Overview
Managing Symptoms
Ethical Issues
Care in the Final Hours
Grief and Loss
Get More Information From NCI
Changes to This Summary (04/28/2009)
Questions or Comments About This Summary
About PDQ

Overview

Key Points for This Section

Planning for the end of life can be both rewarding and difficult. Making end-of-life plans can lower the stress on both the patient and the family. Palliative care relieves symptoms and can improve the quality of life for patients and their families. Hospice programs provide care given by experts on end-of-life issues.

Planning for the end of life can be both rewarding and difficult.

Thinking about and planning for the end-of-life can be a difficult time for patients and their families. Each person will have unique needs and will cope in different ways. This time is easier when patients, families, and health care providers talk openly about end-of-life plans. For many patients and their families, this can be a time of personal growth. These events often give people the chance to find out more about themselves and appreciate what is most important to them.

This summary discusses care during the last days and last hours of life, including treatment of common symptoms and ethical questions that may come up. It may help patients and their families prepare for the kinds of decisions that may be needed during this time.

Making end-of-life plans can lower the stress on both the patient and the family.

When treatment choices and plans are discussed before the last days of life, it can lower the stress on both the patient and the family. Knowing the patient's wishes can help make it easier for family members to make major decisions for the patient during a very emotional time. It is most helpful if end-of life planning and decision-making begin soon after diagnosis and continue during the course of the disease. Having these decisions in writing can make the patient's wishes clear to both the family and the health care team.

End-of-life planning usually includes making choices about the following:

• The goals of care (for example, whether to use certain medicines during the last days of life).
• Where the patient wants to spend his or her final days.
• Which treatments for end-of-life care the patient wishes to receive.
• What type of palliative care and hospice care the patient wishes to receive.

Palliative care relieves symptoms and can improve the quality of life for patients and their families.

The goal of palliative care is to improve the patient's and the family's quality of life by preventing and relieving suffering. This includes treating physical symptoms such as pain, and dealing with emotional, social, and spiritual concerns.

When palliative treatment is given at the end of life, care is taken to make sure the patient's wishes about treatments he or she wants to receive are followed.

Hospice programs provide care given by experts on end-of-life issues.

Hospice is a program that gives care to people who are near the end of life and have stopped treatment to cure or control their cancer. Hospice care is usually meant for patients who are not expected to live longer than six months. Hospice care focuses on quality of life rather than length of life. The goal of hospice is to help patients live each day to the fullest by making them comfortable and relieving their symptoms. This may include palliative care to control pain and other symptoms so the patient can be as alert and comfortable as possible. Services to help and support the emotional, social, and spiritual needs of patients and their families are also an important part of hospice care.

Hospice programs are designed to keep a patient at home with family and friends, but hospice programs also provide services in hospice centers and in some hospitals and nursing home facilities. The hospice team includes doctors, nurses, spiritual advisors, social workers, nutritionists, and volunteers. Team members are specially trained on issues that occur at the end-of-life. After the patient's death, the hospice program continues to offer support, including grief or bereavement counseling.

(See the PDQ summary on Transitional Care Planning ¹ for more information on home care needs.)

Managing Symptoms

Key Points for This Section

Pain Pain medicines can be given in several ways. Pain during the final hours of life can usually be controlled. Myoclonic jerking may be a side effect of opioid use. Fatigue Shortness of Breath Feeling short of breath is common during the final days or weeks of life. The use of opioids and other methods can help the patient breathe more easily. Cough Death Rattle Rattle occurs when saliva or other fluids collect in the throat and upper airways. Non-drug treatments for rattle include changing the patient's position and giving less fluid. Death rattle is a sign that death may soon occur. Delirium Delirium is common at the end of life. Delirium may be controlled by finding and treating the cause. Hallucinations that are not related to delirium often occur at the end of life. Fever Hemorrhage Sudden hemorrhage (heavy bleeding) may occur in patients who have certain cancers or disorders. Making the patient comfortable is the main goal of care during hemorrhage at the end of life.

Common symptoms at the end of life include pain, feeling very tired, coughing, shortness of breath, rattle, delirium, and fever. Bleeding may also occur.

Pain

Pain medicines can be given in several ways.

In the last days, a patient may not be able to swallow pain medicine. When patients cannot take medicines by mouth, the pain medicine may be given by placing it under the tongue or into the rectum, by injection or infusion, or by placing a patch on the skin. These methods can be used at home with a doctor's order.

