Ques.1: I/a member of my family has cancer. Does this mean that I/he/she will die soon?

Ans.1 : That is not necessarily true. Of course, cancer is a disease where life is at risk, but, generally speaking, almost one-third of all cancer patients are curable.

It is important to remember that there are more than a hundred types of cancers and different cancers have different outcomes. Today, there are a number of cancers: childhood leukemias, cancers of the breast and uterine cervix, Hodgkin’s lymphoma, among others, that are totally curable. Various factors such as stage of the disease, the age and general condition of the patient, etc., determine the ability to make a full recovery. In short, there are a number of variable factors that influence the course and outcome of the disease (prognosis) and there is, therefore, no reason to believe that a diagnosis of cancer necessarily means early death. It is best to discuss your prognosis with your treating oncologist or cancer specialist.

Ques. 2: What is palliative care?

Ans. 2: Palliative Care is care that ensures a comfortable and meaningful period of survival with cancer or any other life limiting illness or condition no matter what the prognosis. It generally plays a more prominent role when the patient is no longer responsive to treatments aimed at cure. It is ‘care beyond cure’; the goal being to provide the best quality of life possible by focusing on the physical, psychosocial and spiritual needs of the patient.

Ques. 3: What is home-based palliative care?

Ans. 3: Care that is brought to the home of the patient by an interdisciplinary team trained in palliative care, with the purpose of providing symptomatic relief and emotional support, is home-based palliative care.

Ques. 4: How is this different from a hospice?

Ans. 4: The terms hospice care and palliative care are used interchangeably and denote the same principles of care outlined above. A hospice is a residential facility where patients who can no longer be looked after at home may be brought in to receive in-patient palliative care.

Ques. 5: Which organisations offer palliative care in Delhi?

Ans.5: CanSupport has pioneered palliative care for cancer patients and their families in North India and continues to do so. The model we have developed and use is a home care model. We work in close collaboration with the Institute Rotary Cancer Hospital (IRCH) at the All India Institute of Medical Sciences (AIIMS) in Delhi and the Shanti Avedna Sadan, a hospice. IRCH has pain and palliative care clinics for out-patients as well as a six-bedded in-patient facility. Shanti Avedna Sadan is a 16-bedded in-patient facility. Should you need any further information about our home care programme or any of the other palliative care services mentioned, please call our helpline (+11-26711212) on any working day between 9.30am and 5.30pm or contact our office. Our address is: Kanak Durga Basti Vikas Kendra, Sector 12 R.K. Puram, New Delhi-110022. Our telephone nos. are: +11-26102851, 26102869. You may email us at: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

Ques. 6: Should a patient with cancer be told about his/her disease?

Ans. 6: A person has the right to know about his/her illness if he or she wants to. Not telling may not only create more fear than is warranted, but is also likely to break the relationship of trust between patient and caregiver as most patients visiting a cancer ward do realize, sooner rather than later, that they have cancer. Research shows that contrary to the belief of members of the family that revealing the diagnosis would make the patient lose hope, people feel for more confident and in control when they know what they are facing. However, it is important to cautiously probe how much a patient knows or wishes to know about his/her illness before parting with information. Assistance from a trained health professional, such as a member of the CanSupport home care team, may be helpful in breaking the diagnosis and discussing the prognosis with the patient.

Ques. 7: Is it true that cancer causes unbearable pain? Is death due to cancer painful?

Ans. 7: A large number of people with cancer do experience pain as it advances. With appropriate treatments, however, it is possible to almost completely alleviate this pain in almost 90% of patients.

Ques. 8: How is cancer pain controlled?

Ans. 8: Pain caused by the spread of cancer can be alleviated by a skilful combination of different analgesics (drugs to control pain) as well as by non-medical methods. The ability to do so depend on a correct reading of the cause and nature of the pain. This is what palliative care doctors are trained to do. Drugs also need to be taken in the right dose, at the right time and in the right combinations to be effective. The analgesics commonly prescribed to control pain include paracetamols, opioids like codeine and morphine, antidepressants, anticonvulsants, antispasmodics, muscle relaxants, corticosteroids, etc. Non-medical means that can help to ease pain are yoga, meditation, massage, cold compresses, a warm bath, soothing music, activities to distract and deep breathing and relaxation exercises.

