Lung cancer with brain metastases near the end of life

Brain metastases may lead to headaches, seizures, weakness, balance problems, speech changes, confusion, sleepiness, or changes in personality. Near the end of life, a person may spend more time asleep, eat and drink less, need help with personal care, or become less able to communicate. These changes vary and can also be caused by medicines, infection, dehydration, or treatable swelling around a tumour. A person's symptoms do not provide a reliable timetable. The clinical team can explain what they are seeing and what may be reversible.

Ask the oncology or palliative care team to review pain, seizures, nausea, breathlessness, agitation, constipation, and anxiety. Medicines may be adjusted when swallowing becomes difficult, and care can often be provided at home, in hospital, or in a hospice according to local services and preferences. Keep the room calm, offer mouth care, and let the person rest; do not force food or drink. Discuss who should make decisions if the person cannot speak for themselves, what treatments they want, and whom to call day or night. Radiotherapy or other cancer treatment may still be considered when it is likely to relieve a specific problem.

Seek emergency help for a first seizure, a seizure that does not stop, sudden severe headache, sudden weakness, loss of consciousness, or severe breathing difficulty. Contact the care team promptly for new confusion, repeated vomiting, uncontrolled pain, agitation, or inability to take prescribed medicines. If a person is already receiving end-of-life support, use the agreed urgent contact number so the team can guide you.

Which symptoms might be reversible? What changes should we expect next? What is the plan for seizures and pain? Who do we call overnight? Would radiotherapy help a particular symptom? Can palliative care support us at home?