Understanding what might happen

During the last weeks of life, you may go through emotional and physical changes. You may also have new or different symptoms. This is normal. But it can be upsetting for you and the people around you. Being prepared for what may happen can make the situation a little easier to cope with.

Booklets and resources

Emotional changes

You may feel lots of different emotions, including:

  • worry
  • anxiety
  • panic
  • anger
  • resentment
  • sadness
  • depression.

It is natural to have any of these feelings in the last few weeks of your life. You may feel different things at different times. How you are feeling physically can often affect your emotions.

Talking to someone about your emotions and what is happening may help you feel better. This could be a family member, friend or partner. Or it could be someone in your healthcare team, such as your GP or a palliative care nurse or doctor.

You might prefer to talk to someone you do not know, such as a trained counsellor. You may also find it helpful to talk to a religious or spiritual adviser. You can do this even if you have not attended religious services or had contact with spiritual leaders before. There are also support organisations that can help.

You may not want to talk about what is happening. Everyone is different and it is important to do what is right for you. If other people want to talk about your situation and you do not, tell them gently that you would prefer not to. They may find it helpful to call the free Macmillan Support Line (0808 808 00 00, 7 days a week, 8am to 8pm).

You may become withdrawn and quiet. This is a natural part of gradually retreating from the world. You may find yourself losing interest in the things and people around you, even close family or friends.

Becoming withdrawn can sometimes be caused by depression. If you or people close to you think you might be depressed, tell your doctor or nurse. They can give you help and support.

Physical changes and symptoms

Physical changes and symptoms vary. Here, we describe some of the physical changes that can happen in the last few weeks of life. Some people may have symptoms we have not described here.

Your healthcare team will monitor you and review your symptoms and medicines. They may stop some medicines if you do not need them anymore. If you have new symptoms, your doctor or nurse may prescribe new medicines to help manage them.

In many Boots pharmacies, Macmillan Information Pharmacists offer free specialist advice and support about end-of-life care. This includes information and support about accessing medicines. You can check live stock availability on the Boots website, or download the list of pharmacies that offer the Palliative Care Service.

Some people find complementary therapies can improve their quality of life and well-being (see below). They may sometimes help reduce symptoms.

Tiredness and lack of energy

It is normal to have less energy as you approach the end of your life. You may find you need help to do things you usually do for yourself. You may also need to rest more. Tiredness and weakness can make it harder for you to focus or take part in what is going on around you.

Things that can help

  • Try to pace yourself. Save your energy for the things that matter to you and that you enjoy.
  • If you have important things that you need or want to do, do them at a time when you have more energy.
  • Try to do less cooking, cleaning or other household jobs. If you can, ask family or friends to help.
  • There are organisations and shops that can deliver ready-made meals. You can store these in a freezer until you want to use them.
  • If you find eating tiring, try eating little and often.
  • If you get tired when washing and getting dressed, ask someone to help you.
  • Use equipment that helps you with daily tasks, such as a raised toilet seat, bath board or walking frame. Sit down to do tasks if you can.

We have more information about coping with fatigue.

Difficulty sleeping

There are many reasons why you may find it difficult to sleep. These include:

  • feeling anxious, depressed or stressed
  • feeling afraid that you might die in the night
  • having symptoms that are not well controlled, such as pain, breathlessness or incontinence
  • taking medicines which can keep you awake, such as steroids
  • other factors, such as light or noise, or sleeping too much during the day.

Tell your doctor or nurse if you are not sleeping well. Also tell them about any specific worries or symptoms that might be affecting your sleep. They may be able to suggest things to help. For example, they may suggest taking some medications at a different time of the day. Sleeping tablets may help some people. Your doctor can prescribe these if they think they will help.

We have more information about difficulty sleeping and steroids.

