UKC

Terminal cancer of relative - what to expect?

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 JJL 28 May 2016

At the grim stage of life when the previous generation are dying.

Mother in law has had her PICC line removed yesterday as the chemotherapy is not working. She will get some targeted radiotherapy as specific tumours (lung, liver, bowel) grow, but this is unlikely to provide much posponement - the consultant "would be surprised if she was alive this time next year".

We are providing support at a 200 mile distance and need to think through how that might need to evolve as the year goes through.

Anybody had a relative die this way? Is it a gradual decline or a sudden plummet? Of the final stage, is it a couple of weeks in a hospice/palliative at home, or a more protracted process (one of the decisions we need to make is whether to move her nearer us - better support, but will pull her away from familiar places and people).

We're going to speak with Macmillan next week, but would be interested in any wisdom.
Post edited at 19:34
 Trangia 28 May 2016
In reply to JJL:
Really sorry to hear this. Yes, I've been through this experience more than once, the last time very recently. The 200 mile separation is going to be a major obstacle and you are going to get physically and mentally exhausted trying to provide emotional and practical support at that distance.

Have you discussed what to expect with her oncologist?

Do you have room in your home for her to move in with you? That may be the best solution if you can do it. If not you may have to see if there is a rest home in your vicinity where she can move to and you can visit regularly and take her out whenever possible, unless you or you partner can move in with her?

Every case is different but I am afraid there is no easy way of dealing with this. You will find Macmillan very helpful and they will put you in touch with agencies and offer support.

One of the problems nationally is the lack of Government practical and financial support for end of life care. Hopefully you will have family who will rally around.

If she wishes to die at home you will have to think very carefully about this. It might be worth enquiring about Hospice at Home care. Our family has just been through this. The carers were superb and unbelievably compassionate and understanding, but the lack of funding resulted in times, even during the final week, when the admin just could not find carers which puts a huge strain on the relatives particularly when it came to administering pain killers, and the physical and emotional sides of caring. For this reason unless you are convinced that your local health service can really deliver, I advise if possible going down the in patient hospice route, if a bed can be found, for the final week or so.

Unfortunately it seems that it's rarely possible to predict just how long this may go on for or when she will start to need 24 hour care, but you probably won't reach this stage for quite a few months.

My sympathy and I wish you all the best.
Post edited at 20:11
In reply to JJL:

There really isn't a one size fits all solution I'm afraid, the best you can do is try to be as flexible with plans as possible and take your MILs views into account. Macmillan are very good.

Don't forget to look after yourselves though (my mistake in similar circumstances).
 Billhook 28 May 2016
In reply to JJL:

Macmillan = from experience of similar will provide you with the support you need!
abseil 28 May 2016
In reply to JJL:

> Anybody had a relative die this way? Is it a gradual decline or a sudden plummet? .... would be interested in any wisdom.

Very, very sorry to read about your situation. And much sympathy to you and your family.

Both my parents died [in different years] fairly quickly of cancer - more of a plummet than a gradual decline. Couple of weeks in a hospice situation, finally.

We found support at a distance to be problematic, to say the least, so yes, I would think this through. Other wisdom, very sorry to say this but get ready for some hard and upsetting times, to say the least. Try, to the maximum, to help other family members who are affected to deal with it, as well as help them in practical ways. Seek as much help, and advice, from doctors and nurses as you can in the final stages - they knew exactly what was happening, and what was shortly to come, and we didn't know and were not ready either practically or emotionally.
Post edited at 20:38
 marsbar 28 May 2016
In reply to JJL:

I think to an extent you should be a little bit selfish for everyone's sake. 2 of my friends (unconnected) have survived reasonably serious car accidents probably partly due excessive amounts of driving up and down motorways tired and stressed out trying to look after ill relatives and balance that with work and family life.

If you think it best, then move her nearer to you. You will have enough to deal with.