Pain during the final hours of life can usually be controlled.

Opioid analgesics work very well to relieve pain and are commonly used at the end of life. Some patients worry that the use of opioids may cause death to occur sooner, but studies have shown no link between opioid use and early death.

(See the PDQ summary on Pain ² for more information about opioids.)

Myoclonic jerking may be a side effect of opioid use.

Myoclonic jerks are sudden muscle twitches or jerks that cannot be controlled by the person having them. A hiccup is one type of myoclonic jerk. Myoclonic jerking often occurs in the arms or legs. Taking very high doses of an opioid for a long time may cause this side effect, but it can have other causes as well. In patients taking opioids, it may begin with jerking movements that happen once in a while and then begin to happen more often. Rarely, there is constant jerking of different muscle groups all over the body.

When opioids are the cause of myoclonic jerking, changing to another opioid may help. Different patients respond to opioids in different ways and certain opioids may be more likely than others to cause myoclonic jerking in some people.

When the patient is very near death, medicine to stop the myoclonic jerking may be given instead of changing the opioid. When myoclonic jerking is severe, drugs may be used to calm the patient down, relieve anxiety, and help the patient sleep.

Fatigue

Fatigue (feeling very tired) can have many causes at the end of life. These include physical and mental changes and side effects of treatments. Drugs that increase brain activity, alertness, attention, and energy may be helpful. (See the PDQ summary on Fatigue ³ for more information.)

Shortness of Breath

Feeling short of breath is common during the final days or weeks of life.

Shortness of breath or not being able to catch your breath is often caused by advanced cancer. Other causes include the following:

• Build-up of fluid in the abdomen.
• Loss of muscle strength.
• Hypoxemia (a condition in which there is not enough oxygen in the blood).
• Chronic obstructive pulmonary disease (COPD).
• Pneumonia.
• Infection.

The use of opioids and other methods can help the patient breathe more easily.

Very low doses of an opioid may relieve shortness of breath in patients who are not taking opioids for pain. Higher doses may be needed in patients who are taking opioids for pain or who have severe shortness of breath.

Other methods that may help patients who feel short of breath include the following:

• Treating anxiety caused by shortness of breath.
• Directing a cool fan towards the patient’s face.
• Having the patient sit up.
• Having the patient do breathing and relaxation exercises, if able.
• Using acupuncture or acupressure.
• Giving antibiotics if shortness of breath is caused by an infection.
• Giving extra oxygen if shortness of breath is caused by hypoxemia.

In rare cases, shortness of breath may not be relieved by any of these treatments. Sedation with drugs may be needed, to help the patient feel more comfortable.

Some patients have spasms of the air passages in the lungs along with shortness of breath. Bronchodilators (drugs that open up small airways in the lungs) or steroid drugs (which relieve swelling and inflammation) may relieve these spasms.

Cough

Chronic coughing at the end of life may add to a patient's discomfort. Repeated coughing can cause pain and loss of sleep, increase tiredness, and make shortness of breath worse. At the end of life, the decision may be to treat the symptoms of the cough rather than finding and treating the cause. The following types of drugs may be used to make the patient as comfortable as possible:

• Opioids to stop the coughing.
• Corticosteroids to shrink swollen lymph vessels.
• Antibiotics to treat infection.
• Bronchodilators to decrease wheezing and coughing from chronic obstructive pulmonary disease.
• Diuretics to relieve coughing caused by congestive heart failure.

Also, the doctor may look at drugs the patient is already taking, as some drugs (such as ACE inhibitors for high blood pressure or heart failure) can cause cough.

(See the PDQ summary on Cardiopulmonary Syndromes ⁴ for more information.)

Death Rattle

Rattle occurs when saliva or other fluids collect in the throat and upper airways.

Rattle occurs when saliva or other fluids build up in the throat and airways in a patient who is too weak to clear the throat. There are two types of rattle. Death rattle is caused by saliva pooling at the back of the throat. The other kind of rattle is caused by fluid in the airways from an infection, a tumor, or excess fluid in body tissues.

Drugs may be given to decrease the amount of saliva in the mouth or to dry the upper airway. Since most patients with rattle are unable to swallow, these drugs are usually given in patches on the skin or by infusion.