It must be remembered that pain is not merely a physical phenomenon. It has a psychological and emotional component too. Hence it is very important to share the patient’s worries, fears and anxieties, which members of the CanSupport home care team are trained to do.

Ques. 9: What is the role of morphine in the management of cancer pain?

Ans. 9: Morphine is a very effective drug which is used to control severe and unremitting cancer pain. It is possible to adjust the dose to meet each individual’s requirement for pain relief without fear of addiction. Initial side-effects such as drowsiness, nausea or vomiting also quickly settle down. Constipation is a more persistent side-effect but it can easily be controlled with the appropriate use of laxatives. Morphine is a drug that is not freely available. CanSupport is fortunate to have a license for oral morphine which allows it to buy, store and dispense this drug to home care patients who need it. .

Ques. 10: My relative with cancer has a reduced appetite. What should I do?

Ans. 10: Anorexia (reduced appetite) is a common symptom as cancer advances. It is often very distressing for family members when the patient refuses to eat as one of the ways in which they can show they care is by preparing food to tempt their loved one to eat. It is, therefore, important to understand that a reduced appetite is often encountered in advanced cancer and that there may be a variety of causes; some of which are easier to change than others. Should there be dyspepsia (heartburn), constipation, a sore mouth, altered taste, pain, etc, a consultation with the treating doctor is advisable. Symptoms such as cachexia (extreme weight loss), which accompany cancer as it advances and cause reduced appetite and progressive weakness in over 50% of patients are not usually responsive to drug treatment. Corticosteroids and progesterons have been used with little benefit.

As a caregiver there are simple measures you can take to make the patient feel more at ease:

* Do not force feed. Emphasis should be on allowing the patient to decide the type and amount of food he/she wants to eat.
* Adjust the diet to counter changes in taste.
* Give smaller helpings of food at more frequent intervals.
* If the patient can only take liquids, try and vary them by including juices, curd, coconut water, soups, etc.

Ques.11: Are there any dietary restrictions for a patient with advanced cancer?

Ans.11: Unless otherwise advised by the doctor, there are no dietary restrictions. Allow the patient to eat what ever he/she desires. Try to introduce variation in the diet to make it more interesting. Sometimes the sense of taste can change as a result of the illness or because of treatments; ask him/her about it.

Ques. 12: What can be done for insomnia (inability to sleep)?

Ans. 12: Insomnia (sleeplessness) is a frequently encountered symptom that can be controlled using simple measures. It may be caused by pain, anxiety, depression, breathlessness, etc., and can, therefore, be overcome by addressing the underlying cause. It is important to ensure that the patient has a comfortable mattress to sleep on. Adjust posture to suit the patient’s comfort, perhaps by putting more pillows under the head. A glass of warm milk at bedtime can also be of benefit; on the other hand, avoid stimulating drinks like tea/coffee/alcohol before bedtime. The patient’s room should be away from bright light and loud noises.

If required, sedatives may be prescribed after consultation with the doctor as it is important for the patient’s well being that he/she gets proper sleep. Sometimes the cause of insomnia may be related to concerns regarding the disease and its outcome, decreased self esteem, a feeling of being dependant, loss of role in the family, financial insecurity, worries about the future, including the future of the family, etc. It is necessary to discuss these fears and anxieties with the patient and encourage him/her to express and share his/her feelings.

Ques.13: Can radiotherapy and chemotherapy help manage symptoms of advanced cancer?

Ans.13: Radiotherapy and chemotherapy can be of benefit in certain situations. These will need to be carefully assessed by the treating team.

While radiotherapy can help alleviate symptoms like pain, bleeding, spinal chord compression, difficulty in swallowing, etc., chemotherapy can help to temporarily improve the quality of life in certain cancers even at an advanced stage. It is best to discuss this with the treating doctor and the palliative care team.

Ques.14: As the condition of my relative begins to deteriorate and the end seems near should I rush him/her to a hospital?

Ans.14: At this stage it may not be beneficial to rush the patient to a hospital for a number of reasons: the process involved in shifting such a patient, the likely use of invasive procedures by the hospital, the likelihood of the patient being isolated in the ICU, the use of life support equipment, like ventilators, etc. All these increase the suffering of the patient without significantly altering the course of the disease. At this stage, it is the patient’s comfort that requires the greatest consideration.

