Key points
- The end of life may last months, weeks, days or hours. Not everyone has all of the changes, and the exact timing cannot be predicted [1].
- Sleeping more, losing the wish to eat and drink, passing less urine, cold and bluish hands and feet, and irregular breathing are common at this time and are usually part of the natural process [1].
- Do not force food or drink on the person; it can cause discomfort or choking. Keeping the mouth and lips moist helps more [1, 2].
- Pain and breathlessness can usually be controlled in the last days too. Studies have shown no link between using morphine and similar medicines and dying sooner [1].
- Most people can still hear even when they can no longer speak; talk to the person you love and hold their hand [1, 6].
- Looking after yourself matters too: grieving before the loss is normal, and many caregivers say they wish they had asked for help sooner [12].
What are the last days of life with cancer like?
Most families do not know the signs that death is near. Knowing what changes may happen helps them get ready to say goodbye to the person they love and makes this time less stressful and confusing [1]. Some caregivers have said that they wished they had known sooner what changes to expect [10].
These changes may happen over a few weeks, a few days or a few hours. Not all of them happen in everyone, so it can be hard to know how close death is [1]. Ask the doctor or nurse to explain what changes are likely in the person you are caring for and how you can help [1].
If you have not yet talked with the person about their wishes, ask what matters to them while they can still make decisions: where they want to be cared for, and which treatments they do or do not want [1, 9]. For the difference between palliative care and end-of-life care, see What is palliative care?
End-of-life signs in cancer: which changes are normal?
| Change | What happens | How you can help |
|---|---|---|
| Sleeping a lot and tiredness | Tiredness is one of the most common symptoms in the last days and may get worse every day [1] | Let them rest; when they are awake, be with them and talk to them [1] |
| Losing the wish to eat and drink | In the last days and hours, most people lose the wish to eat and drink, and the body needs less food [1, 10] | Offer food but do not insist; ice chips or moistening the mouth and lips help [1, 10] |
| Responding less or not responding | The person becomes more withdrawn, answers slowly or does not answer at all [1] | Talk to them and touch them; most people can still hear [1, 6] |
| Confusion, restlessness or seeing things that are not there | Common in the last days; sometimes there is a treatable cause, such as a medicine, dehydration or a change in the body's salts. Seeing loved ones who have died is also common [1] | Make sure they do not fall or hurt themselves, and tell the care team [1] |
| Changes in breathing | Breathing becomes irregular: very shallow, with short pauses, or fast and deep [1] | Keep the person slightly sitting up; for breathlessness, a cool fan aimed at the face helps [1] |
| A rattling sound when breathing | Saliva collects in the throat because the person is too weak to clear it; it is upsetting for those at the bedside but does not seem to distress the person [1, 2] | Raise the head of the bed, prop the person up with pillows or turn them onto their side [1] |
| Cold, blotchy or bluish hands and feet | Blood flow changes and blood pressure usually falls [1] | Keep them warm with blankets; do not use electric blankets or heating pads [1] |
| Less urine, and darker urine | One of the common changes of the last days [1] | If the lower tummy is swollen or painful, tell the care team; the bladder may be full [2] |
| Trouble swallowing | Food, drink and tablets become hard to swallow [1] | Medicines can be given by injection, skin patch or suppository; ask the doctor [1] |
Not everyone has all of these changes, and their order and timing differ from person to person [1].
Why do cancer patients sleep so much?
In the last weeks and days, the body becomes weaker and tiredness is one of the most common symptoms; it may get worse every day, and the person may be drowsy and weak [1]. The person may withdraw from what is around them, sleep more and show less interest in what is going on [1]. These changes usually do not mean that you have done anything wrong.
But if the person suddenly becomes very drowsy or confused, tell the care team; sometimes the cause is a medicine, dehydration or a change in the body's salts that can be treated [1]. Sometimes the doctor may also give a medicine that makes the person a little more alert and energetic [1].
Cancer patient not eating: should they have a drip or tube feeding?
Giving food is one of the ways families show their love, so it is very hard for many families when the person stops eating. But in advanced cancer, appetite falls and the body needs less food [10]. Offer food, but do not pressure the person [10]. If they want it, give them small amounts of food they enjoy [1]. Food and drink should not be forced, because this can cause discomfort or choking [1].
About a drip (fluids into a vein): many families want the person to be put on a drip. In the last days, giving fluids has not been shown to help people live longer or improve their quality of life; the harm is usually small, and families sometimes feel the person is less tired and more alert [1]. In a study of 129 people with advanced cancer, giving one litre of fluid a day, compared with a very small amount, did not improve symptoms, quality of life or length of life [5]. Fluids may ease distressing signs of dehydration, such as thirst or confusion, but they may also cause other problems; so decide about them for each person individually, together with the care team [2].