Non-drug treatments for rattle include changing the patient's position and giving less fluid.

Raising the head of the bed, propping the patient up with pillows, or turning the patient to either side may help relieve rattle. If the rattle is caused by fluid at the back of the throat, excess fluid may be gently removed from the mouth using a suction tube. If the rattle is caused by fluid in the airways, the fluid is usually not removed by suction. Suctioning causes severe physical and mental stress on the patient.

At the end of life, the body needs less food and fluid. Reducing food and fluids can lessen the excess fluid in the body and greatly relieve rattle.

Death rattle is a sign that death may soon occur.

Death rattle is a sign that death may occur in hours or days. Rattle can be very upsetting for those at the bedside. It does not seem to be painful for the patient.

Delirium

Delirium is common at the end of life.

Delirium is common during the final days of life. Some patients may be confused, nervous, and restless, and have hallucinations (see or hear things not really there). Other patients may be quiet and withdrawn. (See the PDQ summary on Cognitive Disorders and Delirium ⁵ for more information.)

Delirium can be caused by the direct effects of cancer, such as a growing tumor in the brain. Other causes include the following:

• A higher- or lower-than-normal amount of certain chemicals in the blood that keep the heart, kidneys, nerves, and muscles working the way they should.
• Side effects of drugs or drug interactions (changes in the way a drug acts in the body when taken with certain other drugs, herbal medicine, or foods).
• Stopping the use of certain drugs or alcohol.
• Dehydration (the loss of needed water from the body).
• A full bladder or constipation.
• Shortness of breath.

Delirium may be controlled by finding and treating the cause.

Depending on the cause of the delirium, treatment may include the following:

• Giving drugs to fix the level of certain chemicals in the blood.
• Stopping or lowering the dose of the drugs that are causing delirium.
• Stopping drugs that may cause drug interactions but are no longer useful at the end of life, such as drugs to lower cholesterol.
• Treating dehydration by putting fluids into the bloodstream.

For some patients in the last hours of life, the decision may be to treat only the symptoms of delirium and make the patient as comfortable as possible. There are drugs that work very well to relieve these symptoms.

Hallucinations that are not related to delirium often occur at the end of life.

It is common for dying patients to have hallucinations that include loved ones who have already died. It is normal for family members to feel distress when these hallucinations occur. Speaking with clergy, the hospital chaplain, or other religious advisors is often helpful.

Fever

Fever and infections are common at the end-of-life. Because patients often have many medical problems at the end of life, it can be hard to know the cause of a fever and if treatment will help the patient. Patients near the end of life may choose not to treat the cause of the fever but only to receive comfort measures, such as acetaminophen.

Hemorrhage

Sudden hemorrhage (heavy bleeding) may occur in patients who have certain cancers or disorders.

Hemorrhage (a lot of bleeding in a short time) is rare but may occur in the last hours or minutes of life. Blood vessels may be damaged by certain cancers or cancer treatments. Radiation therapy, for example, can weaken blood vessels in the area that was treated. Tumors can also damage blood vessels. Patients with the following conditions are at risk for this symptom:

• Head and neck cancers.
• Stomach cancer.
• Esophageal cancer.
• Leukemias and other blood cancers.
• Blood clotting disorders.

The patient should talk with the doctor about any concerns he or she has about the chance of hemorrhage.

Making the patient comfortable is the main goal of care during hemorrhage at the end of life.

When hemorrhage occurs during cancer care, it is treated with bandages and medicines or with treatments such as radiation therapy, surgery, and blood transfusions. When sudden bleeding occurs at the end of life, however, patients usually die soon afterwards. Resuscitation (restarting the heart) usually will not work. The main goal of care is to help the patient be calm and comfortable and to support family members. If hemorrhage occurs, it can be very upsetting for family members. It is helpful if the family talks about the feelings this causes and asks questions about it.

The following steps can be taken when bleeding occurs in the last hours of life:

• Cover the area with dark-colored towels so the blood is not seen.
• Change towels and keep the area clean.
• Speak calmly to the patient and to family members.
• Let the patient know if loved ones are there.

Fast-acting drugs may help calm the patient during this time.