Things that can help

  • If your mattress is uncomfortable, ask your nurse for advice about a more comfortable one.
  • Try to reduce light and noise – wearing an eye mask might help if your room is too light.
  • Try having a warm drink before going to bed. Avoid stimulants like caffeine and alcohol, as they will keep you awake.
  • Keep your bedroom for sleeping. If you wake during the night, try not to toss and turn. Go to another room if you can. When you feel sleepy, go back to bed. If you need to sleep during the day, go to your bed and sleep there.
  • Avoid using a screen, such as a TV, computer, tablet or smartphone, for at least 1 hour before going to bed.
  • Keep a notebook by your bed. If you wake during the night, you can write down anything you are worried about or need to do. You can work through your list during the day and get support and advice from your loved ones, carers or healthcare team.
  • Simple breathing and relaxation exercises may help to reduce anxiety and stress. You can learn them at home using a CD, DVD or podcasts.


Many people worry about pain as their illness gets worse. Not everyone has pain in the last few weeks of life. But if you do, it is important to let your healthcare team know so they can treat it. Tell them exactly where the pain is, how it feels, and how it affects you.

Specialist palliative care doctors and nurses have lots of experience in managing pain. They make sure you have the right dose of painkillers to control your pain, without too many side effects. Your GP or cancer doctor can refer you to a specialist.


Your healthcare team can usually control pain well with painkillers. There are different painkillers for different types of pain. These include:

  • mild painkillers, such as paracetamol
  • moderately strong painkillers, such as codeine
  • strong painkillers, such as tramadol, morphine and oxycodone
  • anti-inflammatory drugs, such as ibuprofen and diclofenac
  • painkillers for nerve pain, such as gabapentin, pregabalin and amitriptyline.

Different painkillers can be given in different ways including:

  • tablets
  • liquid medicines
  • patches stuck onto the skin
  • injections under the skin or through a syringe pump.

You may need more than 1 type of painkiller to get the best effect. Some people need to take larger doses of strong painkillers as they near the end of their life. This is quite normal and safe. Your healthcare team will tell you about your dose of painkillers.

It is important to take your painkillers regularly as your doctors and nurses tell you. Tell them if your pain is not controlled. They can change the dose or may suggest a different painkiller.

Syringe pumps

A syringe pump is a small portable pump used to give medicines. It is also called a syringe driver.

A syringe pump may be used if you cannot take medicines by mouth. For example, if you have difficulty swallowing. A syringe pump may also be used if your body is not able to break down and use medicines taken by mouth. You can have painkillers, anti-sickness medicines, anti-anxiety medicines and several other medicines through a syringe pump.

A syringe holding the medicines is attached to the pump. The pump delivers a continuous dose of the drugs from the syringe through a small, thin needle. The needle is put in just under your skin and held in place with a clear dressing. It is usually placed in your arm, leg or tummy. Usually each syringe has enough medicine for 24 hours. The pump is usually put in a clear, locked box to protect it.

Your nurse will set up a syringe pump for you. Your nurses can change the syringe when needed, usually every 24 hours.

Side effects of painkillers

Painkillers such as codeine, tramadol, morphine and oxycodone have 3 common side effects:

  • drowsiness – this usually goes away after a few days
  • sickness – this usually gets better over a few days
  • constipation – you often need to take a laxative regularly.

We have more information about managing pain.

Weight loss and loss of appetite

You may find that your appetite reduces over time because of your illness or medicines you are taking. You may find eating hard if you no longer like the sight, taste or smell of some foods. Even if you are eating well, you may lose weight, and this can be upsetting.

As you near the end of your life, your body slows down. It does not need as much food, as it cannot digest it or absorb nutrients from it. Do not feel you have to eat – it is normal for your appetite to reduce as you near the end of your life.

Medicines, such as steroids, can sometimes boost your appetite. Your doctor can prescribe these if they are suitable for you.

People close to you may be concerned if you are eating less. Talk to them about what you would like to eat or drink. This means they know the best things to offer you.

Things that can help

  • Have frequent snacks or small meals rather than 3 meals a day. Only eat what you can manage. Do not force yourself to eat.
  • Eat if you feel like eating, and eat the things you want to. Try keeping a flask or cool bag with drinks and snacks nearby. You can then eat or drink something whenever you feel hungry.
  • If you want to eat but do not like the smell of cooking, ask someone else to cook your food.
  • Try eating foods that are easy to chew and digest, such as soup, custard and ice cream.

