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This section describes some of the symptoms that may occur during the final stages of cancer and ways to help you control them.
Some symptoms are caused by the cancer itself, while others are the result of treatment. You may have one or more of these symptoms, or none at all. Any symptoms can usually be controlled with help from the healthcare team or specialist palliative care team working in the community or in hospital.
You may be given treatments such as chemotherapy| or radiotherapy|, with the aim of controlling the cancer for a time and reducing symptoms.
If you want to discuss your treatment options| or get a second opinion|, it may be a good idea to make a specific appointment to go over all the options with your doctor. You can ask them to explain the treatments fully and tell you about the possible benefits and disadvantages of each one. You can also ask them what is likely to happen if you don’t have further treatment.
It’s important that you don’t feel under pressure from your family or friends to accept or refuse further treatment. The final decision is yours, even if you discuss the options with your family or friends.
Many people are frightened of pain. However, there are many effective painkillers and other ways of controlling pain, so it can usually be well controlled.
Everyone feels pain differently. Even people with the same condition have very different experiences. It’s important to explain to your doctors and nurses exactly where your pain is, how it feels and how it affects you, so that they can treat it effectively.
Many people believe that they should put off using painkillers for as long as possible, and only take them when their pain gets unbearable. However, if pain isn’t treated it may be harder to control, so it’s important to take any painkillers that you are prescribed in the way that your doctor advises.
The right painkiller for you depends on the type of pain you have and how bad it is. There are different types of painkillers:
You may also be given other types of drugs to take as well as painkillers. For example: anti-inflammatory drugs may be particularly helpful for bone pain; antidepressants and anticonvulsants, which are usually used to treat epilepsy, are often used to treat nerve pain; and muscle relaxants can help relieve muscle spasm. It’s quite common to be given more than one type of painkiller for your pain.
If you have frequent or constant pain it’s important to take painkillers regularly. Each dose should be enough to control your pain right through to the next dose. If the pain comes back before your next dose is due, let your doctor or nurse know so they can give you a more effective dose or a different drug. It may take a few days to get the drugs and doses right. It’s important to let your doctor know if the pain is not controlled. Some people find it helpful to keep a diary recording when they get pain.
Strong painkillers such as morphine, and painkillers containing codeine, have three common side effects: drowsiness, sickness| and constipation|.
The drowsiness usually wears off after a few days, so it should be possible for you to be free of pain and still be alert enough to do all that you want to do.
If you feel sick, anti-sickness tablets can help, and the sickness usually settles over a few days.
Constipation is a very common side effect and everyone taking strong painkillers should take a laxative regularly. There are a number of different types of laxatives. Some soften the stool, some stimulate the bowel and others contain a combination of both a softener and a stimulant. Your doctor or pharmacist will be able to advise you on the most suitable laxative for you. Don’t be afraid to vary the dose of your laxatives to keep your bowels moving easily.
Most painkillers are available as soluble tablets or liquid medicines, so you can use these if you have problems with swallowing tablets. Some painkillers, such as fentanyl, can be given as a patch stuck onto the skin. If you can’t swallow, or if you’re drowsy or confused and unable to swallow tablets or liquid medicines, some painkillers can be given through a tiny needle inserted just under the skin of the tummy or arm. Enough painkiller for 24 hours is made up and a small portable pump (a syringe driver) is used to give a continuous dose of the drug.
A syringe driver is easy to set up and this is usually done by a nurse. If you’re able to move around and walk, the syringe driver can be carried in a special holster or a pocket. If you’re in bed then it can be put on the bedside table or tucked under a pillow. Other medicines, including those that treat sickness to help you feel more relaxed, can also be given by the syringe driver. Your doctor or palliative care team will be able to discuss if you need a syringe driver and how it works.
Some people fear that being given drugs by a syringe driver will hasten their death. This isn’t true. A syringe driver is simply a different way of giving the same or similar drugs at the doses needed to control your symptoms.
Many people with cancer ask if they will become addicted to drugs such as morphine, or become confused and unable to look after themselves. The answer is no. People who become addicted to drugs choose to take them – usually for reasons other than pain and at larger doses – and then keep taking them because they have a psychological need for them, for example, they may make them feel ‘high’. This is very different to someone who is in pain and who needs to keep taking the drug to keep their pain under control. People in pain have a physical need to take the drug rather than a psychological need.
There is no danger of you becoming addicted to painkillers when they are used to control cancer pain.
The dose you take will be tailored to your needs. The right dose is the dose that controls your pain but doesn’t make you feel drowsy or confused. It can be increased if your pain gets worse. Many people stay on the same dose of morphine for months. However, it can be harmful to stop taking morphine suddenly. If you have another treatment to relieve the pain, for example radiotherapy, the dose of morphine can be gradually reduced under the supervision of your doctor or nurse.
