Treatments for cancer are improving so fast and every year the number of people who get cured increases. Though, many patients can’t get cured and they die due to the disease. This end-of-life stage can bring intense emotions both to the patient and their loved ones. But at the same time it can become a chance to decide how they want to live their last months. This post focuses on the patient with cancer at the end of life.
Post updated on December 2nd 2025.
The notion of “terminal cancer patient”
A terminal cancer patient is considered a person with a progressive, incurable oncological disease, with a life expectancy of less than 6 months.
Although the word “terminal” is the most widespread, many professionals prefer to use “end-of-life-stage“. This expression is more focused on the time it remains instead of the nearness of the death. For some people, being aware of the time that remains can become an opportunity to make decisions on how they want to live this time.
This six-months period is illustrative. Clinical experience shows that prognoses are dim, and frequently the patient lives longer than predicted. The question “how much will I live?” has seldom an exact answer.
We live as if death did not exist
Death takes up a very small place in our normal life. We are used to see it as a far phenomenon, as something that “happens to others”. Our life is like a train going at a high speed and, suddenly, crashes against an unbeatable wall. This wall is death. And death is real, athough we strive not to think of it.
Funeral rituals have also changed. We also experience them at a high speed . Nowadays, less than 48 hours pass between death and burial or cremation. And we tend to keep children away from the process. In the past, vigil holdings lasted for days and children participated, which helped to
Physical and psychological health in the patient with cancer at the end of life
A usual picture of a terminal patient is that with a fading person. Howerer, many patients can keep a normal and active life along the main part of his last months: they travel, have walks, enjoy meals and get involved in pleasing activities.
In order to live this stage like this, to accept the approaching of death is needed. The best-known model is that of the Swiss psychiatrist and writer Elisabeth Kübler-Ross. This model describes 5 stages:
- Denial: The patient rejects the prognosis, and attributes the diagnosis to a mistake.
- Anger: The patient feels frustrated for all the future experiences that he won’t be able to live.
- Bargaining: The attempt to negotiate with God or with the medical team to get more time.
- Depression: The patient understands that there is nothing he can do to avoid death.
- Acceptance: Many people achieve a sort of a calm in front of what is inevitable. This doesn’t mean that they stop being sad.
Anyway this model is not always linear. The process is often irregular, it advances, it retreats, unexpected reactions and emotions like fear, anger, sadness and uncertainty appear, as well as concerns for the family, specially for children do.
The importance of palliative care
Palliative care are a complete plan to control the physical and psychological symptoms of the patient with cancer at the end of life: pain, confusion, fatigue, loss of appetite, etc.. To do so, caregiving requires a multidisciplinary team with doctors, nurses, psychologists, social workers and other professionals.
Shared decision making and clear communication are key. From the disclosure of bad news until the accompanying following death communication is the axis that holds the patient’s and his family’s dignity and autonomy.
You will want to read too: Communication within the family during cancer and Communication among the oncologist and the patient
Establishing feasible goals
The difficulty to accept the approaching of death can drive to therapeutic obstinacy: this is, to insist in treatments that bring no benefit but, at the same time, can damage quality of life. This obstinacy can come from the patient itself, from the family or from the medical staff. It has good intentions, but its result is counter-productive.
Patient, family and medical staff take different speeds to mode forward the acceptance of death. With this, disagreements about which decisions are to be made can rise. For years, avoidance of death at all cost, even above improving quality of life, was the priority. But fortunately this view is changing.
When healing becomes impossible, to set it as a goal can only drive to frustration. It is more feasible setting other goals like symptom control in order to use time doing meaningful activities.
At the same time it is little realistic requiring the patient to be “happy” during this stage. It is more suitable the aim for alleviating emotional suffering, making symptoms milder: to transform desperation into sadness; or terror into concern. Some people get to die happy, but it shouldn’t be imposed as a goal.
You can read too: 10 benefits of psychological support for cancer patients
How to live last months
It takes time to accept that death approaches. All reactions are acceptable: fear, anger, crying, silence, etc. Sentences like “everything will be alright” or “you must be strong” may have a good intention, but they can add feelings of pressure and discomfort.
It is usual that the patient with cancer at the end of live is more worried about his family than about itself. Although it may seem surprising, it’s a fair concern and it deserves being respected.
Conversations about tough issues (inheritances, funeral ceremonies, pending matters) can produce reluctance. The best way to tackle them is finding a quiet moment and telling that, although these can be hard conversations, they can help to alleviate suffering. This can be done by both the patient or a family member.
When quality of life makes it possible, many patients consider this stage as an opportunity to solve pending issues. Some real examples I have seen in my clinical practice are:
- Making up with a brother after 30 years of not talking to him.
- Paying the granddaughter’s wedding, and attending it.
- Learning something meaningful (e.g., to write own’s name in chinese).
- Going all over America from north to south.
In Psychology we also work on the life review or reminiscence: a review of own’s story to find a meaning to life. This process provides calm and helps to close stages.
Patient’s family may also need emotional accompanying. Their suffering is as meaningful as that of the patient, and they can seek professional psychological assistance if they need it.
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