The last few weeks of life

You are likely to have some physical and emotional changes in the last few weeks of your life. These are normal but it may be hard for you and the people around you. Knowing what to expect can help you cope.

You may have lots of different emotions such as worry or anger. Talking honestly about how you feel can help. You can talk to family, friends or the professionals looking after you, or you may want to talk to a counsellor or support organisation.

Becoming more withdrawn as you get close to death is normal. Your carers may need extra support as this happens.

Your healthcare team can help you with any physical symptoms you have. Usually it is possible to manage your symptoms at home, but sometimes it may help to spend a few days in a hospital or hospice.

Sometimes complementary therapies can be used to improve your quality of life or reduce symptoms.

What will happen in the last few weeks of life?

During the last few weeks of life, you may experience different emotional and physical changes and symptoms. Even though this is normal, it can be upsetting for you and the people around you. Being prepared for what may happen can make things a little easier to cope with.


Emotional changes

You may feel lots of different emotions including worry, anxiety, panic, anger, resentment, sadness and depression. It’s natural to have these feelings in the last few weeks of your life. You may also feel concerned that you’re less able to do things and worry about the loss of your role in your family or with friends.

Talking to your family and friends about how you’re feeling can help. If you’re at home and have a nurse, you can talk to them about any concerns you have. You may find you feel much better once you’ve talked about your concerns.

Some people prefer to talk to a person they don’t know, such as a trained counsellor. If you’d like to see a trained counsellor, your GP may be able to refer you.

Many support organisations can help and some have helplines. Talking to a religious or spiritual adviser can also be helpful even if you’ve not attended religious services or had contact with spiritual leaders before.

It’s not uncommon for people to become withdrawn. For some this may be due to depression. If you think you are depressed let your doctor or nurse know because they can give you help and support. For others, it’s a natural part of gradually withdrawing from the world. You may find yourself losing interest in the things and the people around you, even close family.


Coping with physical changes and symptoms

The physical changes and symptoms that occur vary with the type of illness a person has. Here, we describe physical changes that generally happen in the last few weeks of life. We also discuss changes that may only happen with some types of cancer.

As you become less well, your doctor or nurse will review your medicines. Some medicines may be stopped if they’re no longer needed. If you have new symptoms your doctor or nurse may prescribe new medicines to control them. Medicines can be changed as often as you need. Complementary therapies may improve quality of life and well-being. They may also sometimes help to reduce symptoms.


Tiredness and lack of energy

It’s normal to have less energy and not be able to do things for yourself. Tiredness and weakness can make it harder for you to concentrate or take part in what’s going on around you.

You may find you need to rest a lot during the day. If you’re not moving around very much, you may get sore areas, for example on your bottom or heels. Your district nurse can organise equipment, such as a pressure relieving cushion for your chair or a mattress for your bed, to help prevent this. It can also help to change your position regularly if you can.

Helpful hints for managing tiredness

  • Try to pace yourself and save your energy for the things that matter to you and that you enjoy.
  • Cut down on any tasks, such as cooking, cleaning or making the bed. You could ask your friends and family to help you with these.
  • Ask a carer to help you wash and dress if this tires you out.
  • Use equipment that helps you with daily tasks, such as a raised toilet seat, bath board or walking frame.
  • If you have important things that you want to do, such as sorting out your financial affairs, do them at a time of day when you have more energy.
  • If you’re struggling with eating, you may find it easier to eat small amounts of food often.

We have more information on coping with tiredness and lack of energy.


Difficulty sleeping

Some people find they can’t sleep well at night. There may be many reasons for this, including:

  • taking some medicines which can keep you awake, for example, steroids
  • feeling anxious or depressed, or perhaps scared of dying in the night
  • having symptoms that aren’t controlled, such as pain, breathlessness or incontinence
  • other factors, such as light, noise and sleeping during the day.

It’s important to tell your doctor or nurse if you’re not sleeping well. Once the causes of your sleeplessness are known, your sleep can often be improved.

Let your doctor or nurse know if you have any anxieties or symptoms, such as pain, breathlessness or incontinence, that are affecting your sleep. For example, if pain is causing sleeplessness, this may be helped by adjusting your dose of painkillers at night. Your nurse can advise you about this.

Helpful hints for helping you sleep

  • If your mattress is uncomfortable, ask your nurse for advice on a more comfortable one.
  • Try to reduce light and noise at night.
  • Have a warm drink before going to bed, but avoid caffeine and alcohol at night time.
  • Keep your bedroom for sleeping. If you wake up during the night, go to another room in the house if you can. When you feel sleepy, go back to bed again. If you need to sleep during the day, go to your bed and sleep.
  • Avoid using any screen, such as a TV, computer screen, or smartphone for at least an hour before going to bed.
  • Keep a ‘worry book’ so that if you wake up during the night you can write down the things you’re worried about. You can work through your list of worries during the day and get support and advice from your carers or your doctor or nurse.
  • Try using relaxation techniques at night. You may find it helpful to use a relaxation CD or to listen to some soothing music.
  • If you find touch and massage helpful, you could ask your carer to give your hands or feet a gentle massage.

