Guidance by Phase

Advanced cancer

The approach of death can sometimes lead to a kind of liberation. In its shadow, life suddenly takes on an intensity, resonance, and savor we may never have known before.

David Servan-Schreiber, MD, PhD, author of Anticancer: A New Way of Life

Navigating as the end of life nears

Take care of difficult emotions and physical distress first

Learning that your cancer is advancing and you are nearing the end of your life can bring up many different feelings. It’s not uncommon to feel shock, fear, anger, disappointment, sadness, and/or guilt. Feeling this way hurts. But going into and through the difficult emotions and improving your physical comfort is important for being able to plan and spend the time you have left in the most meaningful way possible.

So, before we even look ahead, let’s stop now and take a moment to breathe slowly and deeply. With each inhalation, take in peace and comfort. With each exhalation, release what you don’t need. Take a few more of these slow, deep breaths. For now, breathing in and out one breath at a time is all that matters.

Now notice what you feel. Name the feelings and ask them what they are here to tell you. Listen compassionately. Make note of what the feelings have to say to you.

Once you have an idea of what you need, take care of the physical and emotional feelings of distress first. Rest assured that there are guides, sherpas so to say, who can shine a light on the people and resources who will support you and your loved ones during this time. 

Some sections of CancerChoices will help you take care of difficult emotions and physical distress common during this time. 

Get clear on what matters now

Once you’ve tended to your difficult emotions and physical distress, you may be in a better frame of mind to ask “What matters most to me now?” When exploring how you want to spend your life now, the answer may be your best guide to how to live, which treatments to use, and perhaps equally important which treatments to stop. This exploration is actually one of the 7 Healing Practices and a good place to start in caring for yourself.

Learn about your choices

Sometimes, when treatments are no longer working and cancer is progressing, doctors may say something like: “I’m sorry, there’s nothing more that we can do…” Once they get that far in the sentence, people usually don’t hear the rest: “… to treat your cancer.” The statement might end there, or it may include the following most important part of the message: “but we can manage your symptoms and improve the quality of your life. We will continue to be involved in your care.” 

Even if you didn’t hear this last bit from your doctor, rest assured that options are available to help you make the most of this time of your life, and as comfortably as possible. Your team may bring in new members who are experts in comfort care.

Some people decide they don’t want to take any more treatments to try to stop the cancer. When they stop conventional treatmentthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy, they might actually feel better because treatment side effects are no longer a burden.

Other people may want to “fight until the end” with whatever conventional treatments the doctor will give them, even if the likelihood of good results is not high. Some may also want to “leave no stone unturned” and pursue treatments beyond conventional therapies, including experimental therapies. 

Make and integrate your choices

You may choose to explore one or more of several options.

Even when cancer is not curable or controllable, healing is still possible.

Advance care planning

Advance care planning is a process in which you learn about your choices, then decide how you wish to be cared for as you are nearing the end of your life. We strongly encourage you to make your wishes known to your doctor, the person who will make decisions if you can’t (your healthcare agent), and your loved ones. We advise completing this process before you have a crisis in which you may not be able to communicate your wishes and make decisions for yourself. 

Self care and complementary therapies you can do now

7 Healing Practices

Complementary therapies

Either alone or in addition to self-care healing practices, complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocialtherapy, and acupuncture therapies such as supplements, mind-body approaches, and more might help you now. Many of these therapies help ease difficult emotions or help manage symptoms such as pain.

You may already have a team of complementary therapists lined up from when you were originally diagnosed. This might be a good time to get in touch with them and see if they have something to offer you now. More and more hospice and palliative care programs are offering complementary therapies—consider asking about this if you are interviewing potential programs.

If you are considering complementary therapies for the first time, you may be wondering how you can choose which are likely to be helpful for you. Ideally, an integrative oncology doctor, nurse, navigator, or advocate would be able to guide you in choosing therapies that are right for you at this time.

