This section describes some of the symptoms which may occur during the final stages of cancer. Some are caused by the cancer itself, while others are the result of treatment. You may have one or more of these symptoms, or none at all. However, if you do have symptoms, these can usually be controlled with help from your nursing and medical team.

If you need to attend hospital you can ask to see a hospital palliative care nurse (sometimes called a hospital Macmillan nurse). They can advise the doctors and nurses looking after you on how best to manage your symptoms and can offer emotional support to you and your loved ones.

You may be given treatments such as chemotherapy or radiotherapy, with the aim of controlling the cancer for a time and reducing symptoms. You may feel that you want to discuss all the treatment options or get a second opinion.

It might be a good idea to make a specific appointment to go over all the options with your doctor again. You can ask your doctors to explain all the treatments fully and to tell you about the benefits and possible disadvantages of each treatment. You can also ask them what is likely to happen if you have no further treatment.

It’s important that you don’t feel under pressure from your family or friends to accept or refuse further treatment. The final decision must be your own, even if you discuss the options with your partner or friends.

Many people are frightened of pain. However, there are many effective painkillers and ways of controlling pain, so it can usually be well controlled. Everyone feels pain differently. Even people with the same condition have very different experiences. It’s important to help your doctors and nurses understand exactly where your pain is, how it feels and how it affects you, so that they can treat it effectively.

Many people believe that they should put off using painkillers for as long as possible, and only take them when their pain gets unbearable. However, if pain is not treated it may become more difficult to control, so it's important to take any painkillers that you are prescribed in the way that your doctor advises.

There are different types of painkillers for different types of pain. The type of painkiller also needs to be matched to how bad the pain is. International guidelines set out the types of painkiller that are most effective for different levels of pain. This is known as the analgesic ladder. It recommends specific types of painkiller for mild, moderate and severe pain.

• Mild pain – mild painkillers or anti-inflammatory drugs, for example paracetamol or ibuprofen.
• Moderate pain – weak opioid painkillers such as codeine.
• Severe pain – strong opioid painkillers, for example morphine.

For some types of pain you may be given other types of drugs to take as well as your painkillers. Anti-inflammatory drugs, antidepressants, anticonvulsants (usually used to treat epilepsy) and muscle relaxants can all help with different types of pain.

If you have frequent or constant pain it’s important to take painkillers regularly. Each dose of the painkiller should be enough to control your pain right through to the next dose. If the pain comes back before your next dose is due, let your doctor or nurse know so they can give you a more effective dose or drug. It may take a few days to get the drugs and doses right, so be willing to persevere and let your doctor know if the pain is not controlled. Some people find it helpful to keep a diary recording when they get pain.

Side effects of painkillers

Strong painkillers have three common side effects – drowsiness, sickness and constipation. The drowsiness usually wears off after a few days, so it should be possible for you to be free of pain and still be alert enough to do all that you want to do.

If you feel sick, anti-sickness pills can help, and the sickness usually settles gradually over a few days.

Constipation is such a common side effect that everyone taking strong painkillers should take a laxative regularly; many people need to take one which softens the stools and one which stimulates the bowel. Ask your doctor or pharmacist for advice. Don’t be afraid to vary the dose of your laxatives to keep your bowels moving easily.

Taking painkillers

Most painkillers are available as liquid medicines. You can use these if you have problems with swallowing tablets. Some painkillers can be given as a patch stuck onto the skin. If you can’t swallow, or if you’re drowsy or confused and don’t want to swallow tablets or liquid medicines, the painkiller can be given through a tiny tube inserted just under the skin of the tummy or arm. Enough painkiller for 24 hours is made up and a small portable pump (a syringe driver) is used to give a continuous dose of the drug. The pump is set up by a doctor or nurse.

A syringe driver is very easy to set up. If you’re able to move around and walk, the syringe driver can be carried in a special holster or a pocket. If you are in bed then it can be put on the bedside table or tucked under a pillow. Other medicines, for example to treat sickness, can also be given by the syringe driver.

Painkillers used for pain control do not cause addiction

Many people with cancer ask if they will become addicted to drugs such as morphine, or become confused and unable to look after themselves. The answer is 'no'. People who become addicted to drugs initially choose to take them, and then keep taking them because they have a psychological need for them. This is very different to someone who is in pain, 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.

There is no danger of you becoming addicted to painkillers such as morphine

The dose you take will be carefully tailored to your own needs and will only be increased if your pain gets worse. The right dose is the dose that gets rid of your pain. Many people stay on the same dose of morphine for many months. However, it can be harmful to stop taking morphine suddenly. If your pain is relieved by some other treatment, for example radiotherapy, the dose can be gradually reduced under the supervision of your doctor or nurse.

Strong feelings or emotions such as fear, anxiety, depression and tiredness can make your pain worse. So, it’s important to try to treat the emotional as well as the physical causes of your pain. Learning to relax and get rid of some of your fears and anxieties, if only for short periods of time each day, can play a very useful part in controlling pain. You can relax by becoming aware of different groups of muscles around your body and learning to relax them so that you can do this consciously when you are under stress or in pain.

