End-of-life care of a cancer patient:

End-of-life care of a patient with cancer should be considered the most important component during the cancer journey. A patient with cancer suffers many difficulties while fighting the disease. These sufferings and difficulties are as follows.

Altered nutrition: End-of-life care of a cancer patient:

 Nutrition is the basic requirement for the human body. Patients suffering from cancer are unable to fulfill this need due to multiple factors, as follows.

Pain: End-of-life care of a cancer patient:

Pain in the cancer patient is one of the most disturbing factors. If a patient is in pain, he or she is unable to take proper diet.

Secondly, medication used to control has side effects, such as drowsiness and lethargy, due to which the patient becomes unable to take proper nutrition. This further leads to weight loss and weakness.

So, in a patient who is suffering from end-stage nutritional management is very important to fulfill the body’s requirements. This is done if following ways.

Nutrition given through a vein:

In this method, a diet full of nutritional requirements is given to the patient through a vein. Secondly, for parental nutrition, a central line is recommended to give the nutrition.

By passing a nasogastric tube: in this method, a tube is passed through the nasal pathway, which empties into the stomach, and nutrition, usually in liquid form, is given through it.

By peg tube: End-of-life care of a cancer patient:

If the food tube or stomach of the patient is obstructed, a tube is placed surgically in the stomach, or the first part of the small intestine is placed to provide nutrition.

Oral diet: End-of-life care of a cancer patient:

If a patient can take orally, some supplemental diet such as Pediasure or Ensure could be added in routine with a soft or liquid diet.

For calories, a soft diet or a liquid diet, which is less in quantity but packed with calories, is recommended.

The food should be given in small portions for proper absorption and to prevent indigestion.

How to prevent indigestion?

To prevent indigestion, the proper quantity and nature of the food are very important. The food should be well-cooked and hygienic.

Secondly, the patient’s activity is necessary to keep the gut active. If the patient is in complete bed rest. Food must be given in the sitting position. And medicine to improve gut motility should be added.

Nausea and vomiting:

Nausea and vomiting also disturbs patient’s nutrition. So, patients who are suffering from indigestion, medicine for nausea and vomiting must be administered before feeding.

Furthermore, a patient at the end stage is at high risk for aspiration (food slips into air tube while feeding or due to reflex back from the stomach).

How to prevent a patient from food aspiration?

Food aspiration could be a medical emergency if not followed properly. Patients who are at high risk for food aspiration should be monitored closely; the following precautions should be taken to prevent food aspiration.

• Keep the patient in an upright position while feeding or at least 30 minutes after feeding.
• While sleeping, the patient should be lying in the left lateral position so that the food can be expelled safely.
• Must assess the level of consciousness before giving food. If the patient is unable to swallow the food, do not give forcefully.

Some tumors,s such as cancer of the gastrointestinal tract:

Patient’s nutrition gets disturbed due to tumors such as gastric tube cancers or stomach or intestinal tumors. In such patients, the nutritional requirements become a top challenge for healthcare providers.

In patients with such conditions, a liquid diet or total parental nutrition is required. However, in some cases, such as intestinal obstruction (small bowel or large bowel obstruction), patients’ nutritional requirements are fulfilled through only total parental nutrition.

Unable to feed due to severe weakness:

In the end stage of a cancer patient, weakness becomes the major issue. This is due to the following reasons:

• Poor nutrition
• Muscle weakness due to severe malnutrition
• Disease progression: In patients with metastatic disease, many body systems become affected, such as the lungs, liver, intestines, bone marrow, and brain. In such cases patient become fully dependent on others to fulfill their needs. A patient with such a condition becomes physically weak and bedbound.

How to take care of a bedbound patient?

A bedbound patient is unable to perform daily activities and cannot get out of bed or walk. Such a patient becomes highly risky for the following complications.s

• Risk of Skin breakdown: End-of-life care of a cancer patient:

A fully bedbound patient is at higher risk of skin damage, usually known as bedsores, which typically occur under bony areas.

How to prevent bedsores/skin breakdown in such patients?

A skin breakdown or bedsore is prevented through the following measures:

• Frequent positioning of a patient
• Back massage with a good moisturizer, which helps in improving blood circulation and also gives a soothing effect to the patient.
• Apply an air mattress to reduce friction and pressure
• Make a chart to keep a record of frequent position changes
• Frequent diaper change also helps in keeping skin dry and prevents skin rashes, which can further lead to skin breakdown.
• In such patients, proper hydration is very important to keep the skin intact. This may be carried out by providing fluids orally or in the form of intravenous.

Mouth ulcers: End-of-life care of a cancer patient:

Mouth ulcers are also a major issue in patients with compromised immunity, which directly impact patient’s nutritional status. To prevent mouth ulcers following skills should be performed

• Mouth care with a good antiseptic mouthwash after every meal
• Rinsing with salty water can prevent getting an oral cavity infection. This should also be done after every meal.

Pain management in end life stage.

Pain management is the most important issue for patients with terminal illness. The most important priority in this stage is to keep the patient free from pain. The pain control can be done through the following measures:

• Oral pain killers
• Intravenous pain killers
• Patient-controlled analgesia in the most severe cases

 Disturbed Emotional or mental health and depression:

As in the end stage of cancer, there is no hope for a cure, patients are mentally disturbed due to many factors such as physical dependency, pain, altered body image due to hair loss or any amputation or breast removal.

All these factors affect patients’ mental health and can lead to depression. To manage depression and isolation of the patient at this stage, give emotional support by offering your presence all the time, try to meet up with the patient with her/his loved ones or favorite person.

Fear of separation/death:

Patients at the end stage of cancer feel depressed due to the nature of the disease and the fear of separation from their loved ones. Always be with the patient in a peaceful environment and surround the patient with love and good memories.

Physical care: End-of-life care of a cancer patient:

Patients at the end of life stage need physical assistance for feeding, bathing, and walking, so assist patients in taking meals, take care of personal hygiene by providing bed bath, sponge bath, hair wash, mouth care, and perineal care. Keeping a patient physically neat and clean make patient comfortable and relaxed.