If you don’t have access to an integrative oncology professional, then think about what you want complementary therapies to help with: improving treatment outcomes, balancing your body terrainthe internal conditions of your body, including nutritional status, fitness, blood sugar balance, hormone balance, inflammation and more, and/or managing side effects and symptoms. You can browse our reviews of complementary therapies for those effects.

Similarly, if you want to know which therapies are useful for someone with advanced cancer, use the “Cancer types” filter, selecting “Advanced cancer.”

Traditional medicine systems

Traditional medical treatment systems come from the accumulated knowledge, skills and practices of indigenous cultures around the world. An example is traditional Chinese medicine (TCM).

Get more help

You may be saying to yourself, “This is great that there’s all this information here, but I’d like some help navigating this site.” or “Well all this written information and guidance is helpful, but I also need more individualized one-on-one help.” The good news is that living and breathing guides can lead you through this website, or the bigger unfamiliar territory of cancer.

We’re with you

You are not alone. We’re here to help and connect you with resources that will benefit you and those you love.

Personal stories

A nurse’s view

Laura Pole, RN, MSN, OCNS: Over the many years I’ve worked as a hospice and palliative care nurse, I’ve witnessed many people open the gifts of love and death that came in packages as varied and unique as the person receiving them. I’ve learned that though the prognosis is short, time also seems to expand to accommodate an unfolding, moving through, and resolution of many choices. 

When learning that the end of life is near, I’ve seen some people choose to spend their last days far away from home, taking conventional or alternative therapies in a hospital or clinic. I’ve seen others go into hospice care and live and die at home with treatments providing comfort. Others, though few, choose to end their lives at a time of their choosing, through their own self-deliverance or with medical aid in dying. Mostly, I’ve seen people move through phases. Starting with somewhat “aggressive” life-saving care in the hospital or at an alternative therapy clinic. Then they weaving in palliative care for symptom management while still perhaps receiving chemotherapy. And they stop all aggressive treatment and elect to receive comfort care at home. I’ve seen many use complementary therapies and healing practices all along the way. There is no right or wrong way to spend the end of one’s life—there’s your way. And exploring, getting clear, and being true to your way can be one of the greatest and most meaningful accomplishments of your life.

I’ve seen fear come up for many at this time. I’ve learned that fear can be a great illuminator if we choose to interact and be patient with it. As a caregiver, I’ve learned not to be afraid of nor help cover up someone’s fears with medications and platitudes. But to just be present with the fear and remind the person that they’re not alone. That they have what they need to move into and through the fear, if they choose.

Take Dave, for instance. Dave was forty-something, had a wife and 2 adult daughters who adored him and he adored them. He had lung cancer and was told he would likely not live much longer. His doctor referred Dave to our hospice and I went out to do our assessment and see if he was eligible for our services. As he sat there with his oxygen machine hissing and puffing beside him, he said that he was very afraid that the cancer would smother him. If his breathing or heart stopped, he would want to be resuscitated and taken to the hospital and put on a ventilator to keep him from smothering.

Weeks and even months passed. Dave continued to need oxygen and the fear was still there, but he was taking care of unfinished business and was surrounded by his loving family and friends. An incredibly kind and giving volunteer hospice nurse, Margaret, was a steady presence for Dave for all these months. One night, Dave did stop breathing, and Margaret did mouth-to-mouth resuscitation while his wife called the EMS.

Dave started breathing and awoke, and Margaret said “We’ve called the ambulance to take you to the hospital.” Dave said, “Cancel it—I’ve seen death and I’m not afraid.” 

Dave’s daughter Sue, who lived out of town, had been driving hours to get home to be with her Dad. By the time she arrived, Dave was again unconscious, but now breathing more comfortably than he’d breathed in months. I sat with Sue on a small sofa in Dave’s room. As we talked quietly, something told me to have Sue go to her Dad’s bedside. Just as she did, Dave breathed his last quiet breath. No more fear. The grace of whatever he’d seen replaced the fear with peace.

I know this peace is possible. I wish it for you.

My Advice to People with Advanced Cancer

Cancer Help Program alumna Suz Mondello shares three pieces of advice for people with advanced cancer.

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