Not much else to say, but thinking of you and your spouse.
 aln 29 May 2016
In reply to JJL:

Just made a donation to MacMillan. Not much but my wee contribution,
 Big Ger 29 May 2016
In reply to JJL:



> Mother in law has had her PICC line removed yesterday as the chemotherapy is not working. She will get some targeted radiotherapy as specific tumours (lung, liver, bowel) grow, but this is unlikely to provide much posponement - the consultant "would be surprised if she was alive this time next year".

> We are providing support at a 200 mile distance and need to think through how that might need to evolve as the year goes through.

I'm in a similar position with my mother, though at a slightly bigger distance. Fortunately for me one of my sisters lives within walking distance, and is shouldering the burden at present.

I'm awaiting the call to come back.
 Bulls Crack 29 May 2016
In reply to JJL:

Going through a very similar experience right now with my wife's mum. She has terminal cancer and severe dementia (made more severe by the drug regime for the cancer) She lives near us so about 2 months ago we adapted a room and she came to live with us. The rate of change has been rapid I.e. weekly, and it's sometimes been difficult to adapt to carewise and keeping on top of all the various health and care options is really difficult.

She's back in hospital now since we reached a point last week where we couldn't adequately care for her and she needed the drug regime sorting out. It's this balance between the care you can provide, the palliative care that's available, the medical input from the GP and the hospital and the severity and rate of change that make for difficult decisions all round. The crucial decision for us seems to be when do we move from one care regime to another such as a hospice but I think the rate of change will determine this.

Macmillan and palliative care nurses seem to have the best handle on things and can advise accordingly.
1
Rigid Raider 29 May 2016
In reply to JJL:

Currently we are caring for my MIL who has ovarian cancer, which is, luckily, pain-free. She is also incontinent and we had her staying for six months while she received the chemo, which turned out to be a huge strain as we couldn't go anywhere and the smell was terrible, despite all efforts to keep her clean. After the chemo she was keen to return to her home town 90 miles away, so she went into a care home. Quite soon she began to complain that she disliked it so last Friday I went down and drove her back to a care home near here, where she went once for respite while we cleared her house and she really liked. It's too soon to say whether she will be happy there or not but the other residents are a lot more sociable.

When my MIL arrived at our house for her chemo she had not been well looked after and within two days we got her admitted to hospital where it was realised that she was severely malnourished and dehydrated. After a week she had got a lot better but that week in a hospital bed did her more harm in the long run - somebody told us that every week a person over 70 spends in bed ages them by ten years. She lost most of her remaining muscle tone and acquired an invalid mindset, so now, eight months after the diagnosis she has lost the use of her legs.

The one thing we have learned from all this is how much time and effort it takes to look after a sick person; my wife is a former sales manager so she has the resources, the energy and the determination to get things sorted even if it means several hours hanging on phone calls. We have realised how easy it must be to fall out of the system and we wonder how people manage when they don't have a dedicated "health manager" working on their behalf. When you learn which people to call and you've got the right phone numbers the NHS and Social Services are superb.



 Timmd 29 May 2016
In reply to JJL:

It's different for each person, but don't be too surprised if it's a sudden plummet rather than a gradual decline, especially as time passes - be prepared is what I mean. I lost my mum to liver cancer in autumn 2013, and the curve seemed to become steeper towards the end, I think the medical peeps were a little surprised.





In reply to Timmd:

Just to reiterate the different for each person thing.

My wife (42) was given weeks or at best a couple of months to live, 9 months and after a gradual decline she died. The medical people and charities like Macmillan will try their best to help but even they get things wrong at times - don't blame them if they do get things wrong as long as they seem to be trying their best to help.
 Timmd 29 May 2016
In reply to L'Eeyore:
Absolutely - the medical people and related nurses are wholly focused on doing their best to help, I've no ill feeling towards anybody at all.

