Approach to managing sweating in palliative care

Wilcock A, 2020

Sweating is an unpleasant and debilitating symptom that can impair quality of life in patients with palliative care needs. Profuse sweating can also cause significant fluid loss and can interfere with the adhesion of dressings or transdermal patches.

Causes of sweating include:

  • hot flushes associated with hormonal therapies for breast or prostate cancer
  • paraneoplastic syndromes
  • systemic disease, including infection with fever
  • concurrent physical symptoms (eg pain)
  • emotional distress, usually causing sweating of axillae, palms, and soles of the feet
  • adverse effects of drugs (eg some antidepressants, opioids).

Use a stepwise approach to manage sweating; see Approach to managing sweating in palliative care. Consider the potential benefits and burdens of each intervention, and the patient’s prognosis, preferences and goals of care—see Principles of symptom management in palliative care.

Evidence to support drug therapy for sweating in palliative care is limited. Response to therapy can be inconsistent, therefore, a range of drugs may need to be tried.

Sweating in a patient with palliative care needs can also be caused by a concomitant condition unrelated to their life-limiting illness; see advice on sweating disorders in the Dermatology guidelines for management.

For management of hot flushes associated with menopause, see the Sexual and Reproductive Health guidelines.

Table 1. Approach to managing sweating in palliative care

Step 1. Discuss possible cause(s) and treatment options with the patient

Explain that it may not be possible to treat the cause of sweating, but that it can often be managed using general measures and, if necessary, drug therapy.

Step 2. Identify the cause of sweating and address it if appropriate

Consider stopping or reducing the dose of drugs that may be causing sweating.

Treat infection causing fever (eg urinary tract infection, febrile neutropenia), if appropriate.

Treat pain.

Step 3. Use general skincare measures and topical therapy

Good skincare is essential.

Advise the patient to:

  • use bedsheets made from cotton or silk
  • spread towels in areas of profuse sweating.

Use of topical antiperspirants for localised sweating of axillae, palms, and soles of the feet; see the Dermatology guidelines.

Step 4. Consider systemic drug therapy if sweating persists and is severe and distressing

Consider the impact of sweating on the patient’s quality of life, and the potential benefits and harms of systemic drug treatment. For advice on drug therapy for sweating, see:

Step 5. Seek specialist palliative care advice

If sweating persists, seek expert advice.