Ethical Issues

Key Points for This Section

Choices about care and treatment at the end of life should be made while the patient is able to make them. Nutrition Support The goals of nutrition support for patients in the last days of life are different from the goals during cancer treatment. Making plans for nutrition support in the last days is helpful. Two types of nutrition support are commonly used. Resuscitation Ventilator Use Ventilator use may keep the patient alive after normal breathing stops. Before a ventilator is turned off, family members will be given information about what to expect. Sedation

Choices about care and treatment at the end of life should be made while the patient is able to make them.

In addition to decisions about treating symptoms at the end-of-life, it is also helpful for patients to decide if and when they want this treatment to stop. A patient may wish to receive all possible treatments, only some treatments, or no treatment at all. These decisions may be written down ahead of time in an advance directive, such as a living will. Advance directive is the general term for different types of legal documents that describe the treatment or care a patient wishes to receive or not receive when he or she is no longer able to speak their wishes.

The patient may also name a healthcare proxy to make these decisions when he or she becomes unable to do so. Having advance directives in place makes it easier for family members and caregivers when very important decisions have to be made in the last days, such as whether to give nutrition support, restart the heart, help with breathing, or give sedatives.

When the patient does not make choices about end-of-life care, or does not share his choices with family members, health care proxies, or the health care team, treatment may be given near death against the patient's wishes. As a result, studies show that the patient's quality of life may be worse and the family's grieving process may be more difficult.

Nutrition Support

The goals of nutrition support for patients in the last days of life are different from the goals during cancer treatment.

Nutrition support can improve health and boost healing during cancer treatment. The goals of nutrition therapy for patients during the last hours of life are different from the goals for patients in active cancer treatment and recovery. In the final days of life, patients often lose the desire to eat or drink and may refuse food or fluids that are offered to them. Also, procedures used to put feeding tubes in place and problems that can occur with these types of feedings may be hard on a patient.

Making plans for nutrition support in the last days is helpful.

The goal of end-of-life care is to prevent suffering and relieve symptoms. If nutrition support causes the patient more discomfort than help, then nutrition support near the end of life may be stopped. The needs and best interests of each patient guide the decision to give nutrition support. When decisions and plans about nutrition support are made by the patient, doctors and family members can be sure they are doing what the patient wants.

Two types of nutrition support are commonly used.

If the patient cannot swallow, two types of nutrition support are commonly used:

• Enteral nutrition uses a tube inserted into the stomach or intestine.
• Parenteral nutrition uses an intravenous (IV) catheter inserted into a vein.

Each type of nutrition support has benefits and risks. (See the PDQ summary on Nutrition in Cancer Care ⁶ for more information.)

Resuscitation

An important decision for the patient to make is whether to have cardiopulmonary resuscitation (CPR) (trying to restart the heart and breathing when it stops). It is best if patients talk with their family, doctors, and caregivers about their wishes for CPR as early as possible (for example, when being admitted to the hospital or when active cancer treatment is stopped). A do-not-resuscitate (DNR) order is written by a doctor to tell other health professionals not to perform CPR at the moment of death, so that the natural process of dying occurs. If the patient wishes, he or she can ask the doctor to write a DNR order. The patient can ask that the DNR order be changed or removed at any time.

Ventilator Use

Ventilator use may keep the patient alive after normal breathing stops.

A ventilator is a machine that helps patients breathe. Sometimes, using a ventilator will not improve the patient's condition, but will keep the patient alive longer. If the goal of care is to help the patient live longer, a ventilator may be used, according to the patient's wishes. If ventilator support stops helping the patient or is no longer what the patient wants, the patient, family, and health care team may decide to turn the ventilator off.

Some patients may want to be allowed to die when breathing gets difficult or stops. It is important for the patient to tell family members and health care providers, before breathing becomes difficult, of his or her wishes about being kept alive with a ventilator.

Before a ventilator is turned off, family members will be given information about what to expect.

Family members will be given information about how the patient may respond when the ventilator is removed and about pain relief or sedation to keep the patient comfortable. Family members will be given time to contact other loved ones who wish to be there. Chaplains or social workers may be called to give help and support to the family.

Sedation

The decision whether to sedate a patient at the end of life is a difficult one. Sedation may be considered for a patient's comfort or for a physical condition such as uncontrolled pain. A patient's thoughts and feelings about end-of-life sedation may depend greatly on his or her own culture and beliefs. Some patients who become anxious facing the end of life may want to be sedated. Other patients may wish to have no procedures, including sedation, just before death. It is important for the patient to tell family members and health care providers of his or her wishes about sedation at the end of life. When patients make their wishes about sedation known ahead of time, doctors and family members can be sure they are doing what the patient would want.

