Care decisions for the last stages of cancer can be about treatments and procedures, pain control, place of care, and spiritual issues.
Some patients choose to begin new chemotherapy treatment in the end stages of cancer. Others wish to let the disease take its course when a cure is not expected. In the end stages of cancer, chemotherapy usually doesn't help you live longer and it may lower the quality of the time that remains. Each person and each cancer is different. Talking with your doctor about the effects of treatment and your quality of life can help you make a decision. You can ask if the treatment will make you comfortable or if it will help you live longer.
Pain and symptom control
Controlling pain and other symptoms can help you have a better quality of life in the end stages of cancer. Pain and symptom control can be part of your care in any place of care, such as the hospital, home, and hospice.
Cardiopulmonary resuscitation (CPR)
It's important to decide if you will want to have cardiopulmonary resuscitation (CPR). CPR is a procedure used to try to restart the heart and breathing when it stops. In advanced cancer, the heart, lungs, and other organs begin to fail and it's harder to restart them with CPR. Your doctor can help you understand how CPR works and talk with you about whether CPR is likely to work for you.
People who are near the end of life may choose not to have CPR done. Your decision about having CPR is personal. Your own spiritual or religious views about death and dying may help you decide. If you decide you don't want CPR, you can ask your doctor to write a do-not-resuscitate (DNR) order. This tells other health care professionals not to perform CPR if your heart or breathing stops. You can remove the DNR order at any time.
Talk with your doctors and other caregivers about CPR as early as possible (for example, when being admitted to the hospital), in case you're not able to make the decision later. If you do choose to have your doctor write a DNR, it's important to tell all your family members and caregivers about it.
Continued
In the United States, if there is no DNR order, you will be given CPR to keep you alive.
Ventilator use
A ventilator is a machine used to help you breathe and keep you alive after normal breathing stops. It doesn't treat a disease or condition. It's used only for life support. You can tell doctors whether you would want to be put on a ventilator if your lungs stop working or if you cannot breathe on your own after CPR. If your goal of care is to live longer, you may choose to have a ventilator used. Or you may choose to have a ventilator for only a certain length of time. It's important to tell your family and health care providers what you want before you have trouble breathing. For more information, see the section on ventilator use in the PDQ summary on Last Days of Life.
Religious and spiritual support
Your religious or spiritual beliefs may help you with end-of-life decisions. Clergy and chaplains can give counseling. You can also talk with a member of your church, a social worker, or even other people who have cancer.