When a patient or caregiver learns that the end of life is near grief, sadness, and other painful emotions are natural responses. But certain actions can help the person with cancer have a reasonably good quality of life, including some hopes, personal goals, and even a feeling of being useful.

Coping With Physical Discomforts Patients should continue to ask their health care teams for help with any physical problem or pain. If your nausea medication is no longer working so well, ask for one that works better. If your mind is in a fog from pain pills, doctors can often adjust or change the prescription.

Several coping strategies can help with a physical problem too.

• Diversion. Watch an interesting movie or visit with friends. Or just watch home movies and reminisce. Listen to beautiful music. Look through family photos. Go outside if possible. Surround yourself with wonderful smells.
  
• Seek information. Lower your stress by trying to understand a problem and learn about remedies.
  
• Action. Doing something, sometimes anything, about a problem can help you feel better. Preparing a letter or videotapes for your loved ones may help ease some of the pain of being parted.
• One step at a time. Address problems one at a time to avoid becoming overwhelmed. Don’t try to resolve all your problem relationships in one day. Begin by spending time with one person and try to connect.
  
• Talk with others. It can be a relief just to "vent."
  
• Self expression. Write in a journal, paint, or meditate if you don't feel like talking.
  
• Find the humor. Even when life seems bleak, there's usually something or someone to lighten the mood. Sometimes even the indignities of being seriously ill can seem funny in the right moment. One young man who had an advanced cancer dressed up for Halloween as the “grim reaper”. Some outsiders were shocked, but for him it eased some of the “doom and gloom” that surrounded him daily

Hope. Hope may seem impossible for someone who knows he or she is dying, but hope is what gets us through each day. You may hope to reconnect with a special person or to have a pain-free day. There may also be genuine hope for relief of symptoms and slowing of the growth of the cancer.

One woman took an hour on her good days to teach art to a friend's daughter. On the bad days she remembered the girl's excitement about her new skills. And the woman could hope and plan for the next good day and the next lesson.

Uncertainty/Anxiety. What is going to happen to me? How much pain will I have? How can I burden my family in this way? What happens after death? These are a few of the fears people with cancer face near the end of life.

These anxieties can sometimes be managed by talking about them with the right person. That "good listener" may be a minister, best friend, or family member. Allowing yourself to feel sad or frustrated can help too. And spiritual or religious beliefs can lessen anxiety in the surrender of control to another power.

If these methods don't help, a doctor can evaluate you for the symptoms of serious anxiety This can be treated with anti-anxiety or antidepressant medications, which may offer just what you need to regroup.

Depression. Feeling sad and down at times is a normal part of any response to illness and side effects of treatment. Feeling down for a long time and being unable to enjoy anything are more troublesome. As with hope, happiness should not be impossible at this stage.

If symptoms last for two weeks or longer, you should talk to a doctor for an evaluation for clinical depression. People treated for depression are often shocked by the improvements in how they feel.

Feeling Alone. Depression and feeling alone (isolation) often go hand in hand. Depression can make you withdraw from others. However, the illness sometimes forces you to be alone. Because of physical limitations, lack of transportation, or treatment scheduling, people with cancer are alone even when they want to be with others. It is helpful if a friend or family member arranges visitors for the person with cancer.

Spirituality. In an attempt to make sense of both the illness and one’s life, spiritual questions are common in advanced illness. This may be true for both the person with cancer and his or her loved ones.

A spiritual counselor can help achieve peaceful answers to troublesome questions. Religious rituals may be comforting and important, such as forgiveness or confession or communion. And believing in life after death and an end to human suffering on earth is reassuring for many.

Mortality. Anyone with advanced cancer along with his or her family is very aware of his or her mortality. Death is a part of life no matter how far off. For many the prospect of death is frightening and painful. Patients and families worry about suffering before death and being alone in death. Sometimes, the illness has gone on for so long with so much suffering that death is seen by all as a relief.

Often caregivers must give more near the end of an illness when they are most exhausted. Not only must they help with physical care that is more complex with an advanced illness, they must also think about the people who will be left behind. They must take care of their own health even though there seems to be no time to do so. However, time spent in self-care will benefit both the caregiver and the person with cancer.

Prolonged Illness.. Illness that goes on and on, for months or even years, places enormous stress on the family. The longer the period of stress, the more at risk the family or caregivers are for psychological distress. At some point, both physical and mental exhaustion can take its toll as fatigue is combined with anxiety, fear, and uncertainty. It is important to seek support and continually ask how everyone is holding up.

Several national organizations and web sites offer more information and help.