Managing your symptoms
Find out about managing symptoms you might have during your last few weeks or months of life.
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This information focuses on information about controlling symptoms that you may have in the last few weeks or months of life. If you are not at this stage of your illness, it may be more helpful to read our information about
Most people, when asked about dying, say that what they want is a peaceful and pain free death. This is usually possible with the right care and treatment. This makes the thought of death far less frightening.
Your GP, district nurses, and hospital doctors and nurses all try to control any symptoms that you have, and keep you as comfortable as possible. They might also refer you to a palliative care team for specialist care.
Palliative care offers relief, support, and comfort to patients and their family and friends. It involves caring for your physical, emotional, psychological, and spiritual needs in the best way possible.
Palliative care teams are made up of
- Specialist doctors and nurses
- Social workers
- Pastoral care workers
- Other health care professionals, such as dietitians, physiotherapists and counsellors
The palliative care team members work together to give you relief from pain and other symptoms. They offer you a support system that aims to allow you to live your life as fully and well as possible until you die. They also support your friends and relatives to help them cope during your illness, and after you die.
Some people don't have pain. But if you do, it can be very stressful and frightening. Many people are frightened that their final days will be spent in pain. They worry that the pain can’t be controlled without distressing side effects such as drowsiness, addiction and losing control. But it is usually possible to control pain and other symptoms without uncomfortable side effects.
If you are in pain, the important thing is to let your medical team know. Also tell them if you are afraid of being in pain, so that they can give you the right information. Controlling pain is much easier if you use painkillers regularly, as soon as the pain starts. If you try not to take painkillers, it takes longer to get the pain under control.
Your doctor, nurse or palliative care team talk you through the best ways to help control your pain. Be as honest with them as you can. This helps them decide on the best treatment and care for you. Most pain can be taken away or controlled to a level you find acceptable. So make sure you tell your health care staff when you are in pain, so that you can be as comfortable as possible.
People in the advanced stages of illness often lose their appetite, especially in the last few weeks of life. This might be due to other symptoms such as pain, sickness or breathlessness. It may just be that you feel too tired or fed up to bother eating much. Or it may be that you simply no longer need to eat so often.
Your body processes slow down as you get more ill. Your body can't digest food as well as it did, or get so much benefit from it. If you are at this stage, eat when you feel like it. Don’t feel you have to force yourself to eat. Other people might still want to encourage you to eat meals. So it is important to let them know if eating is making you feel uncomfortable. You can explain that you don’t feel hungry and you feel better if you don’t eat.
If you can manage it, keeping up your fluid intake may help you feel better. There are different types of liquid meals you may like to try. But if these also make you feel uncomfortable, you can drink water, tea or whatever else you fancy.
In the last few days (or sometimes weeks) of life, people rarely feel hungry. Eating and drinking can become too much effort.
Some people who are dying might feel sick due to their cancer. Or the sickness may be a side effect of medicines they need to take. It can be very unpleasant and distressing to feel sick but it can usually be well controlled with anti sickness medicines.
People with advanced cancer often say that feeling tired and exhausted is the most worrying symptom they have. It can be the symptom that disrupts your life the most. You may notice that you can’t concentrate for long, finish things you started, or stop yourself falling asleep during the day. This can make you feel irritable, easily upset and fuzzy headed. Doctors call this fatigue.
It is important for you, or your carer, to discuss fatigue with your medical team. There are sometimes things that they can do to help. It can also help to use your energy for the things that you like doing and find the most worthwhile. You can leave less important things for other people to do.
Some people with cancer might get confused in the last few weeks of life. Some people have times when they are confused, but other times when they are not confused at all. It can be very distressing to see someone you care about when they are confused.
Confusion can often be mild. But for some people and their carers it can be more serious. A confused person might not be aware of their surroundings. Their speech may become slurred, disjointed and rambling. You may have trouble understanding what they are trying to say.
At times, they might not make sense at all. They may misunderstand sights, sounds and things that are happening around them. Or they may seem to see or hear things that are not there (hallucination). Confusion may make people anxious, upset, restless or even aggressive.
As people get weaker and become more ill, it is common for them to be confused at times. But there is sometimes a physical cause that is treatable, for example
- A high temperature caused by an infection
- Side effects of medicines
- Bowel problems (constipation)
- Changes in the chemical balance in the body, such as high calcium levels
- Lack of oxygen to the brain caused by cancer or another illness
- Cancer spread to the brain
Confusion might clear up quickly if the cause can be treated. But sometimes this is not possible in the final weeks or days of life. The palliative care team can help with tips and care that make the confusion less distressing for you and your loved ones. The following suggestions can help to calm and orientate someone who is confused
- Avoid arguing or disagreeing if they are imagining things – it doesn’t usually help and can make them more distressed
- Confusion can often be worse at night so it can help to leave a night light on and keep the door open in case they wake
- Try to make surroundings peaceful, safe and calm – for example, use low lighting, soft background music and pleasant smells
- Avoid changing the surroundings too much – let them know if you are going to move something or take it away
- Always let them know when you go into or leave the room
- Talk quietly and reassuringly – it often helps to hold their hand when you are talking
Restlessness as someone gets closer to dying is called terminal restlessness or agitation. It might happen in the final days or hours of life. The symptoms are very similar to confusion, but the person may also become very restless or agitated.
The person's muscles might twitch or contract. They may grab at their night and bed clothes continuously. Moaning or calling out is also common. The causes of restlessness can be similar to those of confusion. But terminal restlessness is usually due to the body organs slowing down and not getting rid of waste products. The waste products then build up in the blood.
Terminal restlessness can also be distressing for carers to see. Let the doctor know if you are worried that the person you are caring for is restless. The doctor might be able to prescribe medicines to help them relax. Often they can have these drugs through a syringe pump. This can give continuous small amounts of a drug to help control symptoms.
Carers and relatives might need to talk about their feelings if they are distressed about seeing their relative restless and confused. They can do this with the doctor, nurse, or members of the palliative care team.
You might have symptoms other than the ones we mention here. Different types of cancer affect different parts of the body. Even in the late stages of your cancer, your doctor may want to treat some of these changes.
Treatment can make you much more comfortable. But there may also be times when treatment causes you more distress than comfort. So your doctor may decide against treatment, and try to keep you as comfortable as possible.
Possible changes include
- High calcium levels in your blood (hypercalcaemia)
- Bowel problems
- Breathing problems
- A build up of abdominal fluid known as ascites – it is treated by draining the fluid to help relieve pressure and discomfort
- Problems passing urine – putting a tube into the bladder (catheter) can help relieve this
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Contact the Cancer Research UK nurses on freephone 0808 800 4040 (Open 9am to 5pm, Monday to Friday)
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