I think I was just wanting the OP and his partner to not be taken unawares, so they can say important things, and get families recipes written down and things like that, things like recipes can get overlooked amidst the emotional jumble of things but as time goes on they're a nice way of remembering times past and the person linked to them.

Seize the moment just in case, I guess.
Post edited at 14:27
 Brass Nipples 29 May 2016
In reply to JJL:
Don't be surprised if they don't necessarily want to see you towards the end. My cousin was overwhelmed in the end, and didn't want anymore visits. It takes a lot of energy and if the person was not naturally gregarious , then all the attention can be unsettling and too much. Respect their final wishes no matter how tough for you. It's the last of their dignity and control.
Post edited at 14:35
OP JJL 29 May 2016
In reply to Everyone:

Thanks everyone - for advice and for support.

She's actually amazing; a calm, pragmatic desire to know and understand what's in store.

I hope I can go with such grace when the time comes.

J
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 Geras 30 May 2016
In reply to JJL:
I,m really sorry that you and yours are having to go trough this! You will find that the Macmillan Forums will provide extensive support from fellow travelers and the Macmillan Nurse will provide a lot of help.

The thing is, you need to take care of yourself as well as supporting your partner and Mother in law. It all takes its toll, may be not immediately but it does get to you in the end. You can not be strong for others if you neglect yourself!
 elsewhere 30 May 2016
In reply to JJL:
Look after yourself and your loved ones. It is very stressful. When it is over you may find you are properly relaxing for the first time in months.

 Bob Aitken 31 May 2016
In reply to JJL:

You have my profound sympathy for the journey ahead of you. From sad personal experience I'd have to say that you shouldn't assume that you have a year to work with - the consultant has only given you a 'long stop' prognosis. Of course it could be longer, but the progress of the disease can accelerate abruptly. I'd also recommend that you discuss all the critical practical questions with your mother-in-law as early as you and she can face doing it, because once she's on palliative medication her capacity to engage with complex issues may dwindle rapidly.

We were humbled by the level of practical support and compassionate care that was supplied by GPs, hospital, hospice, community services, and - as others have said - by Macmillan. It's an old saw, but we certainly found that hard times bring out the best in people. I hope you will find the same.
 Trangia 31 May 2016
In reply to Lion Bakes:

> Don't be surprised if they don't necessarily want to see you towards the end. My cousin was overwhelmed in the end, and didn't want anymore visits. It takes a lot of energy and if the person was not naturally gregarious , then all the attention can be unsettling and too much. Respect their final wishes no matter how tough for you. It's the last of their dignity and control.

This is something which relatives can find difficult to understand and can be very unsettling, but is not uncommon. During his final two weeks my father would only see me and asked me to tell other relatives and friends not to visit him. There were several reasons for this. The main one was that he was just too weak and tired, and any effort on his part was just too much. Cancer does this, the thing that everyone I have known who has died from it is that it makes them overwhelmingly tired. Another reason is that they don't want loved ones to see them in this state, and whilst you are grieving for them, they are also grieving at leaving you. Saying good by to visitors is heart wrenching. The visitor may only go through it once, the patient goes through it every time.

When my sister was dying we had a steady stream of well meaning distant relatives, neighbours and friends telephoning and knocking on the door. Whilst you can understand why people do it, and it is comforting to know that people care, it also becomes very wearing for both the patient and you. No sooner have you put the phone down or seen them to the door than along comes another call and you don't have time to get on with things.

Some of her neighbours, she lived in a village where she was a popular and much loved resident, just didn't get it. You would get, almost indignant, responses like "What do you mean she's resting? She was last time I called! When is the best time to call back?" How can you start to try and explain, because many people just don't understand, and think you are stopping them from seeing her?
In reply to Trangia:

Very well put, it was the case with my wife.

I should mention that the opposite can occur.

