Approaching the End of Life With Lung Cancer: What to Expect and What to Do

Hearing from your doctors that you only have weeks or months ahead after a stage 4 lung cancer diagnosis is heartbreaking for you and your loved ones. Your cancer has spread from the lungs to other areas of your body and eventually, treatment options may run out. At some point, your doctor may inform you that you are nearing the end of your life. There will be a lot to think about, especially after hearing that your final days are ahead of you. On top of reflecting on your life and what you’d like to do next, it is also time to consider the support available to you.

There is no clear-cut time frame to define the ‘end of life’. It can range from days to weeks. This unknown time frame would mean that early and well-planned palliative care can ensure the best quality of life, with needs met in every aspect of life. What can palliative care do for you?

• A better quality of life and mood
• Improved symptom control
• Satisfaction for both patients and caregivers
  
  

"Survival is something that can never be predicted with great accuracy... if a clinician were to use such definitions to identify patients requiring EOLC (end-of-life care) they would need a crystal ball or a clairvoyant."

- Dr Richard Lim, the national advisor for palliative medicine in the Health Ministry of Health Malaysia, friend to the sick and the dying.

Every person experiences the end of life differently. Physical symptoms of lung cancer at the final stage can be variable and distressing. They are often a result of tumor invasion, while others are treatment side effects. Many people may not experience these symptoms, but fatigue is common among terminal-stage cancer patients. Signs or symptoms that a person is approaching the end of life:

• Extreme fatigue and a need to sleep or rest much of the time
• Cachexia or muscle wasting and loss of weight
• Reduced ability to care for oneself or perform daily functions
• Speaking less or decreased ability to talk
• Confusion or disorientation, and sometimes accompanied with anger and frustration

It is crucial to note that not everyone will encounter these symptoms and the impact can vary from person to person.

Besides physical needs, many lung cancer patients also suffer from grief and depression. The National Consensus Project (NCP) for Quality Palliative Care segregated the patients’ needs into different domains, including:

• Physical aspects
• Psychological and psychiatric aspects
• Social aspects
• Spiritual, religious and existential aspects
• Cultural aspects
• Ethical and legal aspects

Take advantage of palliative care early in the journey of your cancer treatment. Palliative care is a lot more than hospice care. Palliative care helps with issues other than cancer. It extends to various aspects of life. In palliative care, patients are often advised to:

• Learn breathing exercises as a way to relax
• Adopt new interests or hobbies
• Explore alternative treatments, like acupuncture, to curb pain and drug side effects
• Set goals on practical matters like
  • Financial planning
  • Preparation of wills
  • Power of attorney
  • Spiritual care from a priest
  • Emotional care from a psychologist
    

"If they can’t cure my illness, then this is the next best thing to help me to live with this disease as best I can”

– Jay (39), stage 4 lung cancer

Importantly, the NCP Guidelines encourages the integration of palliative care for both patients and caregivers. Especially in addressing the psychological burden of cancer care, the guidelines stipulate psychological and spiritual care for not just the patients but also the caregivers.

Do I need hospice care?

Modern palliative care for terminal-stage cancer patients has extended beyond hospice settings. People have better access to healthcare resources. You can receive palliative care at home, near your family. You can also have it at an assisted living or skilled nursing facility, or other forms of professional home care, which offers medical supervision, symptoms management and tailored activities. The caregivers and patients should discuss with the palliative care doctors where and how they can support the patients at the end of life.