End of Life Care and Dietby Amy Thomas Patient Expert
While for most people the primary goal of eating and drinking is to sustain energy and life, the goal of nutritional care for those with advanced cancer is quite different. Advanced cancer usually refers to cancer that can no longer be cured, and care of someone at this end stage is typically aimed at preserving the dignity and quality of life. The purpose of eating and drinking shifts from life-prolonging to life-enhancing, and recognizing the change in focus can alleviate some of the stress related to end of life care.
People with advanced cancer generally eat less solid food, and they often prefer soft foods and clear liquids. It's not unusual for someone to refuse food and water in the final days or weeks of their life. Terminally ill patients are often satisfied with small amounts of food, and may only request water to alleviate dry mouth, a frequent complaint at the end of life. Though dry mouth is common, numerous studies have shown that hydration status does not improve this symptom, and patients often benefit more from standard oral care and application of moisture to the lips and mouth. While hydration may have benefit in some cases, including reducing nausea and alleviating delirium, it may worsen respiratory secretions which can be difficult to manage. Given these variables, indiscriminate hydration of terminally ill patients is generally not recommended.
In end of life care, food can be viewed as a source of enjoyment and palliation.
Restriction of generally unhealthy foods (high sugar, high fat) is less of a concern for those in the end stages of life, and any recommendation of dietary restriction should factor in the patient's wishes and quality of life. In certain patients prone to bowel obstruction (those with pancreatic, uterine, ovarian, colon, and some other cancers) doctors may recommend avoiding raw fruits and vegetables, nuts, and seeds because the discomfort from bowel obstruction is typically worse than simply avoiding these particular types of food. But in other cases, such as avoiding sweets to improve blood sugar control in a patient with diabetes, certain restrictions can cause more burden than benefit.
In some cases nutrition and hydration may be viewed as extraordinary means of prolonging life, and at this point the family and caregivers of a patient with advanced cancer may decide to withhold food and drink to avoid extending any discomfort their loved one is experiencing. Caregivers often struggle with the dilemma of withholding food and drink, but the process of starvation is not typically painful, and administering food and drink to a dying person can often prolong the discomfort related to end-stage cancer. Metabolic changes related to starvation, particularly the natural production of ketones for energy, actually suppress the sensation of hunger and trigger a mild sense of euphoria. Studies also indicate the body produces natural pain relievers called endorphins in response to lack of food. The benefits of natural pain relief can be lost when a dying person who is not requesting food is forced to eat.
Decisions about end of life care are ideally made by the patient with support of their loved ones, though there are times when the person dying is unable to fully participate. In these cases family members and caregivers must make decisions with consideration of what the person's preference would likely be and with guidance from the medical care team experienced in such matters. Though generally the rules of nutrition don't apply to someone with advanced cancer, the basic instinct to nourish someone is often difficult to overcome, and caregivers can feel conflicted when making decisions about feeding and hydration for a terminally ill patient. All parties involved should be fully informed by the medical care team to address and possibly alleviate feelings of doubt and uncertainty. To learn more about end of life care please visit the following websites: