What Can You Expect During End Stage Lung Cancer

Physical, Emotional, and Spiritual Changes at the End of Life

Though everyone's experience is different, there are some common stage 4 lung cancer symptoms that may indicate a person is near to dying:

  • Pain
  • Shortness of breath due to fluid build-up
  • Persistent cough
  • Fatigue
  • Muscle loss and weight loss
  • Headaches, seizures, or other neurological problems if the cancer has spread to the brain

People's needs may also vary. Some need oxygen, for instance, while others don't.

It can be hard to think about what to expect at the end of life with lung cancer. But knowing the signs can help you prepare yourself or a loved one for the final stages of this difficult disease.

This article will look at the different factors that affect people in the end stages of lung cancer and considers physical, emotional, and spiritual changes that may affect them.

End of Life Changes

There's no single roadmap, but many families can tell when things "start to change." Some of these physical and emotional changes are nearly universal, no matter what condition a person dies from.

With lung cancer, there are signs along the road that point to its end. Some of these conditions include pleural effusions that require a hollow tube, called a shunt, and repeated draining of fluids. A person may find it hard to be awake because of pain. They may become extremely weak or don't want to eat.

Let's take a closer look at some of the specific changes you may see.

Emotional Changes

Some people want to fight their cancer to the end, but others seem ready to accept death. Your loved one may start to withdraw in those last few months. They may seem less open to visiting with family and friends. Activities that once excited them now no longer capture much interest.

For caregivers, taking care of yourself is very important at this stage. A support system helps you maintain your own well-being so you can support your loved one with cancer as well as possible.

As one woman said of her husband in late-stage lung cancer, he appeared to “have one foot in the next world.” It's not unusual for people to seem lost in thought, or begin to sleep a lot. They also may be frustrated, and irritable over fatigue and other limitations that mean they need more help.

Spiritual Changes

One thing that happens often, and that may seem troubling, is for people to talk about seeing heaven or loved ones who have died before. That's common whether the dying person was religious in life or not.

Sometimes a family may think these visions are delirium or terminal restlessness, an end-of-life agitation that can be frustrating to experience. They may occur when a dying person seems to have an awareness that death is near.

It's important to speak gently instead of "correcting" these comments from a dying person. Offer comfort and let them know they are not alone in the life they still live here. After all, we really don't know what a dying person may or may not see and know.

If loved ones do try to correct a dying person, or tell them they are just "seeing things," they often become quite distraught. It's best to simply listen and allow your loved one to share comments like this, even if they may be upsetting to you.

Physical Changes

The physical changes during the final stages of lung cancer are because of the lung tumor, the cancer's spread to other parts of the body, or the end stages of cancer in general.

By definition, the final stage of lung cancer means there are no more treatment options and a cure is not possible. But palliative treatments, used to ease symptoms or improve comfort, may still be used. If you are enrolled in hospice, you may be given a hospice comfort kit with supplies that can help. Some common physical changes include:

physical changes in end stage lung cancer

Verywell / Brianna Gilmartin

  • Fluid build-up around the lungs: Fluid with cancer cells in it may build up in the spaces around the lungs. This malignant pleural effusion causes shortness of breath and doctors often drain the fluid to improve breathing and comfort levels. If fluid build-up continues, they may recommend pleurodesis, a procedure to prevent fluid from accumulating again. They may also place a shunt for you or a loved one to drain the fluid at home.
  • Obstruction or bleeding from the large airways: Lung cancers that grow near airways may block them as any tumors spread. These tumors also may cause bleeding, which can be treated with radiation or another procedure meant to shrink the tumor.
  • Symptoms due to brain metastases: When lung cancer spreads to the brain, people may have headaches, seizures, and related symptoms like weakness or speech problems. Radiation therapy may slow tumor growth and ease symptoms. New drugs also may be needed to limit the number of seizures.
  • A cough that won't let up: Sometimes the coughing is because of tumor growth in the airways, or fluids that just won't come up. A doctor can show you ways to control coughing and make you or your loved one more comfortable.
  • Shortness of breath: Some people are understandably afraid and say they feel like they are suffocating because of shortness of breath. Thankfully, this rarely ever happens. Oxygen may be helpful but other drugs are key to controlling it. Morphine can "turn off" the signal to the brain so that even if oxygen levels fall, you won't experience shortness of breath.
  • Fatigue and weight loss: Profound fatigue is common in the late stages of lung cancer. Weight loss is nearly universal too, even when people are eating enough. Cancer cachexia, a syndrome of unexplained weight loss and muscle wasting, is very common in the late stages of cancer. 
  • Pain: Many people are anxious about dying in pain. When lung cancer spreads to bones in the chest and spine, there are options for pain control including radiation and pain medications. Using drugs to treat today's pain won't mean that nothing is available if pain gets worse tomorrow. There are different methods for pain control, and you or your loved one won't run out of options.