We have more information on cancer pain| which you may find helpful.
Strong emotions such as fear, anxiety|, depression| and tiredness can make your pain worse. So, it’s important to try to treat the emotional as well as the physical causes of your pain. Learning to relax, even for short periods of time each day, can play a very useful part in controlling pain. You can relax by becoming aware of different groups of muscles around your body and learning to relax them, so that you can do this consciously when you are under stress or in pain.
In visualisation or guided imagery, you bring happy, relaxed pictures into your mind and this can help to reduce pain. Massage with soothing aromatherapy oils can also help you relax.
Our section on complementary therapies| has more information about these techniques and tells you how to find a registered complementary therapist.
Another way of reducing pain is to use distraction, such as listening to music you enjoy or watching a good film.
If you feel sick or have trouble keeping food down, your doctor can prescribe anti-sickness medicines to help. These should be taken regularly to prevent the nausea coming back. They can be taken as tablets or given as suppositories, which are inserted into your back passage. Sometimes anti-sickness medicines are given as an injection by a nurse or doctor. They may also be given in a syringe driver.
We have more information about controlling nausea and vomiting|, which may be helpful.
Many people lose their appetite, especially if they feel sick. The illness itself, or treatments such as radiotherapy and chemotherapy, can cause sickness and loss of appetite. You may be put off even by the sight and smell of food. Small, frequent, simple meals, concentrating on your favourite foods, are likely to be most tempting.
However, as you become more ill, your metabolism slows down and your body can’t digest food so well or take up the goodness from it. At this stage, it’s important not to force yourself to eat.
You may want to try liquid meals when you don’t feel able to eat a proper meal. There are many different types of liquid meals such as Ensure® or Fortisip®, which are complete meals in liquid form. Your doctor or nurse can advise which is best for you and can arrange a supply, often on prescription. There may come a time when even liquid meals are too thick and difficult to digest and you may only want to have clear fluids such as water, squashes or tea.
At this stage, small amounts of liquids may be all that you need to keep you comfortable. You may notice that your mouth feels very dry. This is not a sign that you’re dehydrated or that you need to drink more fluid. At some point, people stop drinking even water and just need to have their mouth kept moist by cleaning it gently.
You may want to try sucking pieces of fruit, such as pineapple. Fruit juices can be made into ice lollies or ice cubes, which you can suck to moisten your mouth. If a dry mouth is stopping you from being able to eat or talk, artificial saliva spray or lozenges may help.
We have more information and tips on coping with a dry mouth|.
You may also wish to see a dietitian for advice on any of the above issues. Your doctor or nurse can arrange this for you.
Fatigue (feeling exhausted all or most of the time) is a common and difficult problem for people with advanced cancer. It can be caused either by the cancer or by symptoms such as pain.
If you feel tired, it’s important to pace yourself and save your energy for the things that matter to you and that you enjoy instead of feeling that you have to do things around the house. Letting other people do these jobs can help you have more energy for things that you really want to do. Just do as much as you feel like. You won’t do yourself any harm if you do too much - you can simply rest and relax a bit more the next day if you need to.
Tiredness and weakness can make it harder for you to concentrate or take part fully in what is going on around you. So, if you have important things to do, such as putting your affairs in order, it’s best to do them as soon as possible and at a time of day when you have more energy. You may also feel more relaxed once they are out of the way.
We have more information on coping with fatigue|.
The cancer may cause certain symptoms that your doctors may want to treat, even at a late stage. Treating these can make a big improvement in how you feel.
There is more information about controlling pain and symptoms in our sections on cancer pain| and controlling the symptoms of cancer|.
Many people find complementary therapies or practices help them feel stronger and more confident in dealing with dying. They can sometimes be used alongside conventional treatments and medicines.
Complementary therapies may help to improve quality of life and well-being and can sometimes help to reduce symptoms. Some complementary therapies, such as meditation or visualisation, can be done by the dying person themselves and may reduce anxiety. Carers and relatives can learn how to do other therapies, such as gentle massage, so that they can use them to support the dying person.
Physical contact and touch can be among the most powerful ways of supporting people who are facing uncertainty, fear or pain, whether emotional or physical. Touching someone gently may express how much you care about them.
Many hospices and hospitals offer complementary therapies alongside conventional care. These may include:
Our section on complementary therapies| has more information about these therapies.
Content last reviewed: 1 February 2011
Next planned review: 2013
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.
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© Macmillan Cancer Support 2013
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