Everyday caring for someone with advanced cancer
This page offers advice to help you to care for someone at home, and to make sure that they are as comfortable as possible.
Washing regularly is important both for personal hygiene and for comfort and morale. Many people who are bed-bound get sticky and uncomfortable, and some cancers can cause heavy sweating.
The person you are looking after will need a regular bath or thorough wash. If they can’t get out of bed or wash themselves, you will need to give them a bed bath. Your district nurse will show you how to do this, or may be able to arrange for someone to come in each day to do it.
Change the bed sheets as often as you can. Ask the district nurse to show you how to do this if the person who is ill can’t get out of bed.
Sometimes it’s possible for the person you are caring for to have a bath at the local hospice’s day centre. The district nurse or palliative care nurse can usually arrange this.
Loose, comfortable clothing, such as tracksuits, skirts or trousers with elastic waistbands, is easy to get on and off. It‘s also a good idea to choose clothes that are easy to wash.
Someone with cancer may feel colder than usual. Warm clothes, such as socks or woollen stockings, a jumper or dressing gown can help to keep them warm. If necessary, keep a hot-water bottle or wheat bag (a microwaveable, wheat-filled bag that’s good at retaining heat for a long time) close to them, taking care not to make it too hot.
Your relative or friend may experience hot flushes because of the treatment they are having, so it may be better to use layers of clothing that can be easily taken off and put on again.
Your relative or friend will feel better if their hair is washed regularly. Some hairdressers and barbers will do home visits, or you could buy a plastic hair-washing tray from disabled aids suppliers, which makes it easier to wash it yourself. If the person’s hair has fallen out due to chemotherapy or radiotherapy, their scalp may become dry and itchy. This can be eased by gently rubbing in some moisturising cream.
It’s important to check with the hospital, GP or district nurse before you apply anything to the skin.
Our section on coping with hair loss has helpful tips on coping with a dry scalp.
The district nurse will show you how to cut nails. It may be possible for someone from a voluntary group to come in to do a manicure or pedicure. Chiropodists or podiatrists will often make home visits, but this service isn’t always free so check first. If the person you are caring for is diabetic, always ask a chiropodist or district nurse to cut their nails.
If your relative or friend's mouth is too sore to use an ordinary toothpaste and toothbrush, try using a child’s toothbrush and mouth rinses. Mouth ulcers and thrush are common when someone is ill. If their mouth becomes very sore or coated, tell the GP or district nurse, who will be able to treat it. If dental treatment is needed, ask the dentist if they can do a home visit. You may need to pay for this.
If the person you are caring for is very weak, you may need to help them go to the toilet or use a commode, bedpan or urinal. This can be one of the most difficult aspects of caring and you may both be embarrassed at first. The district nurse can give you some advice and, if necessary, arrange for someone to come in and help with getting them to the toilet once or twice a day.
Moisturising and massage
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Many people who are in bed all the time find it very soothing to have their limbs and back gently massaged with a light moisturising cream such as aqueous cream, which you can get from the chemist, or almond or vegetable oil. This also stops their skin from drying out. Head massage, or gentle rubbing, can also be very soothing and relaxing. You can use cream if the lips and face are dry.
You shouldn’t massage areas that are swollen, sore, inflamed, or have broken skin, including areas of lymphoedema. If you are unsure, always ask the nurse or doctor before doing any massage. If the person’s skin has been exposed to radiotherapy, check with the hospital, GP or district nurse before you apply anything to the treated area.
If the person you’re looking after needs help to get out of bed, you will need to be taught how to move them safely. Ask the district nurse to show you the best way to do this, and take great care when you do it, as it’s easy to injure your back. The district nurse can arrange for you to have a hoist or sling to help you with moving if it’s needed.
People who are bed-bound, especially those who are very ill or very thin, are at risk of getting pressure sores (bed sores). These are very uncomfortable and can become infected. To avoid getting sores, the person who is ill will need to turn from one side to their back and then to the other side about every two hours. If they can’t turn themselves, ask the district nurse to show you the best way of turning them.
A pressure-relieving mattress and ankle or elbow pads will help to reduce the risk of pressure sores.