If, despite following these hints, you aren’t sleeping enough, talk to your doctor or nurse. They may advise you to try taking sleeping tablets.

We have more information on coping with difficulty sleeping.


Pain

Not everyone gets pain in the last few weeks of life. But if you do, there are usually effective ways of controlling it. If you have pain, it’s important to tell your doctor or nurse exactly where your pain is, how it feels, and how it affects you so they can treat it effectively.


Painkillers

Everyone feels pain differently and there are different types of painkillers for different types of pain. You may need more than one type of painkiller to get the best effect. They include:

  • simple painkillers, such as paracetamol
  • moderately strong painkillers, such as codeine and tramadol
  • strong painkillers, such as morphine, oxycodone, fentanyl and diamorphine
  • anti-inflammatory drugs, such as ibuprofen and diclofenac
  • painkillers for nerve pain, such as gabapentin, pregabalin, amitriptyline and duloxetine. Some of these drugs are also used for other conditions.

Painkillers are usually given as:

  • tablets
  • liquid medicines
  • patches stuck on to the skin.

If you’re finding it difficult to swallow or are being sick, your nurse or doctor can give you painkillers, such as morphine, diamorphine and oxycodone, as an injection or by using a syringe driver.

Syringe driver

A syringe driver is a small portable pump. A syringe, usually containing enough drug(s) for 24 hours, is attached to the pump. The pump delivers a continuous dose of the drug(s) from the syringe through a small needle or tube that is inserted just under the skin of your tummy (abdomen) or arm.

Your nurse or doctor will set it up for you and your nurses will change the syringe each day or when needed. Painkillers, anti-sickness, anti-anxiety and several other medicines can be given by a syringe driver.

Many people worry that their pain will get worse as they near the end of their life and they’ll need to take increasing doses of strong painkillers, such as morphine. It’s important to remember that there’s no such thing as a ‘right’ dose of morphine. The ‘right’ dose is the dose that helps your pain.

You may find it helpful to watch Marie Curie’s film guide for carers about the use of syringe drivers at home.

Side effects of painkillers

Strong painkillers have three common side effects.

  • Drowsiness – This usually wears off after a few days. You should be pain-free and still alert enough to do all that you want to do. You shouldn’t drive if your painkillers make you drowsy.
  • Sickness – If you feel sick, your doctor can prescribe anti-sickness medicines (anti-emetics). Sickness usually settles over a few days.
  • Constipation – This is a common side effect and most people taking strong painkillers need to take a laxative regularly. Your doctor, nurse or pharmacist can advise you about this.

Helpful hints for controlling your pain with painkillers

  • Always take your painkillers regularly as prescribed by your doctor or nurse.
  • Let your doctor or nurse know as soon as possible if your pain isn’t controlled.
  • Keep a pain diary if you can. Ask your district nurse or specialist nurse if they can give you one.
  • Be aware of the side effects of your painkillers and take medicines if needed to keep them controlled.
  • If you get side effects that aren’t being treated or responding to treatment, let your doctor or nurse know.

Other ways of controlling pain

There are a number of other things which may help to control pain. They can be used alongside painkillers.

Helpful hints for other ways to help control your pain

  • Find a comfortable position to sit or lie in.
  • Use any special equipment you have been given. For example, pressure relieving cushions on chairs.
  • Use warmth or cold on the area of pain.
  • Use relaxation techniques, such as deep breathing or meditation.
  • Try to distract your attention away from the pain. For example, listen to music or watch a film you enjoy.
  • Talk to your doctor or nurse about transcutaneous electrical nerve stimulation (TENS) and acupuncture, which are more specialised ways of controlling pain. They will let you know if these are suitable for you.
  • If you know of methods that have helped control your pain in the past, try them to see if they help now.

We have more information about controlling cancer pain or you may find Marie Curie’s booklet Controlling pain useful.

The painkillers weren’t helping so I went into the hospice for a couple of weeks. Now I’m home taking injections each day. My husband has been taught how to do the injections, so it’s been really good.

Donna


Feeling sick and vomiting

Your illness, or your medicines, may make you feel sick (nausea) or be sick (vomit). If this happens, your doctor or nurse can prescribe anti-sickness drugs (anti-emetics), which usually control sickness. These may be taken as tablets or liquid medicines. If you find it difficult to swallow tablets or liquids, they can also be given as suppositories that are inserted into your back passage, as injections or by a syringe driver (see above).