Care in the Final Hours

Key Points for This Section

Knowing what to expect in the final days or hours may be comforting to the family. Patients often lose the desire to eat or drink in the final days or hours. Patients near death may not respond to others. A number of physical changes are common when the patient is near death. Patients and their families may have cultural or religious beliefs and customs that are important at the time of death.

Knowing what to expect in the final days or hours may be comforting to the family.

Most people are not familiar with the signs that death is near. Knowing what to expect can prepare them for the death of their loved one and make this time less stressful and confusing. Health care providers can give family members information about the changes they may see in their loved one in the final hours and how they may help their loved one through it.

Patients often lose the desire to eat or drink in the final days or hours.

In the final days to hours of life, patients often lose the desire to eat or drink, and may refuse food and fluids that are offered to them. The family may give ice chips or swab the mouth and lips to keep them moist. Forcing food and fluids can make the patient uncomfortable or cause choking. Family members may find other ways to show their love for the patient, such as massage.

Patients near death may not respond to others.

Patients may withdraw and spend more time sleeping. They may answer questions slowly or not at all, seem confused, and show little interest in their surroundings. Most patients are still able to hear after they are no longer able to speak. It may give some comfort if family members continue to touch and talk to the patient, even if the patient does not respond.

A number of physical changes are common when the patient is near death.

Some of the following physical changes may occur in the patient at the end of life:

• The patient may feel tired or weak.
• The patient may pass less urine and it may be dark in color.
• The patient’s hands and feet may become blotchy, cold, or blue. Caregivers can use blankets to keep the patient warm. Electric blankets or heating pads should not be used.
• The heart rate may go up or down and become irregular.
• Blood pressure usually goes down.
• Breathing may become irregular, with very shallow breathing, short periods of not breathing, or deep, rapid breathing.

Patients and their families may have cultural or religious beliefs and customs that are important at the time of death.

After the patient dies, family members and caregivers may wish to stay with the patient a while. There may be certain customs or rituals that are important to the patient and family at this time. These might include rituals for coping with death, handling the patient's body, making final arrangements for the body, and honoring the death. The patient and family members should let the health care team know about any customs or rituals they want performed after the patient's death.

Health care providers, hospice staff, social workers, or spiritual leaders can explain the steps that need to be taken once death has occurred, including contacting a funeral home.

(See the PDQ summary on Spirituality in Cancer Care ⁷ for more information.)

Grief and Loss

Grief is a normal reaction to the loss of a loved one. People who feel unable to cope with their loss may be helped by grief counseling or grief therapy with trained professionals. (See the PDQ summary on Loss, Grief, and Bereavement ⁸ for more information.)

Get More Information From NCI

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There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.

Find Publications

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Changes to This Summary (04/28/2009)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Changes were made to this summary to match those made to the health professional version.

Questions or Comments About This Summary

If you have questions or comments about this summary, please send them to Cancer.gov through the Web site’s Contact Form ¹². We can respond only to email messages written in English.

About PDQ

PDQ is a comprehensive cancer database available on NCI's Web site.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site ¹⁰. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.

A clinical trial is a study to answer a scientific question, such as whether one method of treating symptoms is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. Some patients have symptoms caused by cancer treatment or by the cancer itself. During supportive care clinical trials, information is collected about how well new ways to treat symptoms of cancer work. The trials also study side effects of treatment and problems that come up during or after treatment. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients who have symptoms related to cancer treatment may want to think about taking part in a clinical trial.

Listings of clinical trials are included in PDQ and are available online at NCI's Web site ¹³. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Glossary Terms

The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

A drug that is used to lower blood pressure. An ACE inhibitor is a type of antihypertensive agent. Also called angiotensin-converting enzyme inhibitor.

A drug that reduces pain and fever (but not inflammation). It belongs to the family of drugs called analgesics.

The application of pressure or localized massage to specific sites on the body to control symptoms such as pain or nausea. It is a type of complementary and alternative medicine.

The technique of inserting thin needles through the skin at specific points on the body to control pain and other symptoms. It is a type of complementary and alternative medicine.

A legal document that states the treatment or care a person wishes to receive or not receive if he or she becomes unable to make medical decisions (for example, due to being unconscious or in a coma). Some types of advance directives are living wills and do-not-resuscitate (DNR) orders.

