After all appropriate and necessary treatments have been tried, breast cancer may continue to progress or worsen, and doctors may determine it’s time to stop treatment. In some cases, it may be the patient who decides to stop treatment, when the side effects of treatments are no longer worth the impact on the quality of their life. While the time at the end of a person’s life is as unique as the individual, there are some common components and medical care that can ease a person’s transition.1
Hospice
Hospice care is a model of compassionate care given at the end of someone’s life. It is sometimes called end-of-life care, and hospice usually involves a team approach to help the patient with medical care, pain management, emotional support, and spiritual support. In hospice care, the focus is on caring, rather than curing, with the belief that each individual deserves to die pain-free and with dignity. Hospice care can also provide counseling support to the patient’s family members.1,2
Hospice care may include medical professionals, medical equipment and supplies, short-term relief services for caregivers, medications to manage breast cancer-related symptoms, spiritual support and counseling, and/or social work services. Hospice care focuses on controlling pain and symptoms of advanced breast cancer to allow patients to be as comfortable as possible near the end of life. The goal of hospice care isn’t to speed up or postpone death, and if the patient’s cancer goes into remission, hospice care can be discontinued or stopped. Making the choice to have hospice care doesn’t mean the patient is “giving up.” Rather, it means the priorities of treatment have changed.1,2
End-of-life planning
While end-of-life planning can be difficult for the person with breast cancer and for their loved ones, it enables the individual to shape the ending of their story by undertaking the steps to plan for what one wants. End-of-life planning usually includes making decisions on goals of care, where the individual wants to spend their final days (for example, at home versus in the hospital), which treatments for end-of-life care they want to receive, and what type of palliative care and/or hospice care they want to receive.3-5
End-of-life planning encompasses more than just medical care. In addition to making decisions about health care, end-of-life planning can include legal and financial decision-making, funeral and memorial planning, determining what legacy someone wants to leave for others, and/or how they want to be remembered. By making these decisions ahead of time, the person can ensure their individual values are reflected in these decisions and provide helpful information for their families and friends.3-5
Questions to consider for end-of-life planning
Conversations about death and dying can be difficult, but understanding the patient’s wishes and priorities allow the patient to have control over choices made at end of life. Some questions that can help shape a discussion include3:
- What is your understanding of the situation and its potential outcomes?
- What are your biggest fears and concerns? What are your hopes?
- What goals are most important to you?
- What trade-offs are you willing to make, and what ones are you not?
- What is the course of action that best serves this understanding?
Coping for caregivers
Watching someone you love get sicker and near the end of their life is incredibly hard, but being present for the person is one of the most important things a person can do. Ask your loved one what they want and how you can best support them. Some ideas for providing comfort include:
- Share company by talking, watching movies or shows, listening to music, or reading to them.
- Listen to your loved one’s stories of reminiscing and allow them to express their fears or concerns about dying.
- Respect their needs for privacy or quiet time.
- Reassure them you will follow their advance directives, including living wills (legal documentation that specifies the wishes of the patient on the use of breathing machines or other machines that can prolong life).1
Caregivers often put their loved one first and may neglect their own health. It’s critical that caregivers take care of themselves, including getting proper rest, nutrition, and breaks from caregiving. Taking care of someone who is at the end of their life can be incredibly stressful and can cause emotional and physical fatigue, depression, and anxiety. Ask for help from family and friends, and seek professional help if you feel overwhelmed by depression or anxiety.1
