Glioblastoma (GBM) is recognized as the most aggressive primary brain tumor, classified as a Grade IV astrocytoma. The tumor’s rapid, invasive growth within the brain tissue means the dying process is characterized by a progressive loss of neurological function. Understanding this specific progression provides patients and caregivers with a framework for preparation and allows for a sensitive, focused approach to care. This progression is distinct because the source of the decline is the central nervous system, profoundly affecting a person’s cognitive and physical existence.
Neurological Decline and Functional Loss
The physical decline associated with glioblastoma is fundamentally neurological, resulting directly from the tumor mass invading or compressing functional areas of the brain. As the tumor grows, symptoms become more pronounced, reflecting damage to specific neural pathways. This progression often begins with increasing cognitive impairment, making it difficult for the person to process new information, maintain attention, or manage confusion.
Motor functions are commonly affected, leading to worsening hemiparesis (weakness or partial paralysis on one side of the body) and a general loss of coordination. When the tumor impacts language centers, speech disturbances develop, such as aphasia (inability to understand or express speech) or dysarthria (difficulty with the physical act of speaking). Seizures may also increase in frequency or severity as the tumor irritates the brain’s electrical activity. This chronic loss of function is generally gradual, but can accelerate suddenly due to increased brain swelling (edema) or a hemorrhage within the tumor itself.
Signs of Imminent Passing
Signs that death is imminent, typically within the final 24 to 48 hours, involve a cascade of physical changes indicating the body’s systems are shutting down. One of the most noticeable changes is in the breathing pattern, which becomes irregular, often characterized by Cheyne-Stokes respiration (periods of rapid, shallow breaths followed by brief pauses). The patient will become profoundly unresponsive, drifting into deep unconsciousness that is difficult or impossible to rouse.
Circulatory changes manifest as a significant drop in blood pressure and a cooling of the body temperature. The skin may exhibit mottling, a purplish or reddish-blue discoloration that starts in the extremities as peripheral circulation slows. Another clear sign is the inability to swallow. Caregivers should know that while these physical changes can be distressing to observe, they are a natural part of the physical process and do not necessarily cause discomfort for the patient, especially when consciousness is lowered.
Managing Comfort and Symptoms
As the disease progresses, the primary goal of care shifts from aggressive life-prolonging treatments to ensuring comfort and managing symptoms, a shift facilitated by palliative care or hospice services. This focused approach includes aggressive symptom control, with a strong emphasis on pain management, even if the patient appears unresponsive, as discomfort can still be present. Management of seizures requires anticonvulsant medications, which may need adjustment or administration through non-oral routes as the ability to swallow diminishes.
Brain swelling is often managed with corticosteroids like dexamethasone, but these may be gradually tapered as the patient nears the end of life to reduce side effects. Restlessness or agitation, which can be a manifestation of delirium or discomfort, is addressed with appropriate medications to promote a peaceful state. Hospice teams provide holistic support, ensuring medications are administered subcutaneously or rectally when oral intake is no longer possible.
Changes in Consciousness and Communication
A progressive change in consciousness and the ability to communicate is a defining feature of the dying process with glioblastoma. The patient will experience increasing somnolence, spending more time asleep and becoming difficult to wake for extended periods. Interspersed with this deep sleep, periods of delirium or confusion may occur, presenting as disoriented speech, restlessness, or agitation.
The eventual loss of verbal communication is a common stage, often caused by aphasia or a deepening level of unconsciousness. Caregivers can maintain connection by relying on non-verbal methods, understanding that the patient’s level of response does not reflect their capacity to hear. Talking softly, using gentle touch, or playing familiar music can provide comfort, as the sense of hearing is frequently the last sense to fade. This continued relational presence remains a vital source of support.