Visualisation or guided imagery helps you to bring happy relaxed pictures into your mind. These can help distract you and overcome some of your pain. Massage with soothing aromatherapy oils can also help you relax.

Many people find that relaxation and visualisation can help them to control their pain. Our section on complementary therapies gives more information about these techniques and how to find a registered complementary therapist.

If you feel sick or have trouble keeping food down, your doctor can prescribe an anti-sickness medicine to help. This may be taken as tablets, or given as suppositories which are inserted into your back passage (if you cannot manage to swallow tablets). Anti-sickness drugs should be taken regularly to prevent the nausea coming back.

Many people lose their appetite and may feel sick some of the time as well. These may be symptoms of the illness itself or due to treatment, such as radiotherapy and chemotherapy. You may be put off even by the sight and smell of food. Small frequent simple meals, concentrating on your favourite foods, are likely to be most tempting.

However, as you become more ill, your metabolism slows down and your body can't digest the food so well or take up the goodness from it. At this stage it is important not to force yourself to eat.

You may want to try liquid meals when you don’t feel able to eat a proper meal. There are many different types of liquid meal. Your doctor or nurse can advise which is best for you and can arrange a supply, often on prescription. There may come a time when even liquid meals are too thick and difficult to digest and you may only want to have water, squashes or tea.

Small amounts of liquids may be all that you need to keep you comfortable. People usually don’t feel hungry at this stage. You may notice that your mouth feels very dry. This is not a sign that you’re dehydrated or that you need to drink more fluid. At some point, people stop drinking even water and just need to have their mouth kept moist by cleaning it gently.

You may want to try sucking pieces of fruit such as pineapple. Fruit juices can be made into ice lollies or ice cubes which you can suck to moisten your mouth. If a dry mouth is stopping you from being able to eat or talk, artificial saliva spray or lozenges may help.

You may also wish to see a dietitian for advice on any of the above issues. Your doctor or nurse can organise this.

Our section on eating well gives hints and advice on boosting appetite and coping with eating problems.

Fatigue (feeling exhausted all or most of the time) is a common and difficult problem for people with advanced cancer. It can be caused either by the development of the cancer or by coping with other symptoms, such as pain.

If you feel tired, it’s important to pace yourself and to save your energy for the things which matter to you and which you enjoy, instead of feeling that you have to do things around the house. Letting other people do these jobs can help you to have energy for things that you really want to do.

Just do as much as you feel like, but remember you won't do yourself any harm by doing too much – you can simply rest and relax a bit more the next day if you need to.

Tiredness and weakness can make it harder for you to concentrate or to take part fully in what is going on around you. So, if you have important things to do to put your affairs in order, it’s best to do them as soon as possible. You may also feel more relaxed once they are out of the way.

Your cancer may cause certain changes in your body which your doctors may want to treat even at a late stage. Treating the changes can make a big improvement in how you feel and how much you can do.

The changes include:

• High calcium levels in your blood (hypercalcaemia). This can make you feel sick or be sick, and can cause confusion, constipation and make pain more difficult to cope with. A few days of treatment in hospital or a hospice with medicine (bisphosphonates) given through a drip will help to bring the calcium levels down.
• Severe anaemia can make you very tired and breathless. A transfusion of blood may make you feel better very quickly.
• Infections of various kinds can make you feel very ill, but they can usually be treated by antibiotics given as tablets or by drip.
• Fluid around your heart or lungs or in your abdomen (fluid retention) can make it difficult to breathe, and can make you feel bloated and uncomfortable. Taking away some of the fluid through a drainage tube may make you much more comfortable. This may need to be repeated if fluid builds again.
• Pressure sores are common when you spend a lot of time in bed or in a chair without moving. Special mattresses and heel protectors can help to prevent these.
• If you feel agitated or confused your doctors can prescribe medicines to help you feel calmer.
• If you have problems emptying your bladder, this can be dealt with by putting a thin, flexible tube (catheter) into the bladder to drain the urine. Having a catheter will mean that you don’t have the discomfort of trying to use a bedpan or bottle if you can’t get out of bed.
• If you are breathless, oxygen may help. Your doctor can organise this for you on prescription.

There is more information about controlling pain and symptoms in our section on controlling the symptoms of cancer.

Many people find complementary therapies or practices help them feel stronger and more confident in dealing with dying. They can sometimes be used alongside conventional treatments and medicines.

Complementary therapies may help to improve quality of life and wellbeing and can sometimes help to reduce symptoms. Some complementary therapies, such as meditation or visualisation can be done by the dying person themselves and may reduce anxiety. Other therapies such as gentle massage can be done by relatives or carers and may help them to support the dying person.

Physical contact and touch can be among the most powerful ways of supporting people who are facing uncertainty, fear or pain, whether emotional or physical. Touching someone gently may express how much you care about them.

Many hospices and hospitals offer complementary therapies alongside conventional care.

These may include:

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