Carol I am so sorry to hear of your mother's cancer diagnosis on top of the multitude of other health issues she has. It certainly makes treatment decisions more complex. I can understand the use of palliative radiation in an effort to shrink the tumour. The PEG tube is a good avenue for administering nutrition, medication and fluids to keep her hydrated. I would have reservations about the tracheostomy as being hard on her and the care required following. Would the Dr. consider a wait and see on the trach? Are you able to have a meaningful discussion with your Mom about these things to know what she wants in terms of care. There are medications available to control symptoms that occur at the end of life, even shortness of breath. If she gets to the point that she is not able to take her heart medication, cause of her death could be her heart giving out. Usually not an unpleasant death. There certainly are lot of things for you to think about, but if your Mom is able, let her be your guide. Do you have good medical support from your primary care doctor and home care nursing services available, also family support?
Sending you hugs, courage and strength for the days ahead.