Helpful hints for reducing sickness

  • If you’ve been given anti-sickness medicines, take them regularly to prevent the sickness returning.
  • Have warm or cold food, as this doesn’t smell as strong as hot food.
  • Eat dry foods, such as crackers.
  • Food or drink containing ginger can help. You could try crystallised ginger, ginger tea, ginger beer or ginger biscuits.
  • Sip fizzy drinks.
  • Eat little and often.


Weight loss and loss of appetite

You may lose weight, even if you’re eating well, and this can be upsetting. You may also find that your appetite gradually reduces due to your illness or the medicines you’re taking. You may be put off eating by the sight and smell of food.

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

Helpful hints for boosting your appetite

  • Eat small frequent meals.
  • Make your food look more appealing.
  • If you find you are put off eating by the smell of cooking, ask someone else to cook your food and avoid foods with a strong smell.
  • Have a glass of sherry, brandy or your favourite alcoholic drink about 30 minutes before eating. But remember that the effects of alcohol may increase if you’re ill or taking particular medicines, so it’s best to check this with your doctor or nurse.
  • Have snacks handy to nibble.
  • Have nourishing drinks.
  • Avoid filling your stomach with fluid before meals as this may fill you up and cause you to eat less.
  • Eat slowly.

As you near the end of your life, your body slows down. It doesn’t need food as it can’t digest it or absorb nutrients from it. Don’t force yourself to eat as doing so may make you feel unwell.

As a carer, you might feel anxious or upset because your relative or friend no longer wants or enjoys food. Although this can be hard to accept, it’s important not to try to force them to eat. You may want to offer them drinks they like instead.

When Mum lost her appetite, she lost a big part of her life. The hospice staff were wonderful. They organised for her to have a feeding tube. After just four weeks, she was well enough to come home, where I cared for her.

Deirdre


Constipation

Many people find that they get constipated more easily because they aren’t moving around or eating and drinking as much. Medicines, such as strong painkillers, can also cause constipation.

Helpful hints for managing constipation

  • If you’ve been prescribed laxatives to help with constipation, it’s important to take them as prescribed.
  • If you are constipated, let your GP or nurse know as soon as possible. You should also let them know if your laxatives aren’t working or if your bowels become too loose.
  • Drink as much fluid as possible.
  • Add high-fibre foods to your diet, such as fruit and vegetables, brown rice, brown bread or brown pasta if you’re able to eat them.


Breathlessness

Some people may feel breathless. This can be for a number of different reasons including:

  • cancer in the lung
  • chronic lung problems
  • general weakness
  • fluid inside the lung (pulmonary oedema)
  • fluid around the lungs (pleural effusion)
  • chest infections
  • anaemia (low red blood cell count).

Breathlessness can be very frightening. But there are various ways of treating it, depending on what is causing it.

There are several medicines that can be used to help breathlessness, such as a very low dose of morphine.

Oxygen may be helpful for some people. Your GP or nurse can arrange for you to have oxygen at home if you need it.

If breathlessness is caused by a build-up of fluid around your lungs (pleural effusion), the fluid can be drained off. If it’s caused by anaemia (a low red blood cell count), then your doctor may arrange for you to have a blood transfusion.

It’s important to let your doctors and nurses know if you’re breathless or suddenly become more breathless than usual. They can then help you as soon as possible.

Nurses can show you and your carers the best positions for you to sit or stand to help with your breathing. You can also be taught how to breathe more effectively, pace your activity and save your energy.

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

Helpful hints for managing breathlessness

  • Think about ways to arrange your home to make tasks easier. For example, a chair in the hallway or a chair at the top and bottom of the stairs could be used to take a rest when walking between rooms or climbing up and down the stairs.
  • Sit down to carry out everyday tasks like washing and dressing.
  • If you feel breathless, try sitting by an open window, or using an electric fan or handheld fan to blow air on to your face.
  • If you need to talk to someone in another room without getting up or shouting, try using a baby monitor or alarm.
  • If you’re breathless in bed, try using a V-shaped pillow to help you sit in an upright position.
  • If you have difficulty getting to the toilet, use a commode or urine bottle.

We have more information about living with breathlessness and learning how to cope with it.


Cough and wheezing

You may have a cough or feel wheezy, which can be upsetting. Your doctor can prescribe medicines to help with these symptoms. You may find it helpful to sit as upright as possible while supported on pillows. This may also help you breathe more easily.


Mouth problems

You may develop problems with your mouth, such as dryness, ulcers or an infection. These problems can sometimes be made worse by the medication you’re taking. You will be more at risk of mouth problems if you find it difficult to take care of your mouth. It’s important to let your nurse or doctor know if you develop any mouth problems so they can help.

