Pancreatic Cancer

End of life and professional care

Many people wonder what to expect as they reach the end of life. The dying process is unique to each person and people’s needs for symptom management will differ as death approaches. Symptoms may include loss of weight, muscle atrophy, fatigue, weakness, significant loss of appetite and excess fluid in the abdomen (ascites) (see ‘Symptoms of more advanced disease’).
 
People may also develop a bowel obstruction due to tumour growth or a deep vein thrombosis of the upper or lower extremities (Trousseau’s syndrome). They may also have more pain than in the earlier stages of the disease, but doctors have many ways of controlling pain (see ‘Pain management and other palliative care’). People often die from a secondary medical problem, such as pneumonia.
Some people choose to die at home, others in a hospice, although beds are not always available. Many die in hospital; they may be there because a particular problem needs special attention, e.g. a bowel obstruction or a serious infection. Others may be in hospital because they don’t want to be at home but have no access to a hospice; some may choose hospital because they have great trust in the hospital staff (see ‘Making plans for death’).
 
We interviewed some people who had been bereaved through pancreatic cancer. They talked about the palliative care their relative had received. Pain seemed to be quite well controlled wherever people died. Judging when someone will die is difficult, even for experienced professionals. Some people had been told their relative would die within the next day or two, but they lived for much longer.
Palliative care can be given at home by specialist palliative care teams of doctors and nurses. Charities such as Marie Curie Cancer Care (see ‘Resources’ section) offer nursing services at home. These community palliative care services can be accessed via GPs and district nurses. Some people recalled having had excellent nursing and medical care for relatives who had died at home (also see ‘Pain management and other palliative care’). Hugh vividly remembered the care the Marie Curie nurses provided for his mother at home. She had also been visited by a doctor who specialised in pain relief. He said that they were ‘incredible people’. The doctors and nurses gave moral support as well as excellent medical care (also see ‘Other sources of support’).
Several people wished they had got in touch with palliative care nurses earlier. John (Interview 21) and his wife, for example, had assumed things were not bad enough and put off seeking their help. Similarly, Simon regretted not getting the GP and the specialist palliative care nurses involved earlier. But when his wife Karen was dying, he contacted the local palliative care team. The nurses supported both him and his wife. They called frequently during the day and sometimes at night. Sometimes they stayed in the house for two to three hours. As Karen became frailer she moved from the upstairs bedroom downstairs into the front room. The nurses managed to get a hospital bed with an electronic lifting mechanism to make nursing easier. As death approached Karen was sometimes unconscious, but when she noticed her surroundings she was glad to have members of the family by her bed. Karen died peacefully. After she died Simon and his daughters spent some time with her.
John (Interview 21) had cared for his first wife, Ann, until she died. He had the help of a wonderful team of nurses who worked for the Ellenor Hospice at Home charity. These nurses would phone to see if Ann needed anything. They administered pain relief and sometimes stayed the night. John found this comforting – it meant he could sleep through the night without worrying.
Dying in a hospice
Some people’s relatives had died in a hospice. People had spent a few days there before they died. Hospices aim to meet people's physical, emotional, social and spiritual needs. People can also attend a hospice as a day patient for one or two days a week, and are often pleasantly surprised by the cheerful atmosphere and the wonderful support there (also see our Living with dying section).
 
Saba’s mother had attended a hospice once a week for a while. Saba didn’t think her mother had benefited much as a day patient, but said that when her mother was dying, the hospice had been their ‘saving grace’. The staff had respected the family’s Muslim traditions and had treated her mother as a ‘human being’. Saba concluded that the hospice had been the ‘perfect place’ for her mother’s last days. She was also most impressed that the nurses had referred to her mother by name even after she had died. Saba felt that this showed respect.
David’s wife, Fiona, had also died in a hospice. He had visited the place a few weeks before she died. Fiona had liked the hospice – it felt a bit like a hotel. The rooms were attractive rather than simply functional, the food was good and the staff had time to talk, to care and to give drugs as soon as Fiona needed them. David and his sons could visit at any time and they sometimes stayed the night.
Dying in hospital
Anthony’s wife, Martine, died peacefully in hospital. He said that she just stopped breathing. The hospital staff had done all they could to care for her both medically and psychologically.
Theadora’s mother died in hospital. Morphine kept her reasonably comfortable during the four days before she died. She was distressed for a short time, but Theadora said the death was ‘as dignified as you can have in a hospital setting’ with her family around her (see ‘Making plans for death’).
 
Susan’s mother also died in hospital. After being ill at home she developed pneumonia and went into hospital. There the doctors gave her intravenous antibiotics and morphine, but her condition deteriorated and she died two days later.
Last reviewed June 2015.

 

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