About tube feeding: extra nutrition in the last days has not been shown to help and may increase the risk of food going into the lungs and of infection [1].
Instead of food, help with mouth care: moisten the mouth and lips often, give small sips of water if they can manage, and help them brush their teeth or clean their dentures [1, 2].
When a person with cancer is in a coma or unresponsive: can they still hear us?
In the last days and hours, the person may answer slowly or no longer respond to what is said [1]. Even so, most people can still hear for some time after they are no longer able to speak. Touching and talking to the person, even if they do not respond, may comfort them [1].
In a small study at a hospice in Canada, recordings of brain activity showed that the brains of most patients who no longer responded to their surroundings were still reacting to sounds a few hours before death [6]. So say what you want to say; you could read them a prayer or a poem they love.
How to keep the person comfortable at home
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Control pain
Not everyone has pain in the last days, but if there is pain, it can usually be controlled [1, 2]. If the person can no longer take tablets, pain medicine can be given by injection or infusion; with a doctor's order this can also be done at home [1]. Restlessness is sometimes caused by pain or by a full bladder or bowel [2]. See the guide Cancer pain.
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Keep them warm, without electric devices
If the hands and feet are cold, use blankets, not electric blankets or heating pads [1].
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Review medicines with the doctor
Medicines that no longer help the person feel comfortable, such as cholesterol medicine, can be stopped with the doctor's advice [1, 2]. Ask the care team to prescribe medicines in advance for pain, breathlessness, nausea, restlessness and a rattling sound, so that they can be given quickly if needed [2].
When should I call the doctor?
Contact the palliative care team or the person's doctor straight away if:
- pain is not controlled; for example, the person is moaning, grimacing or restless [1, 2]
- they can no longer swallow their medicines and another way of giving them is needed [1]
- breathlessness, restlessness or confusion is distressing them, or they might hurt themselves [1, 2]
- they have not passed urine for several hours and the lower tummy is swollen or painful [2]
- they have a seizure or heavy bleeding, or a fever that is making them uncomfortable [1, 2]
Talk with the doctor in advance about the person's wishes about resuscitation (CPR), so that you know what to do at difficult moments [1]. If there is no plan in place and the person suddenly becomes very unwell, call your local emergency number.
How to talk with the person and say goodbye
Many people are comforted by sharing their feelings and taking the time to say what they need to say [11]. You do not have to find the perfect words; the most important thing is not what you say, but that you show you care [10]. Often, simply being there is enough [11]. Listen more; you do not have to solve every problem [11].
| Instead of this | Try this |
|---|---|
| "You are going to be just fine." | "Are there some things that worry you?" [10] |
| "Don't talk like that! You can beat this!" | "It must be hard to come to terms with all of this." [10] |
| "I can't see how anyone can help anymore." | "We will be there for you always." [10] |
| "Please don't give up. I need you here." | "I will miss you terribly. But we will get through somehow." [10] |
| "There has to be something more to try." | "Let's be sure to get the best of medical treatments, but we will be together when we have done all we can." [10] |
| "Don't be glum. You'll get well." | "It must be hard. Can I just sit with you for a while?" [10] |
These phrases come from a handbook for people facing serious illness, quoted by the US National Cancer Institute.
Religious and cultural customs and beliefs, such as prayer or the presence of a faith leader, matter to many families at this time; tell the care team what is important to the person and your family [1].
Children: if a child wants to visit, explain gently beforehand what they will see; for example, that grandma is in bed and may be asleep or talk only a little, but that she will know they are there. Give the child a choice too; if they do not want to or cannot come, they can write a letter, draw a picture or send a voice message [10]. See the guide How do I talk to my children about my cancer?
For more words that help, see the guide What to say (and not say) to someone with cancer.
After death: the first moments
After the person dies, family members may wish to stay with them for a while [1]. Tell the care team in advance about customs and rituals that are important to your family, such as religious rites and ways of saying farewell [1]. Health care staff, a social worker or a faith leader can explain the steps that need to be taken after a death [1].
Looking after yourself, and anticipatory grief
You may start to grieve before the person you love dies; this is called "anticipatory grief" and it is normal [12]. The person who is ill may feel it too: about 1 in every 4 people with cancer that cannot be cured feels this kind of grief [8]. Talking with someone trained to help with grief can help the person and their family come to terms with a death that is near [8].
Caregivers sometimes suffer even more than the person who is ill, so support for the caregiver matters from the start [1]. Many caregivers say they took on too much and wish they had asked for help sooner [12]. Feeling guilty, angry or exhausted is also normal; talk with someone you trust [12]. The hospice team or volunteers can take over for a while so that you can rest [9]. See the guide A guide for family members and caregivers.