It is about listening to what the sufferer wants rather than what you think is best.
 RichardMc 31 May 2016
In reply to JJL:

Ouch !this is very close to home. I was diagnosed with a brain tumour on 4th Feb. oncologist will not be drawn on how long; So quality of life's what we concentrate on but I suspect the tumour and I will not be celebrating the tumour's birthday.So I have set the quality bar pretty low- getting about the house as and when I want to. , going to the pub once a week with my mates. I too don't know how it ends
OP JJL 31 May 2016
In reply to RichardMc:

Shit. Sorry to hear that; my sympathy feels wholly inadequate. Thanks for the honesty.
1
cb294 31 May 2016
In reply to RichardMc:

Very sorry to hear this, hope you can make the best of a terrible situation.

CB
cb294 31 May 2016
In reply to JJL:

Been through that, my father in law died a couple of years ago following a long struggle with kidney cancer. He was absolutely not ready to go, and kept working on his book, even going into in University office even though long retired, until a week before his death. My inlaws also live about 250 miles away, so be prepared for regular, long drives at increasingly short notice. Also, try and make hospice or care arrangements well in advance: The very end for my FIL was very abrupt, so he became unable to walk to the toilet essentially overnight. Because he tried to stick to his normal routine to the very end, by the time a special nursing bed was delivered to his home he already had to go to palliative care, where he died a couple of days later. Just because we failed to reserve such a bed in time, my wife and MIL had to carry him around the house, causing unnecessary pain. The palliative unit was excellent, though, even it was at a hospital that was probably not ideally suited for treating his cancer. Different specialties, so you really inform yourself well ahead by talking to your local hospice organization

Hope that helps, and I wish you all the strength you need,

CB
astley007 31 May 2016
In reply to RichardMc:

Hi Richard,
Nearly in the same situation as you!!!...Have a large tumour sat in the middle of my chest. Am having very complex surgery on the 11th to try and remove it..this was the only option..at least the oncologist told me if I didnt have it I would have 12 to 18 months.
Now I sit here shitting myself that I am going to "wake up" post surgery to find out is was not successful..would rather not wake up!!!..that how I feel..and I know its tough for my friends to talk to me..but I do wish that they wouldnt state that its going to okay, but their thumbs up, smile..and then walk away thinking thank f*ck its not me!!!!!

So Richard happy to go for a pint with you anytime???..and chat the day/evening away

and the comments from Trangia are also extremely relevent...I get tired, breathless and under the weather, and do get friends who phone up and I do not answer...
"I phoned you the other day"
"yes sorry, was under the weather and resting"
"well I thought I would help and support you..I had 20mins free time to chat!!!"
and sorry whilst I am having rant
I am trying to put some weight on prior to surgery, and it not going well..and as intelligent people we know, there is a complex physiological relationship between cancer and wieght loss (its one of the first questions your GPasks)..so please you are my friends no more comments "just eat more pies!" isnt funny and doesnt work.

Was also going to mention about how your loved ones support you through this...I'm giving mine a real hard/shitty time at the moment!!
If anyone want to start UKC climbers support group, that can chat about any of this, happy to be part of it, Happy to give my number if anyone is bad enough to want it?
Cheers
Nick B
 krikoman 31 May 2016
In reply to astley007:

I'm really sorry for your situation, but it's not your friends fault and at least they are trying.

Who knows WTF to say to someone who might be dead shortly?

I didn't when it was my dad, I f*cking hide out the way hoping he'd get better; he didn't.

I'm now left with empty wishes I never full filled; I wish I'd told him I loved him, but we didn't go in for sloppy stuff in our family, so I didn't!

Be thankful for the people around you and for their inane comments and hopes, it's better than being alone and facing the shit you have to face.

