Care Through the Final Days

Approved by the Cancer.Net Editorial Board, 11/2022

It can help caregivers and loved ones to know what to expect when a person nears the end of their life. There are common signs and symptoms that show that a person is entering the final weeks and days of life. When you know what to expect, it can help relieve anxiety and uncertainty, as well as help you plan for what your loved one needs during this time.

Caregiver responsibilities will depend on where your loved one is receiving care. For example, if the person is receiving care at home instead of a hospice center or other medical facility, you may have more responsibilities. No matter where your loved one is receiving care, the health care team will work with you to provide the best care possible through the end of life and to ensure that your loved one is comfortable.

What are the signs of approaching death?

Death from cancer usually happens after a person becomes weaker and more tired over several weeks or months. Though it is not always possible to predict how long someone will live, these are the common signs and symptoms that suggest a person with cancer may be entering the final weeks of life:

  • Worsening weakness and exhaustion

  • A need to sleep much of the time, often spending most of the day in bed or resting

  • Weight loss and/or muscle loss as part of cachexia

  • Little or no appetite and difficulty eating or swallowing fluids

  • Decreased ability to talk and concentrate

  • Little interest in doing things that they used to find important

  • Loss of interest in the outside world, news, politics, entertainment, and local events

  • Wanting to only have a few people nearby and limiting time spent with visitors

These are the common signs and symptoms that suggest a person may be entering the last days of life:

  • Breathing may slow, sometimes with very long pauses between breaths

  • Noisy breathing, with congestion and gurgling or rattling sounds. These sounds happen because the person is unable to clear fluids from the throat. The sounds may concern you or other people visiting, but the person who is dying is not aware of them.

  • Cool skin that may turn a bluish, dusky color, especially in the person's hands and feet

  • A dry mouth and lips

  • Loss of bladder and bowel control

  • Decreased amount of urine

  • Restlessness or repetitive, involuntary movements

  • Confusion about time, place, and identity of people, including family members and close friends

  • Seeing or hearing people or things who are not there. This is common and usually normal. It is not a reason to worry unless these hallucinations scare or upset the person who is ill. These dream-like experiences often include traveling, preparing for travel, or being welcomed by people who have died.

  • A tendency to drift in and out of consciousness and gradually becoming less and less responsive to touch or voice.

Every person is different. The signs and symptoms that people experience vary. And the order in which signs and symptoms occur can be different. Talk with your loved one's health care team about any signs or symptoms that concern you.

How to provide comfort

You and your loved one's other caregivers and family members can help them feel more comfortable during this time. Their doctors and nurses can guide you through steps based on the person's specific condition and needs.

It is important to ease any physical discomfort, but it may be hard for your loved one to tell you when they are uncomfortable. Some general guidelines for providing physical comfort include:

  • Use an "egg crate" mattress or foam cushions to make beds and chairs more comfortable

  • Help them change positions frequently

  • Change bedsheets at least twice a week or more often, as necessary

  • Elevate their head, if doing so is comfortable, or turn the person onto their side to help make breathing easier

  • Use blankets to help keep the person warm. However, do not use electric blankets, which can cause burns.

  • Gently rub their hands and feet, or soak them in warm water

  • To keep their mouth moist, offer sips of liquid through a straw or from a spoon if they can swallow

  • Use glycerin swabs and lip balm to help with dry mouth and lips

  • Use gentle massage to provide comfort and improve blood circulation

  • Use lotion to soothe and alleviate dry skin, but avoid alcohol-based lotions

Experiencing exhaustion, fatigue, and mental confusion at the end of life is common. These are some things that you can do to ease any discomfort caused by these problems:

  • Speak in a clear, calm voice

  • Remind them of the time, place, and who is present

  • If the person is withdrawn or unresponsive, say things that are supportive and reassuring, but that do not require a response. For example, instead of saying, "How are you?" you might say:

    • "Everything is alright."

    • "We are here with you."

    • "We are supporting one another."

    • "We love you."

How to manage pain at the end of life

Severe pain makes it hard for a person to feel comfortable and at peace at the end of their life. Cancer causes pain in many ways, but it can be treated. Uncontrolled pain often worsens other symptoms, such as fatigue and confusion. These symptoms make it more difficult to concentrate on time spent with family members and friends.

Talk with a member of your loved one's health care team who specializes in pain control or palliative care. They can help find an effective pain-relief strategy. This may require careful planning and communication with several members of the health care team.

Learn more about treating pain with medication and additional ways to manage pain.

When to call the health care team

It is important to know when to call the health care team, especially if you are taking care of a loved one with cancer at home. Ask the health care team when they want you to call and how you can get in touch with them during and after regular business hours. Common reasons why you may need to call the health care team include:

  • Pain that is difficult to manage or relieve

  • Problems taking prescribed medications

  • Signs of distress, such as breathing problems or agitation

  • A sudden change in consciousness, such as becoming less responsive or confused

  • Seizures

  • If you feel overwhelmed by your loved one's condition or needs

Respect your loved one's wishes

Find out ahead of time if the person you are caring for created an advance directive. There are 2 types of advance directives:

Health care power of attorney. This is a person that the patient selects to make healthcare decisions if they are unable to. This person may also be called a health care proxy, agent, or surrogate.

Living will. A living will is a document that lists the type of medical treatments the patient does or does not want at the end of life. For example, some people nearing the end of life choose to have or to refuse artificial life support, such as mechanical respirators or a feeding tube. Or, they request a do not resuscitate (DNR) order. This order states that the person should not have CPR performed if their breathing or heartbeat stops.

Caregivers and other loved ones may not always agree with the decisions in an advance directive. But people with an advanced illness need to know that their final wishes will be respected. As a caregiver, following an advance directive is one of the most important things you can do to help the person die with dignity and peace of mind.

If the person has a DNR order, inform any emergency personnel if you need to call 911 or other local emergency services. Learn more about DNR orders and CPR.

Prepare practical matters in advance

Organizing practical matters in advance will lower some of the stress of caregiving during this period. That can help you concentrate on spending time with your loved one. The following are some tips that can help you prepare different practical matters ahead of time:

  • Make a list of important papers that you may need and where they can be found. These could include bank accounts, real estate, stock holdings, and passwords to accounts and online banking.

  • Make a list of people the person would like to see in the final weeks.

  • Consider who should be present at or around the time of death. Decide whether a clergy member or other spiritual member should be present to provide comfort or important rituals.

  • Make a list of people to call after death occurs. You may want to ask friends or relatives to help make those calls.

  • Choose a funeral home and notify the facility that a death is expected. Most hospices will offer to call the funeral home for you.

  • Make sure you understand your loved one's wishes for funeral and burial services.

  • Notify hospital or hospice staff of important cultural or religious customs about death. This may include people who should be present before and after the time of death. Or, it may include special customs regarding washing, dressing, or caring for the body after death.

Understand what happens immediately after death

After death, the person's muscles will relax, breathing will stop, the heart will stop beating, and there will be no pulse.

Even when death is expected, it is common—and normal—for caregivers to feel emotions like shock and disbelief. Although home health or hospice staff and your loved one's doctor should be notified, a natural death is not an emergency. There is usually no need to call medical personnel immediately. Many people find it comforting to take some time to sit with their loved one, perhaps talking quietly, holding hands, or watching their loved one at peace.

Related Resources

Completing Your Life

Caring for a Loved One

Grief and Loss

How to Cope with Appetite Loss in a Loved One with Cancer: Advice for Caregivers

What Cancer Caregivers Should Know About Hospice Care at Home: A Caregiver’s Story

More Information

National Cancer Institute: End-of-Life Care for People Who Have Cancer