If your relative or friend has lost some or all control of their bladder and/or bowel, ask the district nurse for advice on incontinence. You may also be able to get support from a continence adviser.
You may be able to minimise the problem, for example by making sure the bedroom isn’t far from the toilet, or keeping a commode, bedpan or urinal near the bed or chair at all times.
The district nurse can give you information about using incontinence pads and pants, as well as protective covers for the bed to keep the person who is ill dry and comfortable and the bed clean. If these aren’t effective, the nurse may suggest a catheter, which is a tube inserted into the bladder so that the urine can be drained away into a special bag. A catheter is simple and painless; bags and tubes can easily be hidden by bedclothes and blankets. For men it is also possible to drain urine using a tube connected to a sheath that fits over the penis.
If necessary, your district nurse may organise a visit from a continence adviser to give you advice and information.
You can also find out more from the Bladder and Bowel Foundation.
Many people who are seriously ill become constipated. There are various reasons for this. Some people get constipated because they have lost their appetite and aren’t eating enough, or because they can’t move around much. Painkillers can cause constipation and if they are being taken regularly, laxatives will almost certainly be necessary. The GP can prescribe suitable laxatives.
If the person you are caring for has constipation, tell the GP, district nurse or palliative care nurse. They will probably suggest that the person increases the amount of fluids they drink and may recommend laxatives, suppositories or enemas.
If the person you are caring for has no problems with eating, then it’s helpful to add more fruit and high-fibre foods to their diet.
People who are very ill often have a poor appetite. The treatments and medicines they are taking can affect how they feel about eating. Feeling sick and having diarrhoea or constipation can stop them eating. They may feel too tired to eat, have a sore or dry throat or mouth, or find chewing and swallowing difficult.
Even if the cancer is not causing any other problems, it can affect eating habits. This is because the body’s response to the cancer can include a loss of appetite. The cancer can change the way the body uses food, so it’s possible to lose weight even if eating normally. If your relative or friend is having trouble eating, it may help to ask the GP or district nurse for advice, or to speak to a community dietitian.
The amount they can eat may change from day to day and their likes and dislikes may also alter. Take time to ask them what they’d like to eat. Try to give small meals often, whenever the person feels like eating, rather than at set times of the day. Small meals and snacks can also help to stop the person feeling sick. You may find it helpful to keep a range of different foods so that you can offer them something at any time of the day. Consider keeping tinned foods and pre-prepared frozen meals ready for the time they feel able to eat. Quick food can be as good for them as a meal that takes a long time to prepare.
If they can’t manage solid food, try soft foods such as porridge, bananas, custard, soup, yoghurt or milk-based foods. Liquidised food or a nourishing drink, such as a smoothie or ready-made supplement drinks like Complan®, Build-Up® or Fresubin®, which are complete meals in themselves, are also good. Complan and Build-up can be bought from your chemist and from some supermarkets; Fresubin is available on prescription from your GP. The dietitian at the hospital may give you a supply before your relative or friend comes home.
Moist food is often easier to cope with, and will help to prevent a dry mouth. A glass of crushed ice chips (flavoured or plain), or a bowl of ice cream can be refreshing and help to keep the person’s mouth moist. If their mouth or tongue is sore, drinking through a straw may help.
People with advanced cancer often take a long time to eat. Allow plenty of time so they don’t feel rushed. If you are concerned about the amount they are eating, it’s understandable that you will want to watch them eat. But it can be troubling to have someone watch what you eat. If they prefer, let them eat on their own. They can then eat what they want in their own time. If you have to feed them, make sure you’re sitting comfortably in a chair that gives proper support and allows you to reach them without stretching.
Eating in bed is often uncomfortable. If possible, try to sit your relative or friend up supported with pillows, or in a chair next to the bed. A table that goes across the bed can make eating easier - you may be able to hire one through the occupational therapist or home care team. Cushioned trays that sit safely on the lap or knees are another good way to make eating in bed easier and can be bought in a large home-store. A two-handed cup or a child’s feeder cup can be used for someone who finds it an effort to sit up to drink.