Good luck, I hope things improve for you.
In reply to astley007:

I'm happy to talk about how you get your loved ones to support you with trying not to give them a shitty time. PM me if you want.
astley007 31 May 2016
In reply to krikoman:
Cheers Bud,
I know it tough for all!!!!...spent years holding ropes with them, some have held me on big falls, and I have done the same..we have been away on climbing trips ...shouted and sworn at each other..got pissed!!..argued grades..but they have always marvelled at how smooth I was moving over rock..and how I helped them improve their grades!!!..But they all mates and dont want them to tell me "looking good"..when I look like shite..just want some honesty.
Feeling shite and really down at moment..want someone to come round, shout at me...fight..good old fisticuffs!!!..give me something to go for...be able to come through that scary run-out..going ..YES!!...but just in that downward spiral thats not good.but cannot seem to get out of it!!
Cheers
nick B

 krikoman 31 May 2016
In reply to astley007:

> Cheers Bud,

No worries. If you weren't being sarcastic.

> I know it tough for all!!!!...spent years holding ropes with them, some have held me on big falls, and I have done the same..we have been away on climbing trips ...shouted and sworn at each other..got pissed!!..argued grades..but they have always marvelled at how smooth I was moving over rock..and how I helped them improve their grades!!!..But they all mates and dont want them to tell me "looking good"..when I look like shite..just want some honesty.

Obviously they are scared and probable know you are scared and it's really hard for everyone, try and be forgiving of them, tell them they look like shit!

> Feeling shite and really down at moment..want someone to come round, shout at me...fight..good old fisticuffs!!!..give me something to go for...be able to come through that scary run-out..going ..YES!!...but just in that downward spiral thats not good.but cannot seem to get out of it!!

Hope you get out of your doldrums it's easier to fight when you're happier.

good luck again.














Oh by the way, you look like shit!!


astley007 31 May 2016
In reply to krikoman:

You tos*er!!!!
was grumbling as read down your post..yep its all hard!!..we are all stoical english, that queue and all be proper!!! and yes am stuck in the doldrums......then scrolled down further.....

Your f*cker, how bad do you think I look???...nearly spit my medication out laughing!!!!
Laughed so much I cried....needed to get that out of my system..but dont tell anyone!!!
My round ..half a bitter is there for you
Cheers
Nick B
 krikoman 31 May 2016
In reply to astley007:
> My round ..half a bitter is there for you

> Cheers

> Nick B

I come and get it next year

And you'll have to make it a pint, I don't drink halfs.
Post edited at 22:43
 RichardMc 01 Jun 2016
In reply to astley007:
Well that was not the whole story. Last year i also had a mass in my chest. it was declared to be a condro-sarcoma. in October a surgeon in Christchurch opened me up from sternum to left armpit and removed a mass of over 1 kg. in his words "it was well encapsulated and he gotall the cancerous tissue out. with gentle exercise I recovered from the wound sufficiently to do some easy climbing at Christmas So the score stood atRichard-1 Cancer-0 but then fate stepped in and said " try brain tumour for size " .Some clever neuro surgeons made a whole in my headand saved me but the damage to my brain is permanent clevnow Imust just live from day to day grasping nd cherishing the good things that come my way. however trivial they might seem to an able person; like the original poster i co not know how the end will come but come it will. All the best. Richard.
Post edited at 03:56
 RichardMc 01 Jun 2016
In reply to JJL:

> At the grim stage of life when the previous generation are dying.

> Mother in law has had her PICC line removed yesterday as the chemotherapy is not working. She will get some targeted radiotherapy as specific tumours (lung, liver, bowel) grow, but this is unlikely to provide much posponement - the consultant "would be surprised if she was alive this time next year".

> ocess (one of the decisions we need to make is whether to move her nearer us - bsupport, but will pull her away from familiar places and people).-I w0uld hate to leave my familiar surr0undingswhere i can cope up to s point

> We're going to speak with Macmillan next week, but would be interested in any wisdom.

 blurty 01 Jun 2016
In reply to JJL:

This helped me to put things into perspective: the ring theory:

http://edithsanford.org/community/supporting-a-loved-one-with-breast-cancer...

I hope it helps you too - Best Wishes.

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