How do you know when the end is near for a cancer patient?

[OrangePowder]

And how near?

He's past the timescale we were originally given and TBH until the last couple of weeks hasn't really seemed that ill. He's had a lot of pain, but seemed well in himself if that makes any sense.

Over the last few days, he's really reduced what he's eating. Still has a reasonable breakfast, but nothing else all day and is refusing even sips of drink. He says it makes him fee sick. It takes ages to get him to take the tablets. Asleep a lot and mostly just whimpering when he's awake.

I know this isn't the place to ask really, but his medical people seem to want to skirt around it. I know it's not good, but what might we be looking at?

When my husband was terminal, my doctor signed me off with stress. I was lucky that I was paid in full. You say you work in a school, do you (as I did as a teacher) get full pay for a decent period when you're off sick? My daughter (who lived at home with us) was doing 'on the job' teacher training and her school basically told her to go home and get herself signed off because they felt she needed to be home with her dad.
I'm surprised your school hasn't been as helpful and proactive.

For goodness' sake contact your GP and get signed off.

It's impossible to go by anyone else's experience really. The cancers, the parts of the body that the initial tumour and the metastases affect, any drug effects, will all affect people differently. I found that our MacMillan nurse and the main District Nurse in charge of his care, were the most on the ball and open about timings, but that was very much in the last days/couple of weeks.

I’ve re read your post and I definitely think a hospice is the way forward. Not only for the advice/medical eyes. It means you don’t have to stress about work as much - you can work if you want knowing he’s being cared for.

Hospice beds are at a premium though. Until my late husband was ill, I thought you could pretty much get one on demand. But it's absolutely not like that where I am. Even though there are three hospices within a ten mile radius of where I live.

The intention was always that if at all possible my husband would die at home. And we were lucky to be supported to do that, by Macmillan, our local District nursing team, and Marie Curie nurses.

The most important thing though is that you explore every possibility to take time off, OP. Apart from anything else, you don't need the stress, and you need time to gather the resources (practical and emotional) that you need. I was on the phone a lot, organising things for him, organising our affairs (getting my name as someone who could speak for us both with utility companies etc) and dealing with the various people coming in and out of the house to help him/us.

You say he's in the hospital bed all the time. Who cares for him while you're at work?

@OrangePowder is his cancer terminal or can he have treatment.
My mum died 3 years ago from pancreatic cancer it was 10 months from diagnose there was lots of times we thought it was the end but she fought it for 10 months.
In the end she fell broke her hip and was moved to a hospice probably there 2 weeks before she died the last few days she was totally unconscious and just passed away like that.
For about 8 months she was unable to do anything for herself it's hard so look after yourself too.

My dad had lung cancer it was initially suggested that 6 months might be a reasonable expectation, they wouldn’t give anything more specific but he lived for 2 years. He died at home with my mum, he was reasonably well and pain free still doing DIY etc no sign of imminent passing then he just dropped down dead. A big shock for my mum but a perfect way for him, he would have hated being in a hospital or hospice.

@OrangePowder

I can't take annual leave, I work in school (but am off this week for HT). If I thought it was going to be 4 weeks or so I would take sick leave but it could be much longer. I can't be off sick indefinitely.

I think you could take leave for the last half-term of this year and everyone would understand. I actually think it’s better if you decide now and then you’ll have certainty, your school can arrange long-term cover for the last half term, and you’ll know you have until September come what may. You need to look after yourself to look after others.

@OrangePowder

The nurse said she was going to "try" and get his meds switched to liquid form, but I'm not sure that's going to help him, especially if they taste foul. She said he's not advanced enough for intravenous pain relief. She's going to arrange anti depressants for him to see if relaxing helps.

Does your GP come out to visit? I’d be wanting a second opinion, I think. If he’s feeling sick when he eats and drinks it doesn’t sound like antidepressants are the complete answer. Hospice nurses are amazing - fact - but in this situation you can never have too many eyes and medical opinions, to be honest.

With my father in law he stopped eating and took to his bed about two weeks before he died. He was sleeping most of the time for those two weeks and was too weak to really move on his own. It's such a cruel disease. I'm sorry this is happening to you and your family OP, and everyone else on this thread x

Have they discussed morphine patches? I helped a friend look after her dying mother earlier this year and she had the patches because Oromorph made her sick. Much easier for you to manage.

Talk to your school about your situation and if they won't willingly give you leave for the half-term then ask your doctor to sign you off for a fortnight at a time. The friend I supported earlier this year ended up having two months off sick: her doctor didn't bat an eyelid at signing her off for stress and also offered her anti-depressants.

I would take the hospice up on the offer of a few days' respite care if you can. It'll give you the chance to have a breathing space and spend some time with your children. My mum went to the hospice for three days or so every few weeks, giving my sister and I a chance to catch up on sleep and deal with our own lives. I don't think we would have survived without it.

So sorry you're going through this OP.

I'm a nurse, and do a lot of palliative care in the community. It's so hard to tell, but I generally find as soon as the appetite starts going downhill and the person struggles to take medications it really doesn't take much longer to start to deteriorate properly. However that said, everyone is different and some people really do hang on a lot longer than anyone believes.

I've always tried to be honest with my patients relatives when asked, but only the other week I was looking after a lady who literally looked near the end - I estimated days rather than weeks and she lived another month. It's so difficult and I would hate to advise anyone wrongly when they're making such important decisions for the patient the wider family.

So sorry for your circumstances OP, you sound very calm and strong. Exactly what your DH needs right now

With mum it was 3 weeks of not eating, she was in hospital, she was very poorly, unconscious most of the last week before she died.
My brother was still working until 2 weeks before he died, god knows how. He was admitted to hospital about 10 days before he died and couldnt eat. He had throat cancer.
I'm so sorry OP I know it's an awful time