Mealtimes are often an enjoyable and important part of family and social life. It can be frustrating and worrying when someone you are caring for can’t eat very much and is losing weight. It’s normal for someone with advanced cancer to eat less and lose weight. So try not to take it personally if they can’t always eat what you’ve cooked, and don’t urge or nag them to eat as this can be unhelpful.
Our section on diet and cancer has suggestions for coping with eating problems.
Some people with advanced cancer feel sick or are sick (nausea and vomiting). This may be due to the cancer or it may be a side effect of some medicines. Let the doctor or nurse know if the person feels sick as this can usually be reduced or stopped with anti-sickness medicines. Some other tips to help relieve nausea and vomiting are:
avoid fatty and fried foods
eat cold foods as the smell from cooking and hot food can often increase feelings of nausea
eat small meals and snacks, and drink small amounts of fizzy drinks, such as ginger beer
suck peppermint sweets.
People with advanced cancer are often very worried that they are going to be in severe pain. But not everyone with advanced cancer will have pain. Of those who do, the pain can be completely controlled by medicines in most cases. However, it’s not always possible and some people will have problems with pain.
The hospital doctor or GP will probably already have prescribed some painkillers. They may be given as tablets or capsules, by suppository into the back passage, or by injection. If the painkillers don’t seem to be working, contact the GP, district or palliative care nurse. An adjustment of dose or change of medicine may be all that’s needed.
Some painkillers can make people feel drowsy or light-headed at first, but usually this wears off after a day or so. If not, tell the GP, district or palliative care nurse. Again, the painkillers can probably be changed.
Many people with cancer ask if they will become addicted to drugs such as morphine. People taking painkillers to control pain don’t usually become addicted to them. Most people who become addicted to drugs initially choose to take them, and then keep taking them because they have a psychological need to do so. 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.
If pain and other symptoms are very troublesome and distressing, a short stay in a hospice may help. There, experienced staff can assess and monitor the symptoms and bring them under control as much as possible.
You may be able to help relieve pain and discomfort with simple things, such as:
changing the person’s position
a hot-water bottle (wrapped in a towel to prevent burns)
wheat packs that you can warm in a microwave
Sometimes, just listening to the fears and worries of the person who is ill can help them cope better with pain.
Our sections on controlling cancer pain and controlling the symptoms of cancer give detailed information.
Your relative or friend may have problems sleeping at night. If they are in pain, it can be very difficult to sleep well and their pain control may need to be adjusted slightly.
They may be sleeping a lot during the day. If they are drowsy during the day and can’t sleep at night, ask the GP to check their medication. It may be possible to adjust or change the medicines. Your relative or friend may be anxious and find it difficult to relax. Reading, listening to music, meditating, or having a warm, milky drink or herbal tea in the late evening may help them to relax and fall asleep. Anything containing caffeine, such as coffee, tea and cola drinks should be avoided. The GP can prescribe sleeping tablets if necessary.
Make sure that their mattress and pillows are comfortable, especially if they are spending a lot of time in bed. If the mattress is over 10 years old it could be time to change it. New pillows may be an easier and cheaper option, and could make a difference to their quality of sleep. You may be eligible for a Macmillan grant to help with the costs of buying a new mattress and pillows.
Here are some other ideas to help improve your relative or friend’s sleep:
make sure that the room is at the right temperature - cool with fresh air, but not too cold
have blankets available if needed
keep a hot-water bottle or heated wheat bag close by
make sure there isn’t too much light - you could consider replacing the curtains for darker ones or putting up a blind behind the curtains to shut out more light
try to minimise noise distractions, such as a ticking clock.
Advice from other carers about everyday caring
Try to anticipate problems that may come up out of hours so you can discuss them with professionals during the working day and decide in advance what you should do for each situation. It’s also helpful to have a plan in case you can’t meet the needs of the person you care for at short notice, for example, if you’re ill. It may help to discuss this with social services and the local carers’ centre. If you need help and support, say so.
You can read other carers' tips on looking after yourself when caring for someone with cancer in our booklet Hello, and how are you? [PDF, 914 kb] - a guide written by carers, for carers.