Helpful hints for preventing mouth problems

  • Brush your teeth twice a day using a fluoride toothpaste. Use a soft children’s toothbrush if your mouth is sore.
  • Rinse your mouth with fresh water after brushing.
  • Rinse your mouth three or four times a day to remove debris and keep it clean. You can use water or a salt‑water rinse (one teaspoon of salt to one 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 these as usual and soak them overnight.
  • Use any mouthwashes that have been prescribed for you, and follow the instructions.
  • Cut down on smoking and substances that can dry or irritate the mouth, such as caffeine and alcohol.
  • If you have a dry mouth, sip tonic water or lemonade, or try sucking ice lollies or ice cubes or chewing sugar‑free gum.

You may also find it helpful to watch Marie Curie’s video called Helping a person with mouthcare.


Fluid build-up (oedema)

In some people, fluid collects in a part of their body. This is called oedema. Water tablets (diuretics) can sometimes help get rid of the fluid.

You may have swollen legs and ankles. Your doctor may prescribe special pressure stockings to help control this. Using a footstool to keep your feet up when you’re sitting down, and gently exercising your legs may also help. A nurse or physiotherapist can show you some exercises to do.

You may find it harder to move around if your legs are swollen, and this can be frustrating. It may help to talk to your carers about how you feel. Your nurses can help you find ways of moving around.


Changes in appearance

You may find it upsetting if your appearance has changed, for example if you’ve lost weight or put weight on. It can help to talk through your feelings with your carers or your nurses. They may be able to help you find ways to look and feel better.


Infection

If you’re not moving around much and aren’t eating or drinking well, you may be more at risk of an infection, such as a chest or urine infection. Let your doctor know immediately if you develop a high temperature or start to feel shivery, shaky or unwell. They may prescribe antibiotics to treat the infection.


Anaemia (low red blood cell levels)

Anaemia can make you very tired and breathless. If you’re anaemic, your doctor or nurse may suggest you have a blood transfusion. You’ll usually have this as a day patient in a hospital or hospice. In some areas it may be possible to have it at home.

A blood transfusion may help you feel better very quickly and can be repeated if it’s needed and has helped you before.


Bladder problems

If you have problems emptying or controlling your bladder, a thin, flexible tube (catheter) can be put into your bladder to drain the urine. This can also save you from the discomfort of trying to use a bedpan or bottle if you can’t get out of bed.


Swollen tummy (ascites)

With some types of cancer, fluid may sometimes build up in the tummy (abdomen) and make it swollen, tight and uncomfortable. This is called ascites. Your doctor may suggest you have a tube put into your tummy to drain off the fluid. This is done under local anaesthetic and can be repeated if needed. Ascites can sometimes be helped by taking water tablets (diuretics). Your GP or specialist palliative care nurse will discuss this with you.


High calcium levels (hypercalcaemia)

Some types of cancer can cause high calcium levels in the blood. This can make you feel drowsy or sick and can cause confusion or constipation. It may also make pain more difficult to cope with. If you develop these symptoms, let your nurse or doctor know so they can take a blood test to check your calcium levels.

If your calcium level is high, medicines called bisphosphonates may be needed to help bring your calcium levels down. You have this medicine through a drip and you will need to be in hospital or a hospice for a few days.


Managing difficult symptoms

Usually, it’s possible to manage your symptoms at home, but sometimes it can help to spend a few days or weeks in a hospital or hospice having them treated. Your community palliative care team, district nurse or GP will discuss this with you if they think it would be helpful. In the hospital or hospice, the doctors and nurses will be able to assess your symptoms. They can adjust the dose of your medicines or add in new ones to control your symptoms more quickly than if you were at home.

Once your symptoms are controlled, you can often go home again to the care of your GP, with the support of your community palliative care team and district nurses.


Complementary therapies

Although complementary therapies can’t cure illnesses, many people find they can help them feel stronger and more confident about coping with dying. They may also improve their quality of life and reduce symptoms.

Many hospices and hospitals offer complementary therapies alongside conventional care. These may include:

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

You might like to try some complementary therapies to reduce anxiety, such as relaxation and visualisation. It may also be possible for hospital or hospice staff, trained in complementary therapies, to teach your carers how to give you a massage.

Many hospices and hospitals also offer free complementary therapies to carers. You can ask your nurse about which therapies are available in your local area.

We have more information on cancer and complementary therapies, which you may find useful.


Working together to create information for you

We worked with Marie Curie Cancer Care to write our End of life information.

Thank you to all of the people affected by cancer who reviewed what you're reading and have helped our information to develop.

You could help us too when you join our Cancer Voices Network.

Back to Understanding what will happen

Nearing death

Although death is a normal process, it is natural to worry about what will happen.