End-of-life care focuses on quality and comfort when treatment is no longer an option. Because pain, shortness of breath, and other symptoms are common in late-stage lung cancer, there are helpful drugs and other techniques to help you or your loved one make a better transition.

The Final Days

Many researchers now believe that dying is an active process the body is designed to go through. During the final days, your loved one may begin a phase known as “active dying.”

Your loved one's skin may become cool as body temperature lowers, and you may notice mottling (bluish, blotchy patches) on the skin. The dying person often sweats and, even though the skin is cool, it may feel wet and clammy. They usually stop eating and drinking, and this is normal. They will not feel thirsty or hungry.

As death gets closer, the person's breathing may change. Rapid, deep breaths may alternate with periods of very shallow breathing (Cheyne-stokes respirations). A gurgling sound (the death rattle) may occur due to fluids building up in the back of the throat. This may distress family members but apparently is not upsetting to the dying person.

Confusion is common. Your loved one may be restless, picking at the sheets or clothing. There may be a surge of energy, or even the appetite for a full meal after eating little for days. This can be heart-wrenching if family members misinterpret this as a sign that their loved one is getting better.

Most likely, it is the body’s way of giving them a last chance to say goodbye. They will stop communicating and enter a deep sleep as the dying progresses. Continue to express your love, which the person likely still hears even if they cannot respond.

The Death

It's not necessary to know what actually causes death in order to give your loved one the best care possible. Not everyone wants to know, but some people do.

As dying continues, all breathing stops and the heart stops beating. Some people say they know the exact moment, or "feel" when a loved one has left them. Others find comfort in staying near their loved one’s body as it becomes cooler, and find it easier to let go after that.

If your loved one is dying at home, check with your hospice nurse or doctor ahead of time to know what next steps to take after the death.

In most cases, family members are allowed to spend time mourning and saying goodbye to their loved one before the funeral home is called.

For Loved Ones

Caring for a dying loved one can, at the same time, be the hardest and most rewarding thing you have ever done. But be sure to take care of yourself during this time, even if it feels selfish. Keep in mind that grieving often begins before a loved one dies—it's called anticipatory grief—and can be lonely as others around you may not recognize it. 

When your loved one passes, you may find yourself in a state of shock. What comes next? If you are connected with hospice your hospice team can help you with the next steps, or follow this checklist of responsibilities for survivors after death.


Dying is a natural process for all people, but it's also a profound mystery in the human experience and no two deaths are ever truly the same. It helps to know that there are some common steps as you navigate the physical, emotional, and spiritual changes that come when lung cancer patients die. A dying person usually wants support, but be sure that caregivers have a support system too.

A Word From Verywell

Everyone grieves differently, and this is important to keep in mind even if you feel prepared. You can't rush grief. Take the time you need to say goodbye to this part of your life before moving on to the next. If you continue to struggle with your feelings, seek out a good grief counselor. Those who live on often need support and comfort as they face life without their loved one.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Lynne Eldridge, MD
 Lynne Eldrige, MD, is a lung cancer physician, patient advocate, and award-winning author of "Avoiding Cancer One Day at a Time."