The Last Months of Life with Colon Cancer

There is nothing morbid or dark about wanting to know how a disease will progress, especially if you or a loved one is potentially facing the end of life from it. Your prognosis is largely dependent on the extent of your disease progression and general health. Regardless of what friends or family members tell you, one thing is essential to remember: Although most people experience similar symptoms as the end of life nears, every experience leading up to, and including that moment, is highly individual. 

Entering your final months of life you may not initially notice any changes. However, end stage colon cancer can progress insidiously. Your decline might start with increasing fatigue or sleeplessness, increased discomfort, and decreasing appetite, all of which are easily contributable to your last treatments, depression, stress, pain, and even spiritual distress. 

Fear of Pain

Feeling pain before dying is probably the most prevalent concern when people think about mortality. There are many different pharmaceudical options available to treat your pain proactively, and keep you comfortable throughout the process. Pain medications come in many forms to include:

  • Pills that you can take by mouth, which can work quickly or have a sustained release
  • Patches that go on your skin and continuously release pain medication
  • Rectal suppositories for insertion if you are nauseous or cannot swallow
  • Medication infused lollipops
  • Intravenous (IV) and subcutaneous delivery systems

Narcotic pain relief medications can cause side effects such as dry mouth, constipation, feeling tired, or nausea, but your doctor can help you find the right medication combination to reduce your pain with minimal side effects.

You might grow tired of caregivers asking you to "rate" your pain on a zero to 10 scale, 10 being the worst pain and zero representing no pain at all.

Although it may seem tedious, pain is a very subjective symptom and this tool is one way for caregivers to measure how comfortable -- or uncomfortable -- you are at a given time.

If you haven't already started, keeping a pain journal is a wonderful tool that you and your doctor can use to help get you more comfortable. It doesn't have to be fancy -- you could jot down:

  • When you felt the pain
  • The numerical pain rating (the zero to 10 number)
  • The location of the pain
  • The duration -- meaning how long did the pain last
  • What you did to alleviate the pain and did this work


A fear of pain before death is followed closely by concerns about energy loss and "not being able to do the things I wanted to do". Reducing cancer fatigue is challenging due to its multifactorial nature, but not impossible. Some factors contributing to your fatigue might include:

  • Anemia
  • Decreased appetite and intake of nutrients and hydration
  • Depression
  • Nausea and vomiting
  • Pain
  • Certain prescription medications

You can work with your doctor to alleviate treatable factors, such as anemia, and potentially reduce fatigue by "budgeting" your energy for the day.

Save energy for essential tasks and activities you enjoy without over-doing it. If a loved one or friend is exhausting you with incessant visits it is perfectly acceptable to gently explain that you need some time alone to rest.

Withdrawal and Decreased Appetite

As your disease progresses, one challenging aspect your loved ones might encounter is your declination of food offerings and withdrawal from socialization. Both of these things are very natural and normal, but your family might mistake them as your "giving up". It is important to keep open communication with loved ones and discuss their -- and your -- concerns. 

It's okay if your desire for food has decreased. Try to stay hydrated and eat several smaller meals throughout the day. Large, rich meals may no longer appeal to you. Side effects of treatments and medications, such as dry mouth and nausea, can also reduce your desire to eat. Likewise, your taste in foods might change as your disease progresses: Many people prefer bland foods without heavy sauces, spices, or frying. 

Withdrawing from activities previously enjoyed or less socialization with loved ones can be a normal part of your disease progression, not a conscious choice. Although withdrawal can be a symptom of depression, in later stages of disease progression and final weeks of life it is common. 

The Final Days

During the final days and hours of life, many people are in a sleepy or semi-conscious state. You might sleep for hours at a time with some wakeful periods. During these times confusion is common and hallucinations are possible. You may not recognize family members, or could mistake someone for a different (perhaps deceased) family member or friend.

Towards the end of life, a sudden boost of energy, which is referred to as a rally, may occur and last hours or even days. Unfortunately, the rally can bring false hope to your family that you are "pulling through this" or "getting better", and can even make you doubt the doctor's prognosis. Typically, the rally will pass as quickly as it arrived.

Many people have concerns about what the end of life will "look like" for colon cancer in its final stages. Specific symptoms will correlate to how and where your cancer has metastasized. For instance, if the cancer has spread to the brain, you might be increasingly confused. If the cancer spread to the bones you could have pain in the areas affected, such as in your spine or hip. It is best to talk to your doctor and ask what you can expect and how best to anticipate and proactively treat your symptoms as your disease progresses. 


American Cancer Society. (n.d.). Physical Symptoms in the Last Two to Three Months of Life. Accessed online January 23, 2015.

National Cancer Institute. (n.d.). End of Life Care for People Who Have Cancer. Accessed online January 23, 2015.

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