Coping With Advanced Cancer

Advanced cancer may very well be the hardest thing you and your loved ones will ever have to face. Still, some people with advanced cancer live longer than expected and you still have choices about how you live each day.

If you have ongoing concerns that interfere with your life, or if you just want to communicate and cope the best you can, consider talking with a mental health professional. It can often be very comforting to talk with an expert. Social workers, psychologists, and psychiatrists are all licensed mental health professionals. You can find one by asking your cancer care team or through the nearest large hospital in your area. Even one session with a licensed mental health provider may help you and your family focus on what matters most. Your cancer care team can work with you to find the right provider for you.

Dealing with worry and the unknown

Learning that you have advanced cancer may make you feel lost and afraid. This is normal. Knowing what to expect may help. You may want to ask questions such as:

  • What’s going to happen to me?
  • Have I done everything I should have done?
  • What are my treatment options?
  • What’s the goal of this treatment?
  • Am I going to die soon?
  • How much control will I have over my life? Over my death?
  • Will my wishes be followed?
  • How much pain and suffering might I have?
  • What if I feel like I can’t take any more treatment?
  • Am I a burden to my family?
  • Will this be too much for my family to bear?
  • What am I going to do about money?
  • How long am I going to have to go through this?
  • What happens when I die?

The list of concerns and fears may be overwhelming to think about. Worrying could make it hard for you to focus. Other signs of worrying are restlessness, shortness of breath, trembling, heart racing, sweating, dry mouth, and grouchiness. But few people have all of these symptoms.

There are professionals who can help you manage these concerns. Along with your doctor and nurse, there are social workers, psychologists, psychiatrists, and pastoral counselors who are specially trained to help you talk about your concerns, control your fears, and find meaning in what you’re going through. They can also support your family. Your cancer care team will know the local mental health experts in your area.

Managing worry

  • Sometimes just talking about feelings helps to relieve worry. Choosing the right person to talk with can be important. For some, that person will be a minister or a good friend. For others, it will be a family member.
  • Trying to relax with deep breathing and other techniques can help. It works best if you practice and do it regularly.
  • It’s important to let yourself feel sad and frustrated, without feeling guilty about it.
  • Spiritual support is helpful for many people.

If your worry lasts for long periods of time and is upsetting to you or your family, it’s important that you ask to see a mental health professional who is specially trained to work with people with cancer. A professional may be able to suggest medicines to treat anxiety or depression. Short-term use of these drugs is often helpful and is rarely a problem. It could be just what you need to regroup and go forward.

Finding hope

Hope is an important part of everyday life. Hope gets many of us out of bed in the morning and keeps us going throughout the day.

If you have advanced cancer, you can still have hopes and dreams, even though some of these may have changed. Your hope may be to have a pain-free day, or to do something special with a family member. Just sharing and talking openly can be a hope for people with cancer and their families. There may also be real hope for relief of symptoms and slowing down the growth of the cancer.

And there’s always hope to make the most of the time you have left – for good times with family and friends, times that can be filled with happiness and meaning. For many people, this is a good time to refocus on the most important things in life. Now is the time to do things you’ve always wanted to do and stop doing the things you no longer want to do.

Managing feelings of guilt

Both people with cancer and those who support them often have feelings of guilt.

If you have cancer, you might feel guilty about being ill. These feelings can last even though you know it isn’t your fault. Making others aware of your discomfort or telling loved ones that you need their help can make you feel guilty, too.

Those who care about someone with cancer might also struggle with feeling guilty. They might feel guilty about their good health. They often feel bad about not doing enough for their loved one. Sometimes they even feel bad about the resentment that they feel for what they are doing.

Here are some things that may help with feelings of guilt:

  • Sometimes just talking about these feelings can help. It can clear the air and help ease everyone’s conscience. Sharing this common feeling can bring you closer together.
  • Letting each other off the hook is helpful. You can tell each other that you know everyone is trying to do their best.
  • For caregivers, sharing the work is important. Friends and family who want to help should be given specific tasks to lighten the main caregiver’s load.
  • If the guilty feelings don’t go away, you might need help working through them. Talk to your doctor about meeting with a trained mental health professional who can help you better understand and manage your feelings.

Facing family issues

Illness that goes on for months or even years can put huge stress on the family. The longer the stress lasts, the more at risk the family is for mental distress. Family members may become exhausted in body and mind. Fatigue added to worry and fear can take a toll.

Advanced cancer changes the way family members relate to one another. Families that are able to solve conflicts well and family members who support each other tend to do best in dealing with a loved one’s cancer. Families who found problem-solving hard in the past are likely to have more trouble dealing with this stressful situation. You might want to meet with a counselor and work together to plan how best to support each other and plan for problems that may come up.

Roles within the family may change, too. How family members take on new tasks and fill in for the person with cancer affects how they will adjust to losing that person.

For the person with cancer, the changes in family roles can trigger the grief that comes with loss. For instance, a woman who’s too sick to get out of bed may feel the loss of her role as a wife and/or mother. Understanding this and finding ways for her to still be involved in her family’s day-to-day life may help both her and her family.

People with cancer often say that lack of communication in their families is a problem. Changes in responsibilities can cause resentment and anxiety. Family counseling may help family members learn to deal with the changes that are taking place. It can also help members learn to discuss their feelings more comfortably. Counseling is especially helpful in families where some members don’t feel comfortable openly talking about their feelings.

