Advanced stage cancer patients experience debilitating physical symptoms as well as profound emotional and spiritual struggles. Advanced disease is accompanied by multiple changes and losses for the patient and the family. Palliative care focuses on the relief of overall suffering of patients and families, including symptom control, psychosocial support, and the meeting of spiritual needs. Music therapy and reflexology are complementary therapies that can soothe and provide comfort. When used conjointly, they provide a multifaceted experience that can aid in the reduction of anxiety, pain, and isolation; facilitate communication between patients, family members, and staff; and provide the potential for a more peaceful dying experience for all involved. This article addresses the benefits of the combined use of music therapy and reflexology. Two case studies are presented to illustrate the application and benefits of this dual approach for patients and their families regarding adjustment to the end of life in the presence of anxiety and cognitive impairment.

Individuals with cancer have two to four times an increased risk of depressive disorders compared to the general population. Depressive symptoms are related to impaired daily life functioning and a rise in health care utilization. Pharmacological treatments for depression are usually effective to reduce depressive symptoms, but sometimes lead to serious adverse reactions. We describe a cancer patient who developed sudden psychological and behavioral abnormalities after administration of the antidepressant paroxetine. Impulsive and aggressive symptoms are a so-called activation syndrome that can cause violent or suicidal tendencies. Palliative care staff should pay close attention to these potentially lethal reactions and make an immediate and correct diagnosis.

Should terminal patients know about their impending deaths? How much should they know? How do we determine “should”?