Cancer that has spread to other places in the body and usually cannot be cured or controlled with treatment.

A chemical substance found in beer, wine, and liquor. Alcohol is also found in some medicines, mouthwashes, essential oils (scented liquid taken from plants), and household products.

A drug that reduces pain. Analgesics include aspirin, acetaminophen, and ibuprofen.

A drug used to treat infections caused by bacteria and other microorganisms.

Feelings of fear, dread, and uneasiness that may occur as a reaction to stress. A person with anxiety may sweat, feel restless and tense, and have a rapid heart beat. Extreme anxiety that happens often over time may be a sign of an anxiety disorder.

A state of sadness, grief, and mourning after the loss of a loved one.

The organ that stores urine.

A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.

A mass of blood that forms when blood platelets, proteins, and cells stick together. When a blood clot is attached to the wall of a blood vessel, it is called a thrombus. When it moves through the bloodstream and blocks the flow of blood in another part of the body, it is called an embolus.

The force of circulating blood on the walls of the arteries. Blood pressure is taken using two measurements: systolic (measured when the heart beats, when blood pressure is at its highest) and diastolic (measured between heart beats, when blood pressure is at its lowest). Blood pressure is written with the systolic blood pressure first, followed by the diastolic blood pressure (for example 120/80).

The administration of blood or blood products into a blood vessel.

A tube through which the blood circulates in the body. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins.

A type of drug that causes small airways in the lungs to open up. Bronchodilators are inhaled and are used to treat breathing disorders, such as asthma or emphysema.

A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

Having to do with the heart and lungs.

A flexible tube used to deliver fluids into or withdraw fluids from the body.

A member of the clergy in charge of a chapel or who works with the military or with an institution, such as a hospital.

A waxy, fat-like substance made in the liver, and found in the blood and in all cells of the body. Cholesterol is important for good health and is needed for making cell walls, tissues, hormones, vitamin D, and bile acid. Cholesterol also comes from eating foods taken from animals such as egg yolks, meat, and whole-milk dairy products. Too much cholesterol in the blood may build up in blood vessel walls, block blood flow to tissues and organs, and increase the risk of developing heart disease and stroke.

A disease or condition that persists or progresses over a long period of time.

A type of lung disease marked by permanent damage to tissues in the lungs, making it hard to breathe. Chronic obstructive pulmonary disease includes chronic bronchitis, in which the bronchi (large air passages) are inflamed and scarred, and emphysema, in which the alveoli (tiny air sacs) are damaged. It develops over many years and is usually caused by cigarette smoking. Also called COPD.

Ordained individuals who perform spiritual and/or religious functions.

A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical trial.

A mental state in which one is not thinking clearly.

Weakness of the heart muscle that leads to a buildup of fluid in body tissues.

A condition in which stool becomes hard, dry, and difficult to pass, and bowel movements don’t happen very often. Other symptoms may include painful bowel movements, and feeling bloated, uncomfortable, and sluggish.

To adjust to new situations and overcome problems.

Any steroid hormone made in the adrenal cortex (the outer part of the adrenal gland). They are also made in the laboratory. Corticosteroids have many different effects in the body, and are used to treat many different conditions. They may be used as hormone replacement, to suppress the immune system, and to treat some side effects of cancer and its treatment. Corticosteroids are also used to treat certain lymphomas and lymphoid leukemias.

The process by which a professional counselor helps a person cope with mental or emotional distress, and understand and solve personal problems.

The beliefs, values, and behaviors that are shared within a group, such as a religious group or a nation. Culture includes language, customs, and beliefs about roles and relationships.

To heal or restore health; a treatment to restore health.

A gurgling sound that comes from the back of the throat of a dying person. It is caused by the build-up of saliva and mucus in the throat and upper airways when the person is too weak to cough.

A condition caused by the loss of too much water from the body. Severe diarrhea or vomiting can cause dehydration.

A mental state in which a person is confused, disoriented, and not able to think or remember clearly. The person may also be agitated and have hallucinations, and extreme excitement.

The process of identifying a disease, such as cancer, from its signs and symptoms.

In medicine, a disturbance of normal functioning of the mind or body. Disorders may be caused by genetic factors, disease, or trauma.

Extreme mental or physical pain or suffering.

