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Nan, 84 stage 4 lung spread everywhere

Gem1234
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Hi, my Nan got diagnosed on 03/04/24 with stage 4 lung cancer in both lungs spread to liver, pancreas abdomen and surrounds. She is 84 with copd and when we were at the hospital 2 weeks ago the oncologist told us she probably has weeks not months left. Questions are- she’s struggling with controlling the pain at the minute 2.5mg oral morphine every 4 hours, 50mg tramadol every 4 hours and paracetamol every 4 hours. Would you say she needs to get district nurses back to up dosage as last week they said they’d be back in 4 weeks but she seems to have deteriorated this week? 
she is struggling to eat anything, no more than half a slice of toast in a day? Is there any recommendations if we should be trying to get her to eat more? 
abd her feet have started to swell? 
she’s saying she doesn’t want the nurses out but should we be calling them? 
thanks in advance 

worried grandaughter here xx 

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    Hello Gem1234, and sorry for what your Grandmother and your family are going through.  To answer your questions, YES, definitely let the nurses know that your Grandmother is in pain, and they will be able to help, and your second question regarding the fact that she is hardly eating anything, this is perfectly normal for a person in the end stages of cancer.  Please don't try to force her to eat because this will only cause her more distress.  The reason she is not eating is because her body is starting to shut down and she simply doesn't need much food.  But I would say that you definitely need to let her nurses know about her deteriorating condition.  Take care, xx 

  • Offline in reply to Blue-girl

    Hi Bluegirl thank you for your response. I will try get her to agree to us calling them just so we can get an update with them. We obviously as a family don’t want her in pain and I think she’s worrying that taking more means the end is closer but we can’t have her being in pain. We don’t want to loose her but know looking at the signs it’s closer than any of us want xx 

  • Hello Gem1234 and thanks for the post

    I am sorry to hear about your Nan, this must be such a difficult time for all the family.

    If you feel your nan's pain isn't being well controlled you do need to let the nurses know so they can reassess whether the medications needs to be changed. There is no reason for anyone to be in discomfort so do let them know.

    It does sound like your nan is becoming less well so it is important the nurses take a look at her as they may need to put some extra things in place to support both her and the family.

    It is best to be led by your nan in what she does or doesn't want to eat. It is fine if she isn't eating much, so please don't worry about this. It is more making sure she is kept as comfortable as possible.

    There is information about the last few weeks and days on our website that might be useful to read, so do take a look.

    I hope you can speak to one of the nurses soon.

    Please get back to us if you need any more information or support.  You may find it helpful to talk things through with one of the nurses on our helpline.  The number to call is Freephone 0808 800 4040 and the lines are open from 9am till 5pm Monday to Friday.

    Take care,

    Naomi

  • Offline in reply to CRUK Nurse Naomi

    Hi Naomi, 

    thanks for your response, at the minute the nurses are advising they aren’t prescribers and have told us we need to go back through the gp. I have had a chat with them this morning as Nan isn’t well, is struggling with pain, has recently fallen after taking the oral morp and is concerned. She has told my mum last night she can’t cope anymore wants to go into a hospice and have the end of life meds. It’s heart breaking to hear  thanks again 

  • in reply to Gem1234

    Hi there again

    I am sorry to hear your nan is continuing to deteriorate, this must be such a tough time to see her in this way.

    You have done the right thing speaking to the nurses, as they say, if they aren't prescribers the GP needs to prescribe an increase in meds for her. At the same time if your Nan is struggling at home and wishes to go to the hospice this needs to be considered for her. 

    Sometimes patients can go into the hospice for a short time to get on top of symptoms such as pain and once controlled they can come home again. There are sadly other times when a patient chooses to go into hospice for end-of-life care and that is where their time comes to an end.

    Your Nan must get what she wishes but of course, what change in medications she needs will be assessed by the doctor involved in her care. This will be to manage and control any symptoms she has and keep her as comfortable, and with as good a quality of life, to the very end.

    I hope a plan can be put in place soon so that your Nan can feel a little more content and in control of the situation.

    All the best to you and your family

    Naomi

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