KEY points: End-of-life care provides physical, mental and emotional comfort, as well as social support, to people who are living with and dying of advanced illness. People who have already discussed their wishes for end-of-life care with their loved ones feel less stress at the end of their life, and so do their families.

Advance directives are legal documents that record a person’s wishes for end-of-life care. Research has shown that hospice care may improve the quality of life of a cancer patient who is dying and of the patient’s family.

What does end-of-life care mean for people who have cancer? When a cancer patient’s healthcare team determines that the cancer can no longer be controlled, medical testing and cancer treatment often stop. But the person’s care continues, with an emphasis on improving their quality of life and that of their loved ones, and making them comfortable for the following weeks or months.

Medicines and treatments people receive at the end of life can control pain and other symptoms, such as constipation, nausea, and shortness of breath. Some people remain at home while receiving these treatments, whereas others enter a hospital or other facility. Either way, services are available to help patients and their families with the medical, psychological, social and spiritual issues around dying.

Hospice programs are the most comprehensive and coordinated providers of these services. In Guam the hospice programs operate out of a person's home. A nurse may be sent to the home to assess and assist the patient and provide support. A hospice director is the physician in charge and will be advised if symptoms are not controllable at home or if further need for medications arise.

Pain control is a cornerstone of symptom management. Pain in a loved one many times means pain for the family that is around and assisting the patient with pain. Soon enough it becomes a symptom not only for the patient, but also for the whole family; therefore the importance of pain control in end-stages of cancer.

The period at the end of life is different for each person. The signs and symptoms people have vary as their illness continues, and each person has unique needs for information, palliative treatment, and support. Questions and concerns that family members have about the end of life should be discussed with each other, as well as with the healthcare team, as they arise.

Communication about end-of-life care and decision-making during the final months of a person’s life are very important. Research has shown that if a person who has advanced cancer discusses his or her options for care with a doctor early on, that person’s level of stress decreases and their ability to cope with illness increases. Studies also show that patients prefer an open and honest conversation with their doctor about choices for end-of-life care early in the course of their disease, and are more satisfied when they have this talk.

Experts strongly encourage patients to complete advance directives, which are documents stating a person’s wishes for care. They can dictate (of course upon previous discussion and thought) wishes about life support – intubation (the act of putting a breathing tube in the windpipe of a patient) and cardiac resuscitation, as well as the overall level of "investment" from the healthcare system. They also designate who the patient chooses as the decision-maker for their care when they are unable to decide. It’s important for people with cancer to have these decisions made before they become too sick to make them.

However, if a person does become too sick before they have completed an advance directive, it’s helpful for family caregivers to know what type of care their loved one would want to receive. In fact, everyone – not just cancer patients – should have a good idea of how they view topics such as cardiac resuscitation, intubation and the overall level of investment desired.

Your primary care physician is a good source to start discussion about this topic. Please make sure to bring this up on your next visit with your family doctor. This will ensure that everyone has the questions answered and there are no surprises if something should happen. So beware of issues regarding end of life – this is important for everyone.

We will have more information in future articles.