A drug that increases the production of urine.

A type of advance directive in which a person states that healthcare providers should not perform cardiopulmonary resuscitation (restarting the heart) if his or her heart or breathing stops. Also called DNR order.

The amount of medicine taken, or radiation given, at one time.

Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.

A change in the way a drug acts in the body when taken with certain other drugs, herbals, or foods, or when taken with certain medical conditions. Drug interactions may cause the drug to be more or less effective, or cause effects on the body that are not expected.

A form of nutrition that is delivered into the digestive system as a liquid. Drinking nutrition beverages or formulas and tubefeeding are forms of enteral nutrition. People who are unable to meet their needs with food and beverages alone, and who do not have vomiting or uncontrollable diarrhea may be given tubefeedings. Tubefeeding can be used to add to what a person is able to eat or can be the only source of nutrition. A small feeding tube may be placed through the nose into the stomach or the small intestine, or it may be surgically placed into the stomach or the intestinal tract through an opening made on the outside of the abdomen, depending on how long it will be used.

Cancer that forms in tissues lining the esophagus (the muscular tube through which food passes from the throat to the stomach). Two types of esophageal cancer are squamous cell carcinoma (cancer that begins in flat cells lining the esophagus) and adenocarcinoma (cancer that begins in cells that make and release mucus and other fluids).

A condition marked by extreme tiredness and inability to function due lack of energy. Fatigue may be acute or chronic.

An increase in body temperature above normal (98.6 degrees F), usually caused by disease.

A substance that flows smoothly and takes the shape of its container. Liquids and gases are fluids.

The normal response to a major loss, such as the death of a loved one. Grief may also be felt by a person with a serious, long-term illness or with a terminal illness. It may include feelings of great sadness, anger, guilt, and despair. Physical problems, such as not being able to sleep and changes in appetite, may also be part of grief.

The process by which a trained counselor or a support group helps a person work through normal feelings of sorrow after a loss, such as the death of a loved one.

Treatment that helps a person work through a greater than normal reaction to a loss, such as the death of a loved one. This reaction may include behavioral and physical problems, extreme mourning, and being unable to separate emotionally from the person who died. Grief therapy may be individual or group therapy.

A sight, sound, smell, taste, or touch that a person believes to be real but is not real. Hallucinations can be caused by nervous system disease, certain drugs, or mental disorders.

Cancer that arises in the head or neck region (in the nasal cavity, sinuses, lips, mouth, salivary glands, throat, or larynx [voice box]).

A type of advance directive that gives a person (such as a relative, lawyer, or friend) the authority to make healthcare decisions for another person. It becomes active when that person loses the ability to make decisions for himself or herself. Also called HCP.

In medicine, loss of blood from damaged blood vessels. A hemorrhage may be internal or external, and usually involves a lot of bleeding in a short time.

A type of medicine that uses roots, stems, leaves, flowers, or seeds of plants to improve health, prevent disease, and treat illness.

A blood pressure of 140/90 or higher. High blood pressure usually has no symptoms. It can harm the arteries and cause an increase in the risk of stroke, heart attack, kidney failure, and blindness. Also called hypertension.

A program that provides special care for people who are near the end of life and for their families, either at home, in freestanding facilities, or within hospitals.

Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.

Redness, swelling, pain, and/or a feeling of heat in an area of the body. This is a protective reaction to injury, disease, or irritation of the tissues.

A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion.

Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."

The long, tube-shaped organ in the abdomen that completes the process of digestion. The intestine has two parts, the small intestine and the large intestine. Also called bowel.

Into or within a vein. Intravenous usually refers to a way of giving a drug or other substance through a needle or tube inserted into a vein. Also called IV.

One of a pair of organs in the abdomen. Kidneys remove waste from the blood (as urine), produce erythropoietin (a substance that stimulates red blood cell production), and play a role in blood pressure regulation.

Cancer that starts in blood-forming tissue such as the bone marrow and causes large numbers of blood cells to be produced and enter the bloodstream.

A type of legal advance directive in which a person describes specific treatment guidelines that are to be followed by health care providers if he or she becomes terminally ill and cannot communicate. A living will usually has instructions about whether to use aggressive medical treatment to keep a person alive (such as CPR, artificial nutrition, use of a respirator).

One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.

