personality change in late stage ov cancer

[needtonosoon]

My close friend has been told chemo is not working and hospice has been called. She still is going out and trying to remain active but needs someone with her.  Her decline was sudden and quick (2 weeks) This normally very docile really sweet person has become extremely argumentative and seems to have lost all control over what she will say.  I know she recently starting using a pain patch.  Throughout her 6 year illness we have maintained our normal relationship and neither one of us has made cancer our focus as this is her desire.  We have discussed her treatments, etc but it doesn't consume our conversations.  Right now for the first time I am unsure of what to do or say as what was ok yesterday is wrong today. I couldn't even begin to know what is going through her mind or understand as she knows how rapidly she is declining.   Any advise?  I know I can't stop what is going on but I don't want to make any time we have together worse for her.Thank you

[Annekathryn Goodman, M.D.]

Hi There
You are a true friend.

The change in her behavior could be due to:
delirium from drugs
delirium from infection
delirium from changes in her metabolism such as elevated calcium, kidney failure, or liver failure
she could have developed brain metastases
or finally she could have an agitated depression

whatever the cause, this needs to be evaluated. Be sure  that her doctor knows about this change. Even if she is on hospice care, agitation like this must either produce suffering or be the cause of her suffering. A good , thoughtful evaluation needs to be done to see how to help her
please let us know what happens
take care

[Annekathryn Goodman, M.D.]

Hi There
yes there has been great progress in the treatment of ovarian cancer and that will continue. The progress is not only in therapeutics but in supportive care.  I am so glad that you had a chance to converse. It is a profound privilege to witness a person's journey to the end of their life.
take care

[needtonosoon]

Thank you for your answser. It seems she has been balking at taking an alternative pain med (morphine) as she thought it would signal the end. Thankfully she has a terrific hospice doctor/nurse team and they convinced her to take very small doses as needed and it made a dramatic change.  She took enough just to take the edge off  and we had a great conversation today. She is still declining but I believe she feels it is on "her terms". Even though she knows the end of near I believe it has given her a little peace knowing and or at list thinking she has a little control over her state of mind. It certainly has made her far less aggitated and for that I am greatful.  She is my second friend to lose her life way to early to ovarian cancer.  The first was 20 years ago and she lasted only a brief time as diagnosis was late stage. This time diagnosis was also stage 4 and she is going on 6 years.....I guess there must have been some progress as the past five plus years for her has not been all bad. Oddly at times it has been the source of a lot of laughs. Thank you again