Recognizing the signs and symptoms that signal the coming of the end of life for people with lymphoma can help their loved ones prepare and provide the right care. The exact signs and symptoms differ from person to person. However, common symptoms of dying from lymphoma include extreme fatigue, breathing changes, and loss of appetite.

Lymphoma is a type of cancer that starts in the lymphatic system, which is part of the body’s immune system. There are many types of lymphoma, with the main subtypes being Hodgkin lymphoma and non-Hodgkin lymphoma. Although there are treatments available for the disease, for some, it will be terminal.

1. Fatigue

Fatigue is one of the most common symptoms in the final stages of lymphoma. Cancer-related fatigue is often described as a deep exhaustion that doesn’t improve with rest. It is much more severe than normal tiredness and can make even small tasks like talking or sitting up feel impossible.

Research shows that up to 98% of people with cancer experience extreme fatigue in the last days of life. Unfortunately, most medications don’t help treat fatigue, but short-term use of steroids like dexamethasone may provide temporary relief.

2. Bone Marrow Failure Effects

The bone marrow is where infection-fighting white blood cells, oxygen-carrying red blood cells, and platelets that assist in blood clotting are made. When lymphoma progresses, it can cause changes in blood cell counts, leading to complications.

Anemia occurs when there aren’t enough red blood cells, reducing oxygen supply to cells and organs. This can cause people to feel tired and short of breath. Sometimes, a blood transfusion may help improve energy and quality of life, but the benefits don’t usually last long. 

Low platelet counts (thrombocytopenia) can lead to easy bruising and bleeding. A platelet transfusion might help reduce bleeding. Since platelets have a short lifespan in the body, this benefit also doesn’t last long.

A lack of healthy white blood cells can lead to an infection. 

3. Breathing Changes

Breathlessness is a distressing symptom that becomes more common in the final stages of lymphoma. It can be caused by enlarged lymph nodes or fluid buildup in the chest, restricting air movement in the lungs. It can feel like a constant struggle for air, making simple activities difficult.

Managing breathlessness may involve medications, oxygen therapy, or interventions to improve anxiety and discomfort.

4. Pain 

Pain in the final stages of lymphoma can occur if the cancer spreads into areas that put pressure on bones, nerves, or other organs. While not everyone will experience severe pain, it can be managed with medications and other treatments.

5. Digestive Changes

As lymphoma progresses, people often experience a loss of appetite and changes in digestion. The body’s metabolism slows down, and people often feel full quickly or have no desire to eat. Nausea, constipation, and difficulty swallowing can also make eating uncomfortable.

In the final stages, the body naturally needs less food, which often is a distressing symptom for loved ones.

6. Organ Failure Effects

As lymphoma progresses, the body’s organs begin to fail, as follows:

• The kidneys may stop filtering waste effectively, causing a buildup of toxins in the blood. This can lead to confusion or increased fatigue.
• The liver may also stop working well, resulting in a yellowing of the skin called jaundice.
• Heart function can weaken, causing low blood pressure.

These changes typically develop gradually, and as multiple organs begin to shut down, the body enters the final stage of life.

Cause of Death in Lymphoma Patients 

Death from lymphoma often results either from the body’s inability to fight infections or severe organ failure. Often, the cause of death is considered the lymphoma itself.

Common signs in the week or so leading up to death include:

• Decreased consciousness
• Minimal to no food intake
• Difficulty swallowing liquids
• Inability to sit up or walk

Care and Support During End Stages

Care during the final stages of lymphoma involves focusing on comfort and quality of life. It is important to have open and honest communication between the person with lymphoma, their caregivers, and the healthcare team to ensure the patient’s desires are known and can be met when the time comes. 

Hospice care is a service that specializes in end-of-life care. The hospice team provides care at home or in a facility. Hospice care has been shown to improve quality of life at the end stage. In addition to giving palliative care (providing comfort and dignity) to the dying individual with lymphoma, hospice also offers emotional support to caregivers, which is also important during this difficult time.

Summary 

Common signs and symptoms of dying from lymphoma include extreme fatigue, breathing changes, and digestive changes such as lack of appetite. Some people may have pain and confusion. Hospice care can provide support to the dying person and their caregivers at the end of life.