- When recovery from cancer is not possible, people consider taking steps to address both practical concerns and emotional needs.
- These steps may include grieving the loss of your future, accomplishing unfinished goals, and leaving stories and memories for those close to you.
- You can also help your family and caregivers by organizing your legal and financial affairs ahead of time, as well as creating an advance directive.
Despite everyone’s best efforts, cancer may spread or come back after a remission (no signs of cancer), and a cure or long-term remission is no longer possible. When cancer reaches this stage, it may be referred to as advanced, terminal, or end-stage cancer.
If you are living with advanced cancer and cure is unlikely or impossible, you may feel anger, fear, grief, and regret. It is normal to grieve the decline of your strength, mobility and independence. You may feel robbed of the personal time that the illness and treatments consume and robbed of your future, in addition to the prospect of leaving loved ones. Many people find that talking about their feelings and concerns with the people they love and trust, such as family, friends, and caregivers. provides some level of comfort. Often the best way to go through these very difficult times is together. Learn more about grief and loss .
Putting legal, financial and personal affairs in order
Although discussing dying is sad and often awkward, it is wise to settle your affairs, consider your wishes for care during the last days of life, and communicate those plans to family members and health care professionals. It helps to start the conversation early; you may always revise your goals and plans as your circumstances or preferences change.
Completing your affairs may include locating and organizing important legal and financial documents, such as your will, marriage and birth certificates, social security card, insurance policies, bank statements, investment summaries, and passwords to accounts. If you have complicated finances or are concerned about leaving your family with high medical bills or debts, consider talking with a financial advisor or social worker. Although financial professionals cannot eliminate bills or debts, they will help you organize your finances and create a plan to lessen the stress of financial responsibilities for you and your family. Planning to settle legal, financial, and business affairs allows you and your family to spend more time appreciating the remaining days you have together.
It is also very important for people to create (or update) an advance directive . There are two kinds of advance directives: a durable health care power of attorney (also called a health care proxy, agent, or surrogate), who is a person you select to make health care decisions for you if you are unable to do so; and, a living will, which is a document that lists the type of medical treatments you do or do not want at the end of life. Preparing these well ahead of time, especially along with a conversation with your family, helps avoid confusion and arguments about your wishes during a time when your family is grieving.
In addition, some people find it helpful to plan some aspects of their own funeral or memorial service. You can create a set of written instructions, or talk with your family or close friends about your wishes.
Accomplishing unfinished goals
As you approach the end of your life, there may be certain things you wish to accomplish in the time you have left. These tasks help bring a sense of meaning and completion to your life. They may range from fulfilling a lifelong dream to travel somewhere or to reconnect with a personal friend or relative from years ago, to having simpler meaningful experiences, such as rereading a favorite book or spending time with people who are important to you.
Another step to bring closure includes finding peace in important relationships and saying the things that matter most. This may involve making apologies, seeking resolution to conflicts, saying goodbye to special people, and telling family members how much you love them. If you are unable to communicate these messages in person, consider sending them in writing, by telephone, or through a family member. However, keep in mind that, despite your best efforts, people may not respond the way you want. In addition, some people may not feel comfortable visiting you at this time, or they may fear saying the wrong thing. You may be comforted by knowing that you have done your best to heal a troubled relationship.
Reviewing your life
Consider taking time to reflect on and celebrate the events in your life—the things you have accomplished, the people you have loved, and the individuals and events that have shaped you. This may be a good time to talk with your family and friends about the events and special times you have spent together. You will not only be honoring the life you shared but also creating new memories for them to cherish.
Stories can become heirlooms, gifts to the people who you will leave behind. As you review your life, you may want to write your memories, or record them using an audio or video recorder, or ask someone to write for you as you talk. Sharing your wishes and dreams for loved ones helps ease regrets about leaving them and gives them a sense of connection to you at important times throughout their lives. For young children, you may leave videos and albums that remind them of your love and connection.
Religion and spirituality
Many patients with advanced cancer report that religion and spirituality are an important part of their lives. For some, organized religion is a central part of life, and the support of faith and clergy members is a significant source of comfort at the end of life. For others, spiritual comfort may lie in a sense of connection to nature or people. As you prepare for the end of life, seek spiritual experiences that bring a sense of comfort, meaning, completion, and peace. Studies show that patients who feel spiritually supported have a better quality of life. Patients and their families should feel comfortable asking members of the cancer care team for help finding spiritual support.
End-of-Life Care 
Aging With Dignity: Voicing My Choices : A Planning Guide for Adolescents and Young Adults