Case Record 04 · Advanced Liver Cancer: Comfort, Calm, and Dignity at End of Life

Overview

This case record documents a series of elderly individuals with advanced stage liver cancer who were receiving palliative care and were no longer candidates for curative or aggressive medical intervention.

The record is situated within a regulation informed mindfulness based counselling framework and focuses on observed patterns of nervous system regulation and distress modulation rather than diagnostic, prognostic, or treatment claims.

Support was non invasive and non contact, aligned with palliative care principles, and did not replace, interfere with, or alter medical decision making, symptom management, or end of life planning.

Presenting Pattern

Across these late stage cases, the following patterns were commonly observed:

• Advanced systemic fatigue and physical frailty
• Persistent discomfort or pain despite medical symptom management
• Irregular or laboured breathing patterns
• Disturbed sleep or difficulty resting
• Heightened fear, distress, or agitation related to illness progression
• Emotional burden associated with unresolved life concerns and loss of control

Medical care had appropriately shifted toward comfort focused goals. However, nervous system instability and psychological distress continued to affect perceived comfort and subjective quality of remaining life.

Regulation Based Integrative Formulation

Within a regulation informed framework, these presentations were conceptualised as reduced regulatory capacity in the context of terminal illness.

From a nervous system perspective, patterns were consistent with:

• Prolonged physiological stress responses in the context of terminal illness
• Reduced autonomic flexibility as bodily systems approached exhaustion
• Heightened central sensitivity amplifying pain, breathlessness, and discomfort

Psychologically and emotionally, individuals often demonstrated:

• Fear related to dying and loss of bodily autonomy
• Unexpressed grief, unresolved relational concerns, or existential distress
• Difficulty settling into rest despite physical exhaustion

These factors suggested that distress was not solely driven by physical pathology, but also by sustained nervous system activation and emotional load.

Therapeutic Perspective

Within this regulation informed approach, support focused on:

• Facilitating nervous system settling
• Reducing activation related distress
• Supporting breath rhythm stabilisation
• Strengthening tolerance for bodily sensations
• Enhancing present time orientation

Support was gentle, non directive, and aligned with comfort care priorities. No physical contact or medical intervention was involved.

Supportive Process and Observed Shifts

Support focused on facilitating nervous system settling, supporting breath regulation, and reducing distress during the final stages of illness. The process was gentle, non directive, and aligned with palliative care principles.

Observed changes across these cases included:

• Softer and more regular breathing patterns
• Reduced agitation and visible distress
• Improved capacity to rest or sleep
• Decreased fear responses during periods of discomfort
• Greater sense of calm and dignity reported by individuals and observed by family members

In some cases, family members noted longer periods of relative clarity, presence, or peacefulness during the final phase of life.

Integrative Summary

From a regulation informed perspective, observed changes reflected:

• Reduction in nervous system distress at end of life
• Improved capacity for the body to settle without sustained resistance
• Greater capacity for calm presence despite irreversible illness

Support did not aim to influence medical outcomes, but to strengthen regulatory stability and reduce distress within the final phase of life.

Ethics and Safety Note

This case record is provided for educational and service description purposes only. It does not constitute medical diagnosis, treatment, prognostic claims, or end of life guidance. All medical and palliative decisions remained under appropriate clinical supervision. Individual experiences vary and outcomes are not guaranteed.