### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
My dad has advanced head and neck squamous cell carcinoma. He is no longer receiving any treatment other than medications for pain. He is at home with family caregivers and refuses hospice care. The tumors are rapidly growing and his face, neck, head, and throat are swollen, making him almost unrecognizable. He can no longer speak because his tongue takes up his whole mouth, and he has a feeding tube. He has mucus flowing from his nose and tracheostomy that has an odor that is becoming more and more pungent. My dad is sleeping most of the day, but he is restless. He also twitches and jerks the entire time he is sleeping (i found it to be myoclonus symptoms). I understand his death is nearing, but I am not sure if he has a week or two months left. I also understand that there is not really a "time frame" for determining death. My question is what are the signs that death is very close so that I may gather friends and family to say goodbye?

### output:

Hi, Thanks for writing in to us. Sorry to hear about the disease progress in your dad. Cancer is a difficult condition to treat, and we must fight it till the end. Pain relief is one of the pillars in cancer treatment. The main function in the living is breathing and feeding and if these two are taken care of then the patient can survive for some months. Since he has got a tracheostomy tube inside, his airway is no longer a problem as long it remains patent and free from infection. Feeding is taken care of by rules tube feeding. If he is free from infection involving any major part of the body then he can survive for 2 to 6 months. However, if the tracheostomy opening is getting infected and if the infection has reached the lungs then survival beyond a month is tough. It is best to say goodbye when he is still able to recognize his loved ones are there around him. Instead of saying goodbye it will be better to just meet him and make him forget his pain for some time. This will be good for him also.