Physical Needs of the Person With Terminal Cancer
Meeting the physical needs of the dying is aimed at providing as much comfort as possible. The change from a cure focus to a care focus means providing comfort with the least invasive procedures, while maintaining privacy and dignity. A terminally ill person has many of the same needs as any seriously ill person, including the following:
A routine for sleep and rest. Lack of sleep may be caused by the number of visitors, discomfort, fear of not waking up, restlessness, or day and night confusion. Keep a night light on and/or a bell or intercom available so the person will know where he or she is if awakened and confused. A clock is also helpful.
Nutritional considerations. Nutritional considerations may be difficult to address. Nausea, vomiting, diarrhea, constipation, and reduced eating are often associated with the effects of treatment and the progression of the disease. High-protein shakes may be an option if the person is only able to eat or drink small amounts. A nasogastric or gastric tube is another option for supplemental nutrition. A gastric tube is placed through the skin into the stomach. A nasogastric tube is a tube placed in through the nose and extends to the stomach for delivery of medications and/or nutrition. Total parenteral nutrition (the delivery of nutrients, calories, protein, fat, and/or all caloric needs through a vein) is given into the bloodstream and may be necessary if significant nausea, vomiting, and/or diarrhea are present.
Changes in elimination. Changes in elimination may also occur with a seriously ill or dying person. Diarrhea, constipation, and incontinence are all possible. Care should be given to provide the individual with a clean environment. It is also important not to embarrass or humiliate a person that has recently become incontinent (unable to control the bowel or bladder).
Skin care. Skin care may also be a concern. Nutritional status, elimination problems, and immobility can all cause skin breakdown and/or pain. Infection may occur in this situation. The decision to use antibiotics can be discussed with the doctor.
Respiratory changes. Respiratory changes may occur from pneumonia, the effects of narcotics, or the progression of the disease. Often, people will feel they are unable to "catch their breath." Air hunger, as this is often called, can be frightening. Decreased oxygen in the bloodstream may also cause a seizure. Oxygen supplied through the nose or by a mask may be needed for comfort. A simple fan directing air at the person may help the sensation of breathlessness. Sometimes medications can also lower the person's anxiety related to breathing difficulties.
Nasal symptoms. Secretions from the nose, mouth, and throat may be difficult to manage with a terminally ill person. Suction devices are available, or simply repositioning the person may help drain the excess secretions. There are also medicines that help lessen the amount of secretions.
Pain management. When someone is dying, one of the greatest fears is pain. Every measure should be taken to eliminate pain from the dying process. Pain control options and management plans should be discussed before the person experiences significant pain. Fear of addiction to narcotics is common among families. It is important to understand, however, that the ultimate goal is comfort, which means taking appropriate measures to assure that the person is free from pain. Addiction is rare when pain medication is used appropriately to treat pain.
Pain is a sensation of discomfort, distress, or agony. Because pain is unique to each individual, a person's pain cannot truly be judged by anyone else.
Pain may be acute or chronic. Acute pain is severe and lasts a relatively short time. It is usually a signal that body tissue is being injured in some way, and the pain generally disappears when the injury heals. Chronic pain may range from mild to severe, and is present to some degree for long periods of time. Medicating pain before it becomes too severe is advised. If pain medication is not given for a long period of time, it may not be as helpful. With chronic pain, such as that found with some cancers, long-acting pain medication may be given on a regular schedule over a 24-hour period.
Many people believe that if a person has been diagnosed with a terminal illness they must be in pain. This is not necessarily the case and, when pain is present, it can be reduced or even prevented. Pain management is an important topic to discuss with your doctor.
Although very difficult, discussing the final wishes of the person with cancer can provide both the person and the caregivers with a sense of direction and comfort as the disease progresses. An advance directive can help both patients and families discuss these difficult issues.
An advance directive is a legal document that describes what kind of treatment the patient wants—and does not want—as death nears. For example, he or she may not want antibiotics if an infection occurs, but may want to have tube feedings if food can no longer be taken by mouth. Although caregivers may not agree with the person's decisions, advance directives give the patient the power to die with dignity and peace. Your health care team can provide you with information on advance directives.