The needs of family members and caregivers are important, too. See our information for caregivers and family or call us to learn more.

Maintaining sexual feelings and closeness

During advanced illness, sexual relationships will change. This can be because of physical symptoms such as tiredness, trouble moving, or pain. It can also come from holding back emotions. In most cases sexual desire may decrease, but this doesn’t mean the need for physical closeness and touching will change. In fact, the need to be held and touched may increase. Talking about feelings and continuing to touch and be close to each other can help with feelings of isolation. Still, if you have any doubt about whether it’s OK to have sex or to simply touch, ask your cancer care team. Don’t assume one way or the other.

Support from friends and community

People with life-threatening illnesses have a strong need for other people in their lives. They need others to help them deal with their illness and its emotional effects. Support can come from family and friends; members of a church, synagogue, or other place of worship; mental health professionals; support groups; or community members. Asking for support is one way you can take some control of your situation.

If you don’t get enough support from friends and family, look for it elsewhere. There are others in your community who need your companionship as much as you need theirs. The mutual support of others with cancer might also be a source of comfort. Check with your cancer care team for resources in your community.

Support programs

Support programs come in all kinds of forms and include one-on-one or group counseling and support groups. A support group can be a powerful tool for patients and families. Talking with others who are in situations like yours can help ease loneliness. You can speak without feeling judged. And you can often get useful ideas from others that might help you. The American Cancer Society can help you find many different support programs in your community.

Some groups are formal and focus on learning about cancer or dealing with feelings. Others are informal and social. Some groups involve only people with cancer or only caregivers, while others include spouses, family members, or friends. Some groups focus on specific types of cancer or stages of disease. The length of time groups meet can range from a certain number of weeks to an ongoing program. Some programs have closed membership and others are open to new, drop-in members. For those who cannot attend meetings or appointments, phone counseling is offered by some organizations.

Online groups are another option. Some people find online support groups helpful because they like the privacy it can offer. It may be comforting to chat with other people in situations much like yours, without having to share any more than you want to. But it’s important to remember that chat rooms and message boards are not the best source of medical information, especially if they are not monitored by trained professionals or experts. Each person’s situation is unique, and what helps one person might not be right for someone else.

Support in any form allows you to discuss your feelings and develop coping skills. Studies have found that people who take part in support programs often have an improved quality of life, including better sleep and appetite.

Facing death

Anyone with advanced cancer faces the reality that he or she may die soon. Family members must recognize this, too. Even if the person with advanced cancer is doing well at the moment, death is a likely part of the near future. Thinking about death is frightening and painful for many people. Patients and families also may worry about suffering before death and being alone in death.

Many people with cancer want to be at home until the end. Dealing with a long illness and dying at home can be easier with the support of family and medical staff.

The main goal for a death that cannot be avoided is that it be a “good death.” A good death is one with the least possible amount of pain, discomfort, or suffering for the patient, and the least possible suffering for the family and caregivers. A good death is one that’s in line with the patient’s and loved ones’ wishes, including their culture, values, and ethics. Loved ones are also supported and are with the patient as much as they and the patient want, especially as death nears. Ideally, this allows goodbyes to be said and problems resolved before death. It also lets loved ones to be with the patient at the end.

Nearing the End of Life addresses questions that patients and loved ones ask about what to expect during the last 6 months of life. It can help you know what might happen and how to prepare for this difficult time.

Home care

Home health care is professional health care given in your home. Home care may be right for you if you need care but don’t need to be in a hospital. A wide range of health and social services can be given at home to people with advanced cancer.

Even with home care, your family will be responsible for most of your care. It’s important to talk with your cancer care team so that you understand what types of care you’ll need and how this will affect your family. It’s also important to check with your health insurance company to find out if they will pay for home care.

Hospice care

Hospice is a program designed to give palliative or supportive care near the end of life. The right time for hospice care is when treatment aimed at a cure is no longer helping and the patient is thought to have about 6 months or less to live (but hospice patients can live longer). Together, the patient, family, and doctor decide when hospice care should begin.

Paying for end of life care

It’s important not to forget about money when deciding what type of palliative care you’ll get and where you’ll get it. Insurance policies differ widely. Check with your insurance company to find out which services are covered. Many insurance companies have a case coordinator who will act as your main contact. This person decides what your benefits cover in your specific case. Most health insurance plans cover hospice care. Many states mandate this.

Medicare has a special hospice benefit that not only covers care, but also pays for all medicines. For Medicare information, call the Medicare Helpline at 1-800-MEDICARE (1-800-633-4227); TTY: 1-877-486-2048. They can explain what Medicare covers and how to qualify. You can also get information on their website at www.cms.hhs.gov.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

National Cancer Institute. Coping With Advanced Cancer. May 2014. Accessed at www.cancer.gov/publications/patient-education/advancedcancer.pdf on November 17, 2016.

National Cancer Institute. Planning the Transition to End-of-Life Care in Advanced Cancer–Patient Version (PDQ®). November 24, 2015. Accessed at http://www.cancer.gov/about-cancer/advanced-cancer/planning/end-of-life-pdq#section/_1 on April 28, 2016.

Last Medical Review: December 16, 2016 Last Revised: December 16, 2016

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