A difficult part of the management of cancer patient is when he enters the terminal phase of his illness. When it becomes apparent that active measures to arrest further growth of the cancer are no longer proving effective, it is more important than ever to provide support and attention to the alleviation of distressing symptoms.
Psychological support is the most important aspect. But this has to be supplemented with positive measures to relieve pain, to ensure adequate and appropriate nutrition and treat specific symptoms such as cough, nausea, vomiting, pain, etc.
An individual patient’s reaction to the inevitability of death from a fatal disease depends on a host of interrelated variables including his or her cultural and religious background, age, education, the duration of the illness, reaction of dependents, etc. A period of initial disbelief and denial is often replaced by resentment and anger. This, in turn, is followed by a period of depression, which is almost universal. Many patients, with or without medical intervention, enter a final phase of peacefully accepting the inevitability of death.
When to tell patients that they have a terminal illness, is a matter of experience and judgment that cannot be easily mastered. Avoiding such discussions can only enhance the patient’s sense of loneliness and isolation.
It is not always appropriate to present all of the facts to a patient, especially on a single occasion, and time must be spent to determine the patient’s awareness of his situation. Non-committal, even ambiguous statements about the future may be appropriate but the patient should never be told what is known to be untrue.
The most important principle of managing terminal illness is to provide adequate time for talking with the patient. The doctor must learn to develop the ability to listen to the patient and to learn from him how best to provide him psychological support.
Help of an appropriate religious person or social worker is very useful in such a situation.