Coping with Terminal Cancer
Sometimes, cancer cannot be cured. When that is the case, patients and families are
faced with complex emotions and decisions and a variety of end-of-life issues.
A terminally ill person is not expected to be cured of his or her disease or illness,
but still requires a lot of care and comfort. Knowing what a dying person understands
about his or her condition, as well as his or her fears, feelings, emotions, and physical
changes that occur may help those around them make the diagnosis and dying process
easier to cope with.
The emotional, physical, and spiritual impact a dying friend, family member, or spouse
has on a family and community cannot be measured. Understanding how people at different
ages and developmental levels view death and dying may help to alleviate many of the
fears and uncertainties associated with this process. It is important to realize that
people from non-Western cultures may express grief and make decisions in a way that
may appear unfamiliar or unreasonable, but be culturally appropriate within the framework
of their own culture or community.
The concept of death
Everyone has his or her own unique concept of death. Past experiences with death,
as well as one's age, religious beliefs, emotional development, and surroundings are
what most influence one's own concept of death. Movies, television, and books are
filled with images of death. The person with a terminal condition may have previously
lost a family member, friend, or pet. Treating death as a part of life is difficult,
but may help alleviate some of the fear and confusion associated with it. Dealing
with death must be done within the belief system of the patient and family.
How children and youth view death
Infant. For an infant, death has no real concept. Infants do, however, react to separation
from parent(s), painful procedures, and any alteration in their routine. An infant
that is terminally ill will require as much care, physically and emotionally, to maintain
a comfortable environment as any age group. Maintaining a consistent routine is important
for the infant and his or her caregivers. Because infants cannot verbally communicate
their needs, fear is often expressed by crying.
Toddler. For toddlers, death has very little meaning. They may receive the most anxiety from
the emotions of those around them. When a toddler's parents and loved ones are sad,
depressed, scared, or angry, they sense these emotions and become upset or afraid.
The terms death or forever or permanent may not have real value to children of this age group. Even with previous experiences
with death, the child may not understand the relationship between life and death.
Preschooler. Preschool-aged children may begin to understand that death is something feared by
adults. This age group may view death as temporary or reversible, as in cartoons.
Death is often explained to this age group as went to heaven. Most children in this age group do not understand that death is permanent, that
everyone and every living thing will eventually die, and that dead things do not eat,
sleep, or breathe. Death should not be explained as sleep to prevent the possible development of a sleep disorder.
Their experience with death is influenced by those around them. They may ask questions
about why? and how? death occurs. Preschool children may feel that their thoughts or actions have caused
the death and/or sadness of those around them. The preschool child may have feelings
of guilt and shame.
When children in this age group become seriously ill, they may believe it is punishment
for something they did or thought about. They do not understand how their parents
could not have protected them from this illness.
This same idea may make preschool-age siblings of a dying child feel as if they are
the cause of the illness and death. Young siblings of dying children need a great
deal of reassurance and comfort during this time period.
School-age child. School-aged children are developing a more realistic understanding of death. Although
death may be personified as an angel, skeleton, or ghost, this age group is beginning
to understand death as permanent, universal, and inevitable. They may be very curious
about the physical process of death and what happens after a person dies. They may
fear their own death because of uncertainty of what happens to them after they die.
Fear of the unknown, loss of control, and separation from family and friends can be
the school-aged child's main sources of anxiety and fear related to death.
Adolescent. As with people of all ages, past experiences and emotional development greatly influence
an adolescent's concept of death. Most adolescents understand that death is permanent,
universal, and inevitable. They may or may not have had past experiences with death
of a family member, friend, or pet. Adolescents, similar to adults, may want to have
their religious or cultural rituals observed.
Most adolescents are beginning to establish their identity, independence, and relationship
to peer groups. A predominant theme in adolescence is feelings of immortality or being
exempt from death. Their realization of their own death threatens all of these objectives.
Denial and defiant attitudes may suddenly change the personality of a teenager facing
death. Adolescents may feel as if they no longer belong or fit in with their peers.
In addition, they may feel as if they are unable to communicate with their parents.
Another important concept among adolescents is self-image. A terminal illness and/or
the effects of treatment may cause many physical changes that they must endure. Adolescents
may feel alone in their struggle, and scared, and angry.
It is important for parents to realize that children of all ages respond to death
in a unique way. Children need support and, in particular, someone who will listen
to their thoughts and provide reassurance to alleviate their fears.
How adults deal with death
Grief is a natural human response to the loss of a loved one. It can manifest itself
in many ways. Grief moves in and out of stages from disbelief and denial, to anger
and guilt, to finding a source of comfort, to eventually adjusting to the loss.
It is normal for both the dying person and the survivors to experience grief. For
survivors, the grieving process can take many years and many forms. The challenge
of accepting death and dying as the end stage of life is what the grieving process
is all about.
What is anticipatory grief vs. sudden loss?
Anticipatory grief. This occurs when someone has a prolonged illness, and the patient, as well as the
family, anticipates death. Anticipating the loss of a loved one can be just as painful
and stressful as the actual act of losing that person. Anticipatory grief allows the
family to prepare for the inevitable death. This can be a time to resolve issues and
concerns; seek the support of spiritual leaders, family, and friends; and clarify
the loved one's wishes for funeral and burial arrangements and other end-of-life issues.
Sudden loss. This refers to a death that happens unexpectedly and suddenly, such as a fatal accident
or heart attack. Such tragedies can leave survivors feeling shocked and confused.
Loved ones are often left with many questions, unresolved issues, and a range of emotions,
including anger, guilt, and pain. Support from family, friends, and clergy is vital
to persons experiencing sudden loss.
What may happen in the case of anticipated loss?
Many, although not all, people facing their own death are willing to discuss issues
of death and dying. This can be a time to discuss spiritual issues, resolve family
concerns, reflect on a loved one's life and accomplishments, and express gratitude.
Some may feel that they have unfinished work of personal importance that they must
complete. It also provides an opportunity to put practical matters in order, including
Can funeral expenses be pre-paid?
Which funeral home would the person prefer to handle arrangements?
Can the person assist with obituary information to make sure it is accurate and complete?
What are the individual's specific funeral wishes?
If a church service is in order, can the person facing death help plan favorite scripture
passages or hymns?
Is cremation or burial preferred?
Has a cemetery plot been purchased?
Does the person wish for memorial contributions to be made to a particular charity
or benevolent organization?
Can the person direct others regarding important practical issues, such as wills,
bank accounts, lawyer's name, pension plans, retirement funds, and life insurance