Feeling sick and vomiting

If you feel sick (nausea) or are sick (vomit), your doctor or nurse can prescribe anti-sickness drugs (anti-emetics). These can usually help. There are different types of anti-sickness drugs. They can be given:

  • as tablets or liquid medicines
  • as injections
  • through a syringe pump
  • as suppositories that are inserted into your back passage.

Things that can help

  • Take anti-sickness medicines regularly to help stop the sickness returning.
  • Have warm or cold food, as this does not smell as strong as hot food.
  • Eat dry foods, such as crackers.
  • Food or drink containing ginger can help – try crystallised ginger, ginger tea, ginger beer or ginger biscuits.
  • Eat little and often.
  • If cooking smells make you feel sick, you could ask someone else to prepare food for you.


You may get constipated because you are not moving around or eating and drinking as much. Medicines such as painkillers can also cause constipation. It is important to tell your doctor or nurse if you are constipated so they can prescribe medicines (laxatives) to help. There are different types of laxatives.

Things that can help

  • Take your laxatives as your doctor or nurse tells you to.
  • Tell your GP or nurse if your laxatives are not working, or if your stools (poo) become too loose.
  • Drink as much fluid as you can.
  • If you can eat, try to have some high-fibre foods, such as fruit and vegetables, brown rice, brown bread or brown pasta.
  • If you can, do some gentle exercise like walking.


There are different reasons why you might feel breathless. It is important to tell your doctors and nurses as soon as possible if:

  • you are breathless
  • you suddenly become more breathless than usual.

Breathlessness can be very frightening and may make you feel anxious. This can make breathing feel even more difficult. Your nurse or a physiotherapist can teach you ways to relax, so that you feel less anxious and breathless. Sometimes medicines that treat anxiety can help with breathlessness.

Things that can help

Medicines to help breathlessness

Your doctor may suggest different ways to manage breathlessness, depending on the cause. For example, you may find:

  • medicines, such as a low dose of morphine, can help
  • oxygen may help some people – your GP or nurse can arrange for you to have oxygen at home
  • if you have a build-up of fluid on the lungs (pleural effusion), your doctor at the hospital or hospice may be able to drain it
  • if you have a low level of red blood cells (anaemia), your doctor may arrange for you to have a blood transfusion.

Other ways to manage breathlessness

  • Try sitting by an open window when you feel breathless. An electric or handheld fan blowing air on to your face may also help.
  • How you sit or stand can affect your breathing. A nurse or physiotherapist can show you and your carers the best positions to help. They can also teach you how to breathe more effectively, plan your activities and save your energy.
  • Think about ways to arrange your home to make tasks easier. For example, you could put a chair in the hallway or at the top of the stairs. Then you can rest when walking between rooms or up and down stairs.
  • Sit down to do tasks like washing and dressing.
  • Try using a mobile phone, baby monitor or a 2-way radio to talk to someone in another room, so you do not have to get up.
  • If you have difficulty getting to the toilet, use a commode or urine bottle.
  • Try using a V-shaped pillow to help you sit in a more upright position in bed.

Difficulty moving around

You may gradually find it harder to move around. This may be because you are tired or weak, or have symptoms such as pain, swollen limbs or a swollen tummy.

If you are not moving around very much, your skin may get sore. For example, you may get sore skin on your bottom or heels. Your district nurse can arrange equipment to help prevent this. This could be a pressure‑relieving cushion for your chair or a mattress for your bed.

It is important to change your position regularly if you can. If you need help, your nurse can show your carers how to move you safely so you are comfortable.

Mouth problems

Looking after your mouth is important and can help prevent problems such as a dry or sore mouth, ulcers or an infection. Tell your nurse or doctor if you develop any mouth problems so they can help.

Things that can help

  • If you can, brush your teeth twice a day using a fluoride toothpaste. Use a soft children’s toothbrush if your mouth is sore. Ask someone to help you if you cannot manage this yourself.
  • Rinse your mouth 3 or 4 times a day to remove debris and keep it clean. You can use plain water or a salt‑water rinse. To make the rinse, add 1 teaspoon of salt to 1 pint of cold or warm water. You should rinse your mouth with cold or warm water after using a salt-water rinse.
  • If you have false teeth, clean them as usual and soak them overnight.
  • Use any mouthwashes that you have been prescribed, and follow the instructions.
  • If you have a dry mouth, try sipping water – some people find tonic water helpful. You could also try sucking ice lollies or ice chips, or chewing sugar‑free gum.
  • Use a water-based lip balm to keep your lips moist.


