Advanced Cancer and End of Life Care

Last Updated: October 29, 2018

When a person with cancer is nearing the end of life, it can be hard to know what to expect.

Dr. Timothy Moynihan and patient advocate Andrea Wilson guide viewers through the main focuses of end of life care, communicating about the patient’s final wishes, and coping with difficult emotions.

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Cancer.Net: Doctor-Approved Patient Information from ASCO®

Advanced Cancer and End of Life Care

ASCO: When a person with cancer is nearing the end of life, it can be hard to know what to expect. That is why it is important to talk with the health care team about care through the final days, even though this is a difficult conversation to have. And they will do everything possible to make sure that the person dying is comfortable. These conversations, which include talking about end-of-life wishes and preferences, are different for everyone.

Timothy Moynihan, MD, Medical Oncologist; Member, American Society of Clinical Oncology:  In order to prepare for the end of any person’s life, you need to find out, 1) what’s important to that person. Where do they want to be, who do they want to be with, who do they need to communicate with?

Andrea Wilson, Patient Advocate and Caregiver; Member, American Society of Clinical Oncology:  I raised my younger sister Adrienne from the time she was 8 until she died at the age of 15 from primary liver cancer.  If I could give advice from one caregiver to another, I would say, number one, have the death conversation.  I wish I had. 

Number two, if the patient is an adult, have an advanced directive in place so you really know in writing what that patient’s choices are, so you have a way to also enforce those choices.  Otherwise, you won’t be able to.

ASCO: During this phase of a person’s cancer care, their oncologist will most likely talk about hospice care.

Dr. Moynihan: What I think is really important is to use people who have been trained and made it their life’s work to take care of people in this phase of life.

Many people are just afraid of the word “hospice” because they think it’s giving up or stopping things. When, in fact, we have very good data now that show that in people who get involved in hospice earlier, they actually live longer; they don't live shorter. Not only do they live longer, but they live better and have fewer side effects. And the family does better after them dying.

Andrea Wilson: In the last few weeks of life, the best way you can provide comfort is by taking your cues from the patient.  So if you have a patient who wants to continue fighting, support that patient’s choice.  If you have a patient who has chosen to go into hospice who doesn’t want to pursue any more treatment, support that patient’s choice.  It’s their body.  It’s their decision.

ASCO: Talk with the hospice care team about what physical changes may occur and how they will be managed. It is very common for patients near the end of life to feel more fatigue, and experience shortness of breath and weakness.  They may also lose their appetite or have difficulty eating.

Dr. Moynihan: Other patients may stay very functional right up to the last days and even last day of life. The pathway is very different for each individual, so it’s hard to make hard and fast rules about what people are going to experience.

ASCO: Communicating with the patient is both very important and meaningful, especially when it comes to family members saying goodbye.

Dr. Moynihan: Make sure that they know that they were important in your life and it’s important to thank them. And lastly, it’s really important to just say goodbye. To be able to go through those steps and communicate brings many people a great sense of peace or relief.

ASCO: For more information on end of life care, please visit Cancer.Net.

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Cancer.Net: Doctor-Approved Patient Information from ASCO®

ASCO's patient education programs are supported by Conquer Cancer® The ASCO Foundation  


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