Download As Cancer Progresses

Symptom Management
As Cancer Progresses
This is a difficult time for loved ones. As cancer progresses,
many patients become weaker and are less able to function
than they were previously.
What happens as my illness worsens?
It is difficult to predict what each patient will experience.
It depends on where the cancer first began. Each person’s
response to cancer is different.
“How long do I have?” That’s often the first question patients
and families ask.
Unfortunately, doctors are only able to give patients and
their families an approximate idea of their expected survival
duration. It is almost impossible to know a precise time
frame for survival.
What is palliative therapy?
When cure is not possible, radiation therapy and
chemotherapy can help to relieve symptoms and to improve
quality of life.
These treatments are used to shrink a tumour, or to slow
down its spread. While you may be living with an incurable
cancer, you can still continue to live well.
What can be done to relieve my symptoms?
To help you with your pain or symptoms, we will use
medications as well as treatments that are not drug-related.
It can be helpful to know about some signs and symptoms as
cancer progresses.
Each symptom will be treated according to what is causing
it, and how it makes you feel. On the BC Cancer Agency
website you can find information about pain management,
nausea management, bowel care, breathlessness and other
symptoms you may be experiencing.
Cachexia (sounds like “ka-kek-see-a”).
Will I suffer much?
Cancer-related cachexia is a syndrome often seen in
advanced cancer when a person has symptoms such as
weight loss, loss of muscle, loss of appetite, and weakness.
Pain and symptom management has become much more
effective over the last few years. There are many medication
options to help you to feel better. Your health care team
will do whatever they can to make you as comfortable as
possible.
Cachexia can occur due to changes in your body because of
your cancer or because of increased energy needs, decreased
appetite, and increased muscle and fat breakdown.
Cancer cachexia is different than regular starvation because
it cannot be reversed by eating more.
One of the most important things is to let us know how you
are feeling. Don’t try to live with your symptoms. The success
of your symptom treatment depends on us starting early.
Focus on the pleasure of eating and tasting food. If tolerated,
you may benefit from eating small, frequent calorie dense
meals.
In most cases, symptoms and pain can be well managed with
simple care plans. We can also call in the experts if your pain
or symptoms are complex.
See our nutrition handouts http://www.bccancer.bc.ca/
health-professionals/professional-resources/nutrition/
nutrition-handouts for tips on eating with a low appetite.
Information for loved ones
For advice on what to do if you are losing weight ask to speak
to a registered dietitian at your cancer centre. Check for the
nearest location at http://www.bccancer.bc.ca/our-services/
services/nutrition
You can also speak to a registered dietitian at Health Link BC
by calling at 811 from anywhere in BC, or visit their website at
https://www.healthlinkbc.ca/
This can be a difficult time. You may find it helpful to know
what to expect.
This information will help you understand what your loved
one is going through. It can help prepare you for what may
happen.
Each person is different and these signs and symptoms may
not occur for everyone.
December 2016
How will my loved one die?
The most common experience is that patients with very
advanced cancer become increasingly weak and drowsy and
spend much of their time sleeping. Dying and death is usually
quiet and peaceful.
Your care team at the BC Cancer Agency or in your community
will help you prepare for what to expect and what to do at
this time. Don’t hesitate to ask.
Here are a few things that often (but don’t always) happen:
• Comfort: Pain is seldom a problem as death approaches
• Breathing: It is common to see 10-30 second periods
when breathing stops. This is often followed by a deep
sigh. Gurgling or wet-sounding breathing is often caused
by a collection of saliva at the back of the throat. This
saliva cannot be swallowed because of weak muscles. If
these sounds bother the patient or family, things can be
done to help lessen these symptoms.
• Moaning: It is not uncommon for a person to make a
moaning sound as they breathe out or move. This does
not mean your loved one is in pain. It is the result of air
passing over relaxed vocal cords.
• Colour changes: The skin (especially limbs) is often
bluish and discoloured as well as cool to the touch. This
happens as the circulation slows down and finally stops.
It is a natural part of the body shutting down and is not
painful.
• Swallowing: It is very common that the person becomes
too weak to swallow. It is not necessary to feed a person
who is dying. This may be hard for the family to accept.
Remember that the person is slowing down and they
do not need the same energy for their metabolism as
a healthy person. Being too pushy with food can be
harmful. Time is better spent in giving good mouth care
and providing general comfort for your loved one.
• Vital signs: The pulse usually becomes weaker as the
heart begins to fail.
• Confusion: It is common for some type of confusion to
be present.
What steps do I take after a death?
Your care team at the BC Cancer Agency or in your community
can tell you what to do and who to call after your loved one
has died. It is best to plan for this before it happens. This is a
part of Advance Care Planning. It can save a lot of stress and
upset for both patients and families.
With regard to legal matters, people can have varied roles.
You may need to ask for the help of an expert.
More information is available on our patient handout titled
“Things to do after a death.” This handout is available on
our resources page: http://www.bccancer.bc.ca/health-info/
coping-with-cancer/practical-support/resources.
Learn More
Recommended websites:
• Advanced cancer website: http://www.bccancer.bc.ca/our-services/services/library/recommended-websites/types-ofcancer-websites
• Managing Symptoms and Side Effects website: http://www.bccancer.bc.ca/our-services/services/library/
recommended-websites/managing-symptoms-and-side-effects-websites
• Palliative Care / Hospice Websites: http://www.bccancer.bc.ca/our-services/services/library/recommended-websites/
living-with-cancer-websites/palliative-care-hospice-websites
BC Cancer Agency Library support pathfinders: http://www.bccancer.bc.ca/our-services/services/library
• Advanced Cancer Pathfinder
• Home Care pathfinder
BCCA pamphlet “Eating Challenges with Advanced Cancer,” available on the nutrition handout web page:
http://www.bccancer.bc.ca/health-info/coping-with-cancer/nutrition
BC Cancer Agency webpage: Advanced Cancer & Palliative Care:
http://www.bccancer.bc.ca/health-info/coping-with-cancer/advanced-cancer-palliative-care
BC Cancer Agency information about medical assistance in dying (MAID):
http://www.bccancer.bc.ca/health-info/coping-with-cancer/medical-assistance-in-dying
December 2016