Emotions and Coping as You Near the End of Life

This is written for the person with advanced cancer, but it can be helpful to the people who care for, love, and support this person, too.

Knowing that death is not far away takes an emotional toll on the person with cancer and their loved ones. Some people might feel shock or fear. They might feel guilty about being a burden or worry about how their death will affect loved ones left behind. This is an emotional time, and though it’s hard to talk about them, these issues must be addressed. Knowing these feelings are normal and expected may help you cope with what’s happening. Some of the emotions you can expect to have include:

Fear

People are often afraid to die, but sometimes it can help to pinpoint what part of death they’re afraid of. Are they afraid of where they might die? Are they afraid of dying alone? Are they afraid of suffering or pain? Are they afraid they’ll die and there will be nothing beyond earthly life? Is there a fear that their lives had no purpose or meaning? These are some of the more common reasons for how people may fear death.

Trying to figure out what you fear can help you face it and manage it. It will also help others be able to support and care for you better. For example, if you’re afraid of being alone, share this with your family and loved ones so they can try to always have someone with you. Sharing with loved ones and your health care team gives them a chance to help you find ways to cope with and ease some of your fears. It gives them a chance to talk with you about the ideas you may have, too. It can also give you a chance to look at and deal with some of your fears in new ways.

Anger

Anger is sometimes hard to identify. Very few people actually feel ready to die. It’s perfectly normal to feel angry about your life ending – maybe earlier than you expected. It’s unfair and you have a right to be mad! Unfortunately, anger often gets directed at those closest to us, the ones we love the most. We feel safest with these people and know they’ll probably accept our anger and forgive us for it. But it might help to try to direct anger at the disease and not your loved ones. Also, you can try to channel your anger as a source of energy to help you take action where it’s needed. You can use it as fuel to solve problems, to become assertive, or to get your needs met. Try to re-channel your anger to do meaningful, positive things.

Guilt and regret

In the last stage of life, a person might regret or feel guilty about things they have done or not done, or maybe about things they have said. We feel regret when we think that we should have done something differently. Or maybe there’s something we wish we had not done at all. We may feel guilty when we don’t meet our own expectations or think we haven't met someone else's. But worrying endlessly about things won’t make you feel better about them. Worrying won’t improve relationships or ease burdens.

Sometimes the best thing to do is to decide to “let yourself off the hook” and not feel guilty about things that are out of your control. You can’t change the past, but there are things you might be able to do today. Maybe you'll consider apologizing for the things you regret. Maybe you can ask for forgiveness or forgive others and yourself. It may be best to try to let go of the things that can’t be changed.

This is a good time to talk with your children about the important things you want them to know. It’s also good to talk to them about how to handle their feelings and the loss they will soon go through. Spend your time focusing on your children’s future, not feeling guilty about the past. Strengthen your relationships with loved ones. You may want to write letters to the people you love, record messages for them, or make videos they can watch – give them things they can keep to remember their time with you. Live the best life you can, and use your time for what’s most important to you.

Grief

It’s natural to feel intense grief during the last stage of your life. You’re grieving the loss of the life you planned and expected. You might feel well and not have many symptoms, so you're having trouble grasping that much loss is going to happen. Or, you may have lost things already, such as the strength to get around like you used to, or the interest in doing the things you enjoy, or maybe the ability to get together with friends. You may feel distanced from those who are not coping well with the fact that you are in your last stage of life. This is another loss that can cause sadness and grief. Many physical and emotional losses come before the loss of life itself.

The people you love are grieving too. They know they’re about to physically lose you. How can you and those who love you find meaning in what’s happening? Try to talk to your loved ones about the grief and loss of dreams you’re all going through. Being able to connect spiritually to something greater than one’s self might help your loved ones heal after you are gone.

Talking with someone about these feelings – a partner, a dear friend, a spiritual advisor, someone you trust – can help you process these feelings so that they no longer weigh you down. It may take many tries, but can help you feel that a burden has been lifted. It can help you move on to care for other physical and emotional tasks that are part of the end of life. There are many important tasks at the end of life, but coming to terms with the losses is one of the most painful.

Anxiety and depression

What does anxiety feel like? Anxiety has been described as having a nervous stomach, a shaky feeling all over, being short-tempered, a sense of dread or worry, or a fear of the unknown. It can be unpleasant and make you worry.

Some anxiety is expected, but if it’s severe it may need to be treated through counseling or with medicine. The goal is to make you more comfortable and help you better cope with the changes that are taking place. Anti-anxiety medicines or even anti-depressants may be able to help. Counseling may be especially helpful in helping you focus on the present and not worry about tomorrow. Breaking problems into smaller, easier-to-manage pieces can be a good way to handle some kinds of anxiety.

Depression is more than just feeling sad. Depression includes feeling hopeless or helpless, feeling useless, feeling sad for weeks at a time, and having no joy in any activity. These feelings are not normal, not even when life is ending. Depression can sometimes be helped with anti-depressants, counseling, or a combination of both. Managing anxiety and depression well can make a big difference in how much joy or pleasure you can find in your last stage of life.

Feeling alone

When someone knows they’ve reached their last stage of life, there can be a loneliness that’s different from any other. It’s a loneliness that happens even when you have people around you. There may be people who can really talk with you in a way that helps you feel less lonely. Some of them may be experts who are comfortable talking with people at the end of life, such as hospice social workers, nurses, or other end-of-life caregivers. They may have that special gift for silence or listening when you need it. Finding people that you can connect with can ease your sense of loneliness. Your health care team may end up being one of your greatest resources in this area.

Seeking meaning

It's normal to want to feel like there's a purpose in life and that there is a reason for being on earth and for what has happened in life. Some people find meaning in their work. Others find that raising a family has brought them the greatest sense of joy and accomplishment. It’s helpful to go through a process of reviewing your life and trying to find out what your purpose in life has been. Maybe you're wondering what your special contribution to the world has been. Or, what you have done to make the world a better place. Maybe you would like the world or your children, family, and friends to remember you in a certain way. Think about what things have been really important and that you want your children to know about for their future. It doesn’t have to be something huge or earth-shaking – look for those things that have been important to you and those around you. The end of life experience is full of meaning that can be uncovered using personal reflection. Sharing your thoughts, experiences, and wisdom is a gift that your friends and family can cherish for years to come.