The last few weeks of life

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You may become withdrawn and quiet.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Becoming withdrawn can sometimes be caused by depression.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.

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.

• 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.

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.

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.

• 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.

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.

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.

• 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.

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.

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.