What to Expect When a Person With Cancer is Nearing Death

Your loved one may:

• Be very weak. They may stay in bed and not be able to get up.
• Need help with daily care, like bathing, brushing teeth, and getting dressed.
• Need help using a bedpan or bedside toilet if they can get out of bed.
• Have less interest in food, often eating or drinking very little.
• Have trouble swallowing food or medicines. Their lips may droop.
• Have trouble focusing or paying attention.
• Have sudden jerking movements of the hands, arms, legs, or face.

What caregivers can do

• Help your loved one change positions every 1 to 2 hours. Try to do this about 30 minutes after pain medicine is given, if they have pain.
• Use an "egg crate" mattress or foam cushions to make beds and chairs more comfortable.
• Speak softly and avoid sudden noises or movements.
• If they have trouble swallowing pills, ask about liquid pain medicine or a pain patch.
• If they have trouble swallowing, do not give them solid foods. Try ice chips or small sips of liquid.
• Do not force them to drink. Some dehydration is normal near the end of life.
• Apply cool, moist washcloths to head, face, and body for comfort.

Many people lose their desire to eat or drink in the days to weeks before death. This is normal.

What caregivers can do

• Avoid pushing your loved one to eat or creating stress around food.
• Let them eat what they want, when they want to eat.
• Keep favorite foods and drinks around, but know their tastes may change.
• If food smells bother them, offer cold or room temperature foods.
• Help your loved one take medicines for nausea or pain, as directed.
• Try not to feel upset if they don’t want to eat or aren’t eating as much as they used to.
• Ask how you can best support them and spend time together in ways that don’t involve eating.

Your loved one may:

• Have a dry mouth.
• No longer need some of their medicines unless they help make them more comfortable. These might include vitamins, replacement hormones, blood pressure medicines, and water pills (diuretics).

What caregivers can do

• Put lip balm or lubricant on your loved one’s lips. If a person is using oxygen, choose a water-based, petroleum free product.
• Try giving them ice chips from a spoon, or sips of water or juice from a straw.
• Check with the care team to see which medicines may be stopped. Medicines for pain, nausea, fever, seizures, or anxiety are often continued to help keep the person comfortable.

As their body continues to move through the dying process, your loved one may have hearing and vision changes:

• Vision may become blurry or dim.
• Pupils may not change size.
• They may have trouble closing their eyelids.
• Hearing may decrease. But most people can hear you even after they can no longer speak.

What caregivers can do

• Keep soft or low lighting on as their vision gets weaker.
• Always assume your loved one can still hear you even if they are not responding.
• Keep talking to and gently touching them to provide them comfort and reassurance.

As your loved one gets closer to death, they lose the ability to swallow or cough up mouth fluids like saliva and mucus. This may cause:

• Mouth fluids to thicken and build up. This happens because your loved one is taking in oral liquids and cannot cough as well as they did before.
• Mucus to collect in the back of the throat. This can cause a rattling or gurgling sound when they breathe. It’s sometimes called a “death rattle.” This can be distressing to hear, but it is usually not uncomfortable for your loved one.

What caregivers can do

• Use a cool mist humidifier to help keep mouth secretions thin and easier to manage.
• If your loved one can swallow, offer ice chips or small sips of liquid to help with this.
• Turn them on to their side to help secretions drain and gently clean their mouth with a soft toothbrush or foam swab.
• Ask the doctor or nurse if medicines may help manage secretions.

As the body begins to shut down, changes in blood flow, oxygen, and organ function can affect awareness. When this happens, your loved one may:

• Sleep more and be hard to wake.
• Be confused about time, place, or people.
• Become restless and pick or pull at bed sheets.
• Say things that don’t match what is happening around them.
• Feel more anxious, afraid, and lonely, especially at night.
• Have brief moments of clarity between periods of sleep and confusion.
• Become withdrawn or stop responding.

Sometimes, loved ones may become very restless, confused, or upset and may shout or call out. This is common in the final days before death and is called terminal agitation.

What caregivers can do

• Try to be with your loved one when they are most alert or seem most comforted by your presence.
• Speak in a calm, clear voice.
• Gently remind them who you are and where they are.
• Continue giving pain medicine as prescribed, even near the end of life.
• If they are very restless, check for pain and use breakthrough medicine as directed. Or you can contact the care team.
• Offer gentle touch, such as holding hands or light comforting contact.
• If they can’t respond, say things that are reassuring, but don’t require a response such as, “We’re here with you,” “We’re supporting one another,” or “We love you.”

Changes in breathing are common in the days to hours before a person dies. You may notice:

• Breathing may speed up then slow down.
• There may be pauses in breathing for up to 30 seconds, followed by breathing again.
• Your loved one may grunt while breathing.
• Neck muscles may look tight as they work to breathe.
• Mucus may cause a rattling or gurgling sound with each breath.

What caregivers can do

• Position your loved one on their back or slightly on their side.
• Use pillows or raise the head of the bed to make breathing easier.
• Help them sit up with support or find a position that makes breathing easier.

Your loved one may have changes in their bowel and bladder, such as:

• Urine may become darker and decrease in amount.
• They may lose control of their urine and stool.

What caregivers can do

• Use disposable, waterproof pads under your loved one to protect the bed and keep them dry.
• If a catheter to collect urine is in place, the nurse will teach you how to care for it.
• Bathe your loved one as they are comfortable with it. You might give a sponge bath or clean only areas that need attention.

As your loved one nears death, their circulation slows. Blood shifts toward vital organs to help conserve energy. You may notice that:

• Their arms and legs may feel cool to the touch.
• Skin on hands, feet, arms, or legs may darken and look blue or mottled (blotchy).
• Other areas of their body may look paler or darker than usual.
• Their skin may feel cold and either dry or damp.
• Heart rate may become fast, faint, or irregular.
• Their blood pressure gets lower and becomes hard to hear.

What caregivers can do

• Keep your loved one warm with blankets or light bed coverings.
• Do not use electric blankets or heating pads to avoid burns.

In general, in the last weeks to about a month of life, people often become weaker, sleep more, eat and drink less, and need more help with daily care. They may also become less interested in activities. And they may show changes in thinking or energy levels.

In the last 24 hours, most people are asleep or unconscious and may not respond to voices or touch. However, the senses of hearing and touch are often the last senses to go. So, being near the loved one, holding their hand, and talking to them may continue to provide them with comfort during this time. Breathing may be uneven with pauses, and the body will show clear signs that it is shutting down.

Not everyone is able to report if they are in pain near the end of life. Signs of pain may include grimacing, restlessness, tense body movements, or moaning. The care team uses these signs to help decide if pain medicine is needed. And comfort medicines are often given even if the person cannot speak.

No. At the end of life, the body naturally loses the ability to process food and fluids. Decreased eating and drinking are a normal part of the dying process. This doesn’t cause suffering. Forcing the person to eat or drink can actually cause discomfort. Care during this time focuses instead on comfort and symptom relief.

Not necessarily. Stage IV cancer means the cancer is advanced, so it can shorten life. But how long someone lives varies widely. The timing of death depends on many factors, and it’s not possible to predict exactly when it will occur.