Symptom control

Saturday 1 February, 2014

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On this page:  Palliative care | Pain | Tiredness and fatigue | Loss of appetite | Feeling sick | Shortness of breath | Other symptoms | Using complementary therapies


People experience many different symptoms as cancer progresses. This page describes the common symptoms and how they can be managed.

  • Managing symptoms near the end of life is a common concern.
  • Many people worry that they could spend their last days in pain. Medication can be used to control pain.
  • Loss of appetite occurs as the end of life approaches.
  • Nausea caused by the cancer or other side effects can usually be managed with medications.
  • While shortness of breath is common, it can make you and those around you feel anxious. Talk to your doctor about ways to ease anxiety.
  • Other symptoms include restlessness, feeling confused or experiencing hallucinations. There are ways to cope with these symptoms.

Managing symptoms is a common concern for people who are dying and their family. Near the end of life, the focus of care is usually about maintaining quality of life and remaining pain-free.

Health professionals will do all they can to provide you with the highest possible level of comfort and care during your last days. Ask them any questions you have so you have a good understanding of what to expect.

Palliative care

Palliative care offers relief, support and comfort to people who are dying and their family and friends. It involves caring for your physical, emotional, psychological and spiritual needs.

Your GP and community nurses may be able to provide all the care you need, but they may also call on your local specialist palliative care team. These different professionals work together to give you relief from pain and other symptoms of cancer. They will try to help you live your life as fully as possible until you die. They will also support your family and friends to help them cope during the illness, and after the death.

For more information about what palliative care is, how it helps and how to access it, call Cancer Council 13 11 20 for a free copy of Understanding Palliative Care.

Health professionals in the team

The people in the palliative care team will work together to help meet your physical and emotional needs, and provide support to your family and carers.

Health professionals in the team

Pain

Many people with end-stage cancer worry they could spend their final days in pain, but not everyone with cancer has pain. If you do, the health professionals caring for you will help you control the pain as much as possible.

Everyone experiences pain differently so it might take time to find the right pain relief or combination of treatments for you. Controlling the pain may allow you to continue with activities you enjoy for some time and offer a better quality of life. Even if you have experienced pain from cancer, it will not necessarily get worse as you get closer to dying.

The right pain relief for you depends on the type of pain you have and how bad it is. You might be offered:

  • mild pain medications, such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs)
  • moderate pain medication, such as codeine
  • strong pain medication, such as morphine, oxycodone, hydromorphone and fentanyl.

You may also be given other types of medication to take with the main pain medication. For example: antidepressants and anticonvulsants for nerve pain; anti-anxiety drugs for muscle spasms; or local anaesthetics for nerve pain. If the pain is hard to manage, a pain specialist may consider a nerve block or epidurals.

Some people worry about becoming addicted to pain medication, but this is not a concern when being treated for symptom control for end-stage cancer. For more information call Cancer Council Helpline 13 11 20 for a free copy of Overcoming Cancer Pain.

Tiredness and fatigue

Having a terminal illness will almost certainly leave you feeling fatigued. Try to pace yourself and save your energy for the activities that are most important to you. The fatigue may also affect your ability to think clearly and make decisions. This can be frustrating, particularly when you are dealing with practical concerns. If you are trying to put your affairs in order for family members, you may want to do this at a time of day when you have more energy.

This is the time to let your family and friends help you. If they offer to do something for you, accept their assistance as people often want to help in whatever way they can. If you want to complete a specific task, invite family members or friends to help, or make a list of tasks you’d like their assistance with.

Loss of appetite

Many people find they lose their appetite as they near the end of life. This may be because of other symptoms, such as pain, nausea or breathlessness, or because the body’s energy needs have slowed down and it’s no longer necessary to eat as much.

It’s not necessary to force yourself to eat; this may only make you feel uncomfortable and can cause vomiting and stomach pain. Try having small meals or eat your favourite foods more frequently. Another option is liquid meals. Ask your doctor, nurse or dietitian to recommend something suitable.

It’s common for others to want to encourage you to eat, as preparing food for you is how they show they care. You may need to let them know that you don’t feel like eating, and suggest other ways they can show their love, such as a hand or foot massage.

As the disease progresses, the body reaches a point where it can no longer absorb or get nutrients from food. Clear fluids such as water or weak tea may be all you can handle. There will come a time when even this isn’t tolerated, and family or friends can help keep your mouth moist. See the carers section for suggestions.

Feeling sick

You may feel sick or have trouble keeping food down either from the cancer or from some of the side effects from the medication you’re taking. Nausea can usually be managed with medications. They can be taken as tablets, or if swallowing is difficult, as injections under the skin or suppositories, which are inserted into the bottom and absorbed through the lining of the rectum.

Shortness of breath

Breathlessness, also called dyspnoea, is common at the end of life. Breathing may become uneven, change rhythm, and become noisy. There may also be excessive secretions, creating loud, gurgling sounds. Your health care team will assess if something is causing the dyspnoea and manage it with medication or practical measures, such as being placed near an open window, having a fan in the room or trying relaxation exercises.

Feeling breathless may make you feel distressed and anxious, and this is likely to make the breathlessness worse. Talk to your doctor about medications that can ease your anxiety.

As you spend more and more time in bed, your breathing may change again and you may lose the ability to cough effectively or to swallow and clear secretions from your mouth. Adjusting your position in bed or sitting up slightly can improve this.

Other symptoms

As you approach the final days or hours of life, other symptoms can be managed to help you feel more comfortable.

  • Trouble emptying bladder
    The palliative care nurse or doctor may need to insert a catheter into the bladder to drain the urine and avoid a blockage.
  • Restlessness, calling out or twitching
    At this stage you will probably be unconscious or asleep and unaware of what is happening. While these symptoms are common, your family may find your restlessness upsetting. It may help for them to talk to a doctor or other health professional.
  • Feeling confused or experiencing hallucinations or visions
    This is referred to medically as delirium. Your doctor can give you medications to help you relax and sleep. Your family and friends are likely to find this symptom distressing, and will need support and reassurance.
  • Noisy or moist breathing
    This often occurs when saliva and other fluids collect in the airways. Although the sound is often distressing for family and friends at the bedside, it is thought that the breathing is not painful. Various medications can help dry up new production of secretions but not what is already there.
  • Cool skin
    Although the skin can be cool, particularly the hands and feet, it’s thought that you will be unaware of feeling cold.

Using complementary therapies

Many people use complementary therapies to help them feel better and cope with cancer and its treatment. This is also true for people who are dying with cancer. Complementary therapies may help you relax and reduce anxiety. They can also help calm your emotions, and improve symptoms such as pain and nausea.

Some people find having gentle therapies, such as massage and aromatherapy, helpful. People who find it uncomfortable or painful to be touched may find reiki, meditation or visualisation useful.

More information on complementary therapies


Reviewed by: Dr Melanie Price, Executive Director, Psycho-oncology Co-operative Research Group, Senior Research Fellow, School of Psychology, University of Sydney; Dr Erica Cameron-Taylor, Staff Specialist, Department of Palliative Medicine, Mercy Hospital and Calvery Mater Newcastle, NSW; Gabrielle Gawne-Kelnar, Telephone Support Group Facilitator, Cancer Council NSW; Helpline and Cancer Counselling Service staff, Cancer Council QLD; Judith Quinlivan, Consumer; Linda Wolfe, Consumer; and Dr Mary Brooksbank, Philip Plummer and Claire Maskell Gibson on behalf of Palliative Care Australia. 
Updated: 01 Feb, 2014