Distressing symptoms at the end of life can usually be taken care of at home with help from the home care team. Discuss with them what to expect and what measures can be taken by the caregiver to keep the patient comfortable till the team arrives. Before rushing the patient to the hospital, also ascertain the preference of the patient. Most patients prefer to remain at home, in familiar surroundings, with family near at hand.

Ques. 15: How do I recognize that death is approaching?

Ans. 15: A number of changes occur to which you need to remain alert. Breathing usually slows down; pauses between breaths may last longer than a minute; the patient appears to be in a state of very deep sleep- he/she may not waken during this period; breathing may turn noisy due to secretions collecting in the throat. There is also likely to be less movement, an observable loss of strength and reduced awareness and interaction with the surroundings. The person may start hallucinating or become restless and disoriented. He/She will urinate very little, will be too weak to move and will be unable to eat or swallow. Remember these are general symptoms and may not appear in all patients.

Ques.16: What should my role as a caregiver be at this time?

Ans.16: Follow the following steps:

1. Do not panic. Try to focus on being with the patient and spending quality time together. Some families say that this time at the end of life can be very special and meaningful, even peaceful.
2. Continue giving narcotics and pain medications as prescribed, even if the patient appears to be in a coma.
3. Ask the doctor what pills can be stopped so that the least number of pills need to be given. Ask if any pills can be crushed and mixed in a small amount of liquid or in jam or honey to make them easier to swallow.
4. Enquire about alternative routes for administering medicine if the patient can no longer swallow. There may be tablets that dissolve when placed under the tongue or medication that can be given as a rectal suppository or by injection.
5. In case of breathlessness, loosen clothing, prop up the patient, allow air to blow across the face and chest (a table fan may be used) and encourage slow breathing and relaxation.
6. If there has been no bowel movement during the last 4-5 days, give a rectal suppository/enema to make the bowels move.
7. Moisten lips with cool water.
8. If the eyes are dry/sticky, clean the eyes with clean, cool water two or three times a day.
9. Massage the hands, fingers, wrists, legs to keep the joints moving.
10. Expect the patient to pass less urine as compared to when the patient was better.
11. Change underwear/diaper frequently if the patient can not control bowel movement or the passage of urine. Expose the genital area to air for at least half an hour each day to keep the area as dry as possible.
12. Change the patient’s posture every hour to prevent formation of bed-sores
13. Holding the person’s hand can be very comforting and meaningful at this time.
14. It is important to continue to talk and offer reassurance even though the person appears to be slowly withdrawing. Medical professionals think that hearing is often the last thing to go before death so even when they are not responding in other ways they may still be able to hear you. Simply saying “I’m here and I’ll be with you” offers great support and comfort. This can be a special time to convey your love and share quiet moments of togetherness. Families say that knowing they said everything they wanted to was very comforting and beautiful.
15. Consider singing songs or telling bed-time or relaxing stories. Some find it meaningful to do the routine that their parents did for them at bed-time as a way of providing a familiar way to go into deeper sleep; while also creating a sense of comfort and accompaniment. If there was a song, a story or an image that was of particular meaning to them, you can gently share it now.
16. Many patients are worried about leaving their family behind. Consider saying something like, “I’m here, you can relax and do whatever you need to do now. You can let go. I’m here.” This may be very comforting. If it is clear that they are going or thinking about death you may find it helpful to be more explicit. You may say something like, “When you go we’ll miss you a lot. But I want you to know we love you and we’ll be ok. You can feel free to relax. We’re here.”
17. Similarly, many who work with the dying report that patients often hold on until those moments when there is no one in the room; which is when they let go. Families have commented on how beautiful it was that their dying member was so in tune with their presence that even near the end he/she could tell where everyone was, and chose to die in a way that would be as comfortable as possible for their loved ones (who often are uncomfortable or pained by the idea of them dying). So, if you regret that your loved one died during those few minutes when you went out, you should know it is common. It is striking how connected and in tune people are with their loved ones even while dying.

Ques. 17: How do I register with the CanSupport home care team so that they can look after my loved one?

Ans. 17: Call our CanSupport Helpline number +11-26711212, Monday to Friday, between 9.30am and 5pm, on any working day.