After the death: sadness, poor sleep, loss of appetite, tiredness, guilt and sudden waves of grief, for example on an anniversary or when sorting through the person's belongings, are normal. For most people these feelings ease between 6 months and 2 years later [8]. If the grief is not easing, is very intense or stops you from managing daily life, get help from a grief counsellor or a doctor [8]. The guide Anxiety and depression with cancer can also help.
Frequently asked questions
Does morphine hasten death?
Some patients and families worry that morphine and similar medicines make death come sooner, but studies have shown no link between using these medicines and dying sooner [1]. These medicines relieve pain well in the last days [1]. Studies have also not shown that the calming medicines given for very severe suffering in the last days shorten life [1].
How can we tell how many days they have left?
No one can say exactly. The end of life may be months, weeks, days or hours, and not all signs happen in everyone [1]. Some changes, such as a rattling sound when breathing, usually mean that death may come within hours or days [1]. Ask the care team; they should tell you honestly what they know and what is still uncertain [2].
Is it better for the person to be at home or in hospital?
Many people wish to be at home. People who die at home with the support of a hospice team seem to have better-controlled symptoms and a better quality of life, and their families later find it easier to adjust to the loss [1]. But not everyone chooses home; what matters is to talk together, and with the doctor, about the person's wishes and the best way to carry them out [1].
Do antibiotics or blood transfusions help in the last days?
Family members disagree about continuing treatment; what should we do?
Disagreement like this is very common. Ask the care team to hold a family meeting and explain the goal of treatment: slowing the cancer, easing pain and other symptoms, or prolonging life [10]. In the end, the decision belongs to the person who is ill; if they can no longer speak, think about what they themselves would have wanted [10].
Should we tell the person that they are in their last days?
The UK guideline on care in the last days of life recommends talking about the situation with the person themselves, unless they do not wish to know, and asking how much they would like to know [2]. Some people want to know every detail, and some prefer to know less [9]. If you are not sure how to start, see the guide What to say (and not say) to someone with cancer.
Signs of approaching death and care in the last days (for doctors)
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- NICE NG31: signs that a person may be entering the last days of life: agitation, Cheyne–Stokes breathing, deterioration in level of consciousness, mottled skin, noisy respiratory secretions, progressive weight loss, increasing fatigue and loss of appetite, and changes in communication, mobility or performance status; reassess at least every 24 hours; avoid investigations that are unlikely to change care. Anticipatory medicines for pain, breathlessness, nausea and vomiting, anxiety and agitation, and noisy secretions; subcutaneous or intravenous route (not intramuscular); syringe pump if more than 2 or 3 PRN doses are needed in 24 hours. Oxygen only for symptomatic hypoxaemia; breathlessness: an opioid and/or a benzodiazepine; anxiety: a benzodiazepine; delirium: an antipsychotic; secretions: atropine, glycopyrronium, hyoscine butylbromide or hyoscine hydrobromide. Clinically assisted hydration: a therapeutic trial if signs of dehydration (thirst, delirium) are distressing, with monitoring at least every 12 hours [2].
- Bedside signs of death within 3 days (Hui; 357 patients in two acute palliative care units): specificity above 95% and high positive LR for pulselessness of the radial artery (15.6), decreased urine output (15.2), Cheyne–Stokes breathing (12.4), respiration with mandibular movement (10) and death rattle (9) [3]; and nonreactive pupils (16.7), inability to close the eyelids (13.6), grunting of the vocal cords (11.8), upper gastrointestinal bleeding (10.3), decreased response to verbal stimuli (8.3), drooping of the nasolabial fold (8.3), hyperextension of the neck (7.3) and decreased response to visual stimuli (6.7) [4]. Decreased level of consciousness, PPS ≤20% and dysphagia of liquids appeared earlier and more often but had low specificity (below 90%) [3].
- Hydration (Bruera 2013; 129 hospice patients; saline 1 L per day vs 100 mL per day): no difference in the sum of 4 dehydration symptoms (−3.3 vs −2.8; P=0.77), delirium, quality of life or survival (median 21 vs 15 days; P=0.83) [5].
- Death rattle (SILENCE; 157 patients in 6 Dutch hospices): prophylactic scopolamine butylbromide 20 mg subcutaneously four times a day vs placebo: grade 2 or higher rattle 13% vs 27% (difference 14%; 95% CI 2% to 27%; P=0.02); restlessness 28% vs 23% [7].
- Read more: Palliative care; Early palliative care; tool: Opioid dose conversion.
References
12 referencesShow all referencesClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
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- 4Bedside clinical signs associated with impending death in patients with advanced cancer: preliminary findings of a prospective, longitudinal cohort study
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- 7Effect of Prophylactic Subcutaneous Scopolamine Butylbromide on Death Rattle in Patients at the End of Life: The SILENCE Randomized Clinical Trial
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This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
Printed from the website; the full and up-to-date version: https://drdabiri.com/en/guides/end-of-life-cancer/