about her husband in the late stages of lung cancer, appear to “have one foot in the next world.” He may begin to sleep a lot and become irritable when fatigue and limitations interfere with his ability to care for himself as he did in the past. Having a support system and taking care of yourself is very important at this stage of the journey, both for your own well-being and so you can support your loved one with cancer as well as possible.
The Final DaysDuring the final days, your loved one may begin a phase known as “active dying.” Rather than an event in which the body simply turns off, researchers now believe that dying is an active process the body is designed to go through. Physical signs you may notice in these last days include:
- The skin becomes cool as body temperature lowers; mottling (bluish, blotchy patches) occurs.
- Eating and drinking stops, but there is no sense of hunger or thirst.
- Breathing becomes irregular. Rapid, deep breaths may alternate with periods of very shallow breathing (Cheyne-stokes respirations). A gurgling sound (the death rattle) may occur due to build up of secretions in the back of the throat.
- Perspiration increases, and the skin can feel wet and clammy.
Emotionally, your loved one may become agitated, picking at the sheets or clothing. Confusion and hallucinations are common, and those who are actively dying often speak of seeing loved ones who have gone before. In the last few days, she may have a surge of energy, sitting up if she has been bedridden, or eating a full meal after eating little for days. This can be heart wrenching if family members misinterpret this as a sign that their loved one is getting better. Most likely, it is the body’s way of allowing a dying person a last chance to say goodbye. As dying progresses, she will stop communicating and enter a deep sleep. Even if she does not appear to hear you or know you are present, continue to express your love. It is felt that hearing is one of the final senses to leave in the dying process.
The DeathAs dying continues, your loved one will stop breathing and her heart will cease to beat. Some people claim they have known the moment their loved one left them; they have had a vision, or a physical sensation of their loved one departing. Others find comfort in staying near their loved one’s body as it becomes cooler, finding it easier to let go thereafter. If your loved one is dying at home, check with your hospice nurse or physician ahead of time to know what procedure you should follow after the death. In most cases, family is allowed to spend time mourning and saying goodbye to their loved one before the funeral home is called.
- Coping With Lung Cancer - Caring for Yourself, Family Support, and End of Life Issues
- Where Does Lung Cancer Spread?
- Coping With Anticipatory Grief
American Cancer Society. When Death Is Near. 05/06/09. http://www.cancer.org/docroot/MLT/content/MLT_5_1x_When_Death_Is_Approaching.asp?sitearea=MLT
National Cancer Institute. End-of-Life Care: Questions and Answers. 10/30/02. http://www.cancer.gov/cancertopics/factsheet/Support/end-of-life-care