A thin tube that carries lymph (lymphatic fluid) and white blood cells through the lymphatic system. Also called lymphatic vessel.

A treatment in which the soft tissues of the body are kneaded, rubbed, tapped, and stroked. Massage therapy may help people relax, relieve stress and pain, lower blood pressure, and improve circulation. It is being studied in the treatment of cancer symptoms such as lack of energy, pain, swelling, and depression.

Refers to the practices and procedures used for the prevention, treatment, or relief of symptoms of a diseases or abnormal conditions. This term may also refer to a legal drug used for the same purpose.

A bundle of fibers that receives and sends messages between the body and the brain. The messages are sent by chemical and electrical changes in the cells that make up the nerves.

A health professional trained to care for people who are ill or disabled.

A place that gives care to people who have physical or mental disabilities and need help with activities of daily living (such as taking a bath, getting dressed, and going to the bathroom) but do not need to be in the hospital.

The taking in and use of food and other nourishing material by the body. Nutrition is a 3-part process. First, food or drink is consumed. Second, the body breaks down the food or drink into nutrients. Third, the nutrients travel through the bloodstream to different parts of the body where they are used as "fuel" and for many other purposes. To give the body proper nutrition, a person has to eat and drink enough of the foods that contain key nutrients.

A health professional with special training in nutrition who can help with dietary choices. Also called dietitian.

A substance used to treat moderate to severe pain. Opioids are like opiates, such as morphine and codeine, but are not made from opium. Opioids bind to opioid receptors in the central nervous system. Opioids used to be called narcotics. An opioid is a type of alkaloid.

A colorless, odorless gas. It is needed for animal and plant life. Oxygen that is breathed in enters the blood from the lungs and travels to the tissues.

Care given to improve the quality of life of patients who have a serious or life-threatening disease. The goal of palliative care is to prevent or treat as early as possible the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment. Also called comfort care, supportive care, and symptom management.

A form of nutrition that is delivered into a vein. Parenteral nutrition does not use the digestive system. It may be given to people who are unable to absorb nutrients through the intestinal tract because of vomiting that won't stop, severe diarrhea, or intestinal disease. It may also be given to those undergoing high-dose chemotherapy or radiation and bone marrow transplantation. It is possible to give all of the protein, calories, vitamins and minerals a person needs using parenteral nutrition. Also called hyperalimentation, total parenteral nutrition, and TPN.

PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.

A severe inflammation of the lungs in which the alveoli (tiny air sacs) are filled with fluid. This may cause a decrease in the amount of oxygen that blood can absorb from air breathed into the lung. Pneumonia is usually caused by infection but may also be caused by radiation therapy, allergy, or irritation of lung tissue by inhaled substances. It may involve part or all of the lungs.

The overall enjoyment of life. Many clinical trials assess the effects of cancer and its treatment on the quality of life. These studies measure aspects of an individual’s sense of well-being and ability to carry out various activities.

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.

To become well and healthy again.

The last several inches of the large intestine closest to the anus.

A method used to reduce tension and anxiety, and control pain.

In medicine, a repeated action (such as hand washing) done to relieve feelings of fear, dread, and uneasiness. This is often seen in people who have an obsessive-compulsive disorder.

The watery fluid in the mouth made by the salivary glands. Saliva moistens food to help digestion and it helps protect the mouth against infections.

A drug or substance used to calm a person down, relieve anxiety, or help a person sleep.

A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

A bandage-like patch that releases medicine into the body through the skin. The medicine enters the blood slowly and steadily.

A professional trained to talk with people and their families about emotional or physical needs, and to find them support services.

A sudden contraction of a muscle or group of muscles, such as a cramp.

Having to do with deep, often religious, feelings and beliefs, including a person’s sense of peace, purpose, connection to others, and beliefs about the meaning of life.

A type of drug used to relieve swelling and inflammation. Some steroid drugs may also have antitumor effects.

An organ that is part of the digestive system. The stomach helps digest food by mixing it with digestive juices and churning it into a thin liquid.

Cancer that forms in tissues lining the stomach. Also called gastric cancer.

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

The hollow tube inside the neck that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). The throat is about 5 inches long, depending on body size. Also called pharynx.

A group or layer of cells that work together to perform a specific function.

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.

Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra.

A blood vessel that carries blood to the heart from tissues and organs in the body.

In medicine, a machine used to help a patient breathe. Also called respirator.