When Treatment Options Are Limited

Many cancer survivors live with a diagnosis of cancer for many years; others, unfortunately, never achieve a lessening of their cancer. These situations may become life-threatening, and as people live through the advanced stages of cancer there are many tasks that need to be completed to prepare for the best care one can have at the end of life.

1. What are your preferences with regard to medical care at end-of-life? Have you completed an advance health directive? Have you completed a will and made other legal decisions?

2. Do you want to die at home?  In a hospital?  Somewhere else? Is your family in agreement about your death taking place at home if that is your choice?

3. Is there a hospice program nearby that can help you and your family during your final months and weeks of life? Have you asked your doctor to refer you to such a program?

4. Have you made decisions about funeral arrangements? If you will die at home, how will your death be pronounced? Who will notify the funeral home?

5. How will you and your family know when death is near?

6. If you have pain, how will it be controlled?

   These are very hard questions to face, and not easy subjects to discuss with loved ones or with your health care team. But, you want the time that remains in your life to be as complete as it can be and sharing the facts of your dying with those who love and support you can be a source of great comfort and healing. If possible, use this time to say all of the important things you want to say to others, and do things in which you find pleasure and peace. If you can’t talk about certain issues, do the best that you can do. Perhaps writing to loved ones will allow you to express your feelings when you can’t talk about them directly.

Living With Loss

Losses are a part of life and a part of cancer. Some of these losses, like hair loss and loss of fertility, are physical, but there are emotional losses as well. For example, you may have to learn to live with some limitations, or you may have to alter some goals and hopes to fit your current reality.

Every loss requires a grief response or some type of mourning, but American society is uncomfortable with grief. If you sense this discomfort, you might try to hide your feelings and emotions. But grief must be expressed in some way, and it may be transformed into other emotional experiences such as anger, guilt, or helplessness.

1. How long does a grief reaction last?

   A person’s grief is very individual. Some people may be able to deal with hair loss in a fairly short time. Another person may grieve for that lost hair until it begins to grow again. Some losses, however, are more disfiguring or disabling. You may need to adjust to an altered body image and that may take longer to deal with the grief that accompanies such physical losses. Sometimes others—friends, family members, even your health care team—may not understand the personal meaning of your loss. The result may be that you end up feeling guilty. Well meaning family and friends may make you feel guilty for being sad or depressed, or they may point out how lucky you are to be alive. This can compound your grief.

2. How can I “work through” my grief?

   Grief has been studied a great deal, and four “tasks” have been identified for coming to terms with your grief. These tasks are:

   • Accept the reality of the loss
   • Experience the pain of the grief
   • Adjust to your changed environment
   • Emotionally relocate the loss in your life and move on

3. Are there other ways I can get through my reaction to loss?

   First of all, be gentle with yourself. It’s very hard to adjust to cancer, its treatment, and all of the emotional factors that accompany cancer. Give yourself time to heal. Speak about your feelings—don’t hide your grief.

4. Are there groups or professionals who can help me adjust to my losses?

   You can attend a group meeting or talk with a professional counselor. One of the major values of peer support groups is that you find out you are not alone with your problems, that your fears and concerns are shared by others, and that your reactions are normal for your situation. If you are not comfortable sharing these kinds of feelings with such a group, you may find talking with a counselor or with a member of the clergy helpful. If you don’t know exactly who to talk with, ask your doctor for a referral to an oncology social worker who will be skilled in dealing with loss and grief.

 

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