Coping with Late-Stage Cancer

Coping with advanced cancer is a very complex and difficult process that is unique for each person.^1,2Advanced or late-stage cancer can be very difficult to treat effectively. Some patients may choose to try to treat the cancer for as long as possible, even if it is not very likely to be effective. Other patients may choose to discontinue treatment for the cancer itself in order to focus on feeling as well as possible for as long as possible. This will often involve managing symptoms and side effects to reduce pain and make the patient as comfortable as possible.

If you are coping with decisions about advanced cancer, the healthcare providers on your cancer care team are there to support you and your loved ones through this process. It is important to be open and honest with them about all of your concerns, hopes, fears, and other emotions so that they can help you to make the decisions that are best for you and your family.

Some patients with advanced, late-stage cancer may consider entering hospice care, while others may choose another type of specialized healthcare facility. Other patients may choose to receive care at home from family caregivers assisted by at-home nursing care.

What is hospice care?

Hospice care is an option to consider for patients who have advanced cancer and are expected to live for less than six months.^1,2 Hospice care is a type of palliative care, which focuses on relieving pain and making sure that the patient is as comfortable and has the best quality of life as possible.

Hospices are staffed by compassionate and experienced professionals who are dedicated to helping a patient approach the end of life with dignity, respect, and in a peaceful way. The hospice care team may include healthcare providers, social workers, chaplains, physical and rehabilitation therapists, dietitians, and trained volunteers. Hospices also provide support to patients and their loved ones through trained grief and bereavement counselors.

End-of-life preparations and considerations

Some patients live for months or years after a diagnosis of advanced cancer, but it is important to give thought to end-of-life issues and concerns as soon as possible.² If your loved ones and caregivers clearly understand your preferences, they can respect and fulfill them for you when the time comes.

Some end-of-life issues to consider include choosing a designated healthcare proxy who can make decisions on your behalf if you are unable to do so. Putting your preferences about your medical care in writing allows you to be in control of decisions that may need to be made for you. This can also be a way to support your loved ones if they need to make difficult decisions about your care. Advance directives are legally binding documents that you can use to put your preferences in writing, such as:

• A living will, which describes the types of medical care that you do want and do not want used to keep you alive (such as CPR, artificial life support, or feeding tubes)
• CPR or do-not-resuscitate (DNR) orders describe whether or not you want healthcare providers to perform CPR or use artificial life support if your heart stops or if you stop breathing
• The Physician Orders for Life-Sustaining Treatment (POLST) form is a newer version of a DNR order that can provide more detailed instructions about the types of medical treatment that you do or do not want to receive

As part of end-of-life planning, it can also be helpful for you to locate your important legal and financial documents so that your loved ones will have access to them. These may include wills, birth and marriage certificates, social security information, insurance policies, financial documents, and passwords to online accounts.

Coping and finding support for terminal cancer

There are a variety of strategies that may help patients with advanced cancer cope with the emotional burden and find support as they approach the end of life.² One of the most important strategies is to talk openly and share feelings with your loved ones, rather than trying to avoid the topic. This can make everyone feel more comfortable, loved, supported, and at peace during the difficult process. Counseling can also be an important source of emotional support and help patients and their loved ones find ways to cope.

Some patients may choose to take time, if they are feeling well enough, to have certain experiences they have always wanted or to reconnect with family and friends that have been important in their lives. Other patients find it helpful to take time to reflect about their lives with loved ones, celebrating proud experiences, important life accomplishments, and special times. Some patients with advanced cancer experience a sense of comfort and peace through spirituality, whether or not they are a part of an organized religion, and from support from faith or clergy members.