Fever and infections are common at the end-of-life. Because patients often have many medical problems at the end of life, it can be hard to know the cause of a fever and if treatment will help the patient. Patients near the end of life may choose not to treat the cause of the fever but only to receive comfort measures, such as acetaminophen.
Sudden hemorrhage (heavy bleeding) may occur in patients who have certain cancers or disorders.
Hemorrhage (a lot of bleeding in a short time) is rare but may occur in the last hours or minutes of life. Blood vessels may be damaged by certain cancers or cancer treatments. Radiation therapy, for example, can weaken blood vessels in the area that was treated. Tumors can also damage blood vessels. Patients with the following conditions are at risk for this symptom:
- Head and neck cancers.
- Stomach cancer.
- Esophageal cancer.
- Leukemias and other blood cancers.
- Blood clotting disorders.
The patient should talk with the doctor about any concerns he or she has about the chance of hemorrhage.
Making the patient comfortable is the main goal of care during hemorrhage at the end of life.
When hemorrhage occurs during cancer care, it is treated with bandages and medicines or with treatments such as radiation therapy, surgery, and blood transfusions. When sudden bleeding occurs at the end of life, however, patients usually die soon afterwards. Resuscitation (restarting the heart) usually will not work. The main goal of care is to help the patient be calm and comfortable and to support family members. If hemorrhage occurs, it can be very upsetting for family members. It is helpful if the family talks about the feelings this causes and asks questions about it.
The following steps can be taken when bleeding occurs in the last hours of life:
- Cover the area with dark-colored towels so the blood is not seen.
- Change towels and keep the area clean.
- Speak calmly to the patient and to family members.
- Let the patient know if loved ones are there.
Fast-acting drugs may help calm the patient during this time.