In some people, fluid can build up in the body’s tissues. This causes swelling called oedema.

You may get swelling in your legs and ankles. Your doctor may prescribe pressure stockings to help control this. These are not suitable for everyone. Keeping your feet up and gently exercising your legs may also help. A nurse or physiotherapist can show you some exercises to do.

Taking water tablets (diuretics) can sometimes help get rid of the fluid. Your doctor may prescribe these if they think they may help.

With some types of cancer, fluid can build up in the tummy (abdomen). This causes it to swell and feel tight and uncomfortable. This is called ascites. A doctor can put a tube into the lower part of your tummy to drain off the fluid. This is done using a local anaesthetic. It can be repeated if needed. Your GP or specialist palliative care nurse can discuss this with you. Taking water tablets can sometimes help with ascites.

Bladder problems

You may have problems passing urine (peeing) or controlling your bladder. A nurse can put a thin, flexible tube (catheter) into your bladder to drain the urine. This can also save you from the discomfort of using a bedpan or bottle if you cannot get out of bed.

Managing difficult symptoms

Usually, it is possible to manage your symptoms at home. But sometimes it can be helpful to go into a hospital or hospice to have them treated. Your community palliative care team, district nurse or GP will talk to you if they think this would help.

Being in the hospital or hospice means that the doctors and nurses can assess your symptoms more regularly. They can adjust any medicines more quickly than if you were at home. This means they can also control your symptoms more quickly.

Once your symptoms are controlled better, you can often go home again. You will then be back under your GP’s care, with support from your community palliative care team and district nurses.

Complementary therapies

Many people find complementary therapies can help them feel stronger. They can help you feel more able to cope with physical changes and your worries about dying. They may also improve your sense of well-being and reduce symptoms.

There are many different complementary therapies including:

  • acupuncture
  • relaxation, visualisation, or guided imagery techniques
  • aromatherapy
  • reflexology
  • massage
  • reiki.

Some hospices and hospitals may offer complementary therapies alongside conventional care. Ask at your local hospital or hospice to see what might be available. You may need to pay for complementary therapies at the hospital or hospice.

You can choose to pay privately for complementary therapies. If you wish to do this, it is important to choose a qualified therapist. It is important that a therapist knows about your medical condition and any treatments you are having.

Get this information in another language or format

We are committed to making our website as accessible as possible, to make sure that everyone can use it.

We have information about the end of life in over 16 languages, and in other formats including audiobooks, and easy read.

If we don't have what you are looking for, you can ask for information to be translated for free or provided in a format to suit you. Email us at cancerinformationteam@macmillan.org.uk or call us on 0808 808 00 00.

About our information

  • References

    Below is a sample of the sources used in our advanced cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

    Health Improvement Scotland/ NHS Scotland. Scottish Palliative Care Guidelines. Available from www.palliativecareguidelines.scot.nhs.uk/ [accessed Nov 2021].

    NICE. Care of dying adults in the last days of life. NICE guideline NG31 [Internet]. 2015. Available from www.nice.org.uk/guidance/NG31 [accessed Nov 2021].

    NICE. End of life care for adults: service delivery. NICE guideline NG142 [Internet]. 2019. Available from www.nice.org.uk/guidance/ng142 [accessed Nov 2021].

    NICE. Improving supportive and palliative care for adults with cancer. Cancer service guideline CSG4 [Internet]. 2004. Available from www.nice.org.uk/guidance/csg4 [accessed Nov 2021].

  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Viv Lucas, Consultant in Palliative Medicine.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

  • use plain English
  • explain medical words
  • use short sentences
  • use illustrations to explain text
  • structure the information clearly
  • make sure important points are clear.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.

Date reviewed

Reviewed: 01 September 2022
Next review: 01 September 2025
Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

Our cancer information meets the PIF TICK quality mark.

This means it is easy to use, up-to-date and based on the latest evidence. Learn more about how we produce our information.