Cancer and Palliative Care at Home

During Cancer Treatment

Chemotherapy, radiotherapy and surgery all cause significant side effects that can make daily living very difficult. A home carer can provide practical support through treatment:

• Meal preparation — appetite changes, taste changes, nausea and mouth sores can all affect eating. A carer can prepare small, frequent meals that are easier to tolerate.
• Light housekeeping — keeping the home clean and comfortable when the person has no energy
• Shopping — grocery shopping, prescription collection
• Accompanying to appointments — transport to chemotherapy or radiotherapy appointments
• Medication prompts — anti-nausea medications, pain relief, steroids — all need to be taken on schedule
• Companionship — being there. Treatment is frightening and isolating. A consistent, warm presence matters enormously.
• Infection awareness — chemotherapy causes immunosuppression. Carers must maintain strict hygiene. Any fever (38°C or above) in a person receiving chemotherapy should be treated as a medical emergency — call the oncology team immediately (they will have a 24-hour helpline number).

Cancer-Related Fatigue

Cancer-related fatigue is different from ordinary tiredness. It can be extreme, unrelated to activity, and not relieved by rest. It affects most people undergoing treatment and many people living with cancer.

Home care helps by taking over tasks that would otherwise exhaust the person — allowing them to conserve energy for the things that matter most to them: family time, watching a favourite programme, reading, sitting in the garden.

Do not push someone with cancer-related fatigue to "push through" — this does not help and can worsen the problem.

Palliative and End-of-Life Care

Palliative care focuses on quality of life rather than cure. It can begin at any point after a serious diagnosis — not only at the end of life. Home care is a central part of palliative care at home.

At this stage, a home carer works alongside the palliative care team (which may include a Macmillan nurse, district nurses, and the GP) to provide the daily practical support that allows the person to remain comfortable at home.

The role of home care in palliative care includes:

• Personal care — help with washing, dressing, continence management
• Meals and nutrition — preparing appetising small meals; ensuring hydration
• Medication prompts — ensuring pain relief and other symptom management medications are taken consistently
• Companionship — meaningful company and conversation; sitting with the person
• Supporting family carers — allowing family members to rest and maintain their own wellbeing
• Reporting changes — observing and communicating any changes in condition or comfort to the clinical team

Dying at Home

Studies consistently show that most people, when asked where they would prefer to die, say at home. Around 50% of deaths in the UK now occur at home — up from around 20% a decade ago, in part due to better palliative care support.

Dying at home is possible with the right support in place:

• A Coordinate My Care (CMC) or similar anticipatory care plan ensures all services know the person's wishes
• The palliative care team provides 24-hour advice and can arrange crisis support
• The district nursing team handles clinical care including pain management by injection or syringe driver
• Home care (Ekvarta) handles the practical daily support and companionship
• Family, friends and neighbours provide additional presence and emotional support

Home care carers are not trained to administer controlled drugs or manage clinical equipment. They work alongside the clinical team rather than instead of it.

Fast-Track NHS Funding

Where a person has a rapidly deteriorating condition entering a terminal phase, a clinician can complete a Fast-Track NHS Continuing Healthcare request. This should result in a care package being put in place within 48 hours, funded entirely by the NHS — no means test, no charge.

Ask the palliative care team, Macmillan nurse, or GP to initiate fast-track CHC as early as possible if you believe the person may be in the final weeks of life. See our NHS CHC Guide.

Supporting the Family

A cancer diagnosis and end-of-life care affect the entire family, not only the person who is ill. Family carers often experience significant stress, grief and exhaustion.

Home care provides respite for family carers — allowing them to sleep, leave the house, maintain their own health and have a life outside of caring. This is not selfish — it is essential. See our Carer Burnout guide.

• Macmillan Cancer Support — 0808 808 0000 (free, 7 days a week)
• Marie Curie Helpline — 0800 090 2309 (free)
• Carers UK — 0808 808 7777 (free)