Sweating and temperature changes in palliative care
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Many people living with a terminal illness experience excessive sweating and a high temperature (fever). Fever and sweating are often related but one can happen without the other. These symptoms can be uncomfortable and cause distress, tiredness and confusion. There are simple steps you can take to ease these symptoms, and medicines that can help, once serious underlying causes have been ruled out.
On this page:
Understanding sweating and temperature changes
Sweating is a healthy way for our bodies to cool down when we are hot. The amount that someone sweats depends on how active they are, the temperature of the environment they’re in and their emotional state. People living with a terminal illness may experience changes in body temperature and excessive sweating.
This can cause problems that may affect their quality of life, including:
Having to change soaked clothes and bed sheets often can mean extra work for the person or their carer.
What causes sweating and temperature changes?
There are many causes of sweating and fever including infection, cancer and cancer treatments. There may be more than one cause contributing to a person's symptoms.
Infection
Infection is a common cause of sweating, particularly if the person also has a fever. Sepsis is an overwhelming and life-threatening infection which can affect the whole body. Find out more about sepsis on the NHS website.
People who have had chemotherapy or other treatments that affect the immune system could be at risk of neutropenia. This means they have a low white blood cell count and therefore a weakened immune system. If a person has neutropenia then sweating could be a sign of neutropenic sepsis which is a medical emergency. Find out more about the causes and symptoms of neutropenic sepsis.
Cancer and cancer treatments
Neoplastic fever (also known as tumour fever) is caused by the cancer itself. It can be caused by almost any cancer but is particularly common in people with Hodgkin’s disease, non-Hodgkin’s lymphoma, acute leukaemia, renal cancer and liver metastases.
Treatments for some cancers can change the levels of sex hormones and cause sweating. This includes some breast cancer and prostate cancer treatments.
Other causes
There are many other possible causes of sweating, which include:
- selective serotonin reuptake inhibitor (SSRI) antidepressants – such as citalopram
- hormone therapies – such as tamoxifen, aromatase inhibitors, gonadorelin analogues
- opioids
- reactions to blood products (transfusion reaction)
- pain
- fear and anxiety
- hypoxia (low oxygen levels)
- hypoglycaemia (low blood sugar)
- hyperthyroidism (high level of thyroid hormone – thyroxine)
- low levels of oestrogen, due to a natural or treatment-related menopause
- low levels of androgen sex hormones, due to surgery or hormone therapy
- alcohol withdrawal
- warm environment.
What can I do to help?
If the sweating or temperature change is new or has got worse, speak to the patient's GP, district nurse or specialist nurse. They can check whether there are any underlying causes and look at things that may help.
Understanding the person’s medical history, and the cause of their discomfort, will help you to give more effective care and support. Be aware of their conditions and treatments, and the impact these may have on temperature and sweating. Find out whether they could be at risk of neutropenia and know who to call for urgent help if you suspect they have neutropenic sepsis. Read more about the causes and symptoms of neutropenic sepsis.
Practical tips
These are some simple steps that may help:
- Think about the temperature of the patient's environment. Keep rooms cool and ventilated, according to what feels comfortable for them.
- Try using fans, cooling sprays, or regular sponging and washing.
- Encourage, or help with, good personal hygiene to make sure that the person's skin is kept clean and dry.
- Layer clothing and bed clothes so that they can be adjusted easily.
- Encourage them to drink water and suck on ice, to prevent dehydration.
- Encourage them to reduce their tea and coffee intake because caffeine may make sweating worse. Avoiding alcohol and spicy food may also help.
- Consider clothing fabrics. Some people may feel more comfortable wearing cotton or silk next to the skin as these will feel cooler and absorb sweat more than synthetic fabrics. Other people prefer modern synthetic fabrics (wicking fabrics) used for exercise clothes.
- Offer a towel to sit or lie on to absorb sweat.
- Suggest relaxation techniques, yoga and acupuncture, which may help.
- Check with the patient before making any changes - the overall aim is to make them as comfortable as possible.
What is the medical management?
Speak to the person’s GP, district nurse or specialist nurse if symptoms cannot be managed. They can review the patient's medicines and consider changing any that contribute to sweating. They may prescribe some of the following medicines:
- Sweating with a high temperature can be treated with paracetamol and NSAIDs (non-steroid anti-inflammatory drugs), such as ibuprofen, diclofenac or naproxen.
- NSAIDs and steroids can help with neoplastic fever.
- For symptoms related to hormone insufficiency, hormone replacement therapy may help.
- Other medicines that can help include antidepressants venlafaxine or amitriptyline, cimetidine, beta-blockers and calcium channel blockers.
End of life temperature change
In someone’s last days and hours, their temperature may change a lot as their body is less able to regulate it. This can cause episodes of both high and low temperature, although the overall body temperature will drop as the person begins to die. It is usually associated with clamminess and a change in skin colour.
Useful resources
Scottish Palliative Care Guidelines: sweating
Palliative Care Guidelines Plus: Fever, sweating and hot flushes
Key points
- Sweating and fever can cause discomfort and distress.
- Sweating can have several causes. Understanding what is causing the person’s symptoms will help you provide the best care.
- There are simple things you can do to help someone feel more comfortable.
- Be aware of serious causes of sweating, including sepsis, and know who to call for urgent help.
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Disclaimer
This information is not intended to replace any training, national or local guidelines, or advice from other health or social care professionals.
The Palliative Care Knowledge Zone is not intended for use by people living with a terminal illness or their family and friends, who should access our information for the public.
