8 Signs Death Is Imminent in Advanced Cancer Patients

Researchers have identified eight specific physical signs associated with death within 3 days, which can help clinicians and families in making care decisions. The study was published in Cancer.

David Hui, MD, MSc, of the department of palliative care and rehabilitation medicine at the University of Texas MD Anderson Cancer Center in Houston, and colleagues analyzed 52 physical signs among 357 advanced cancer patients admitted to acute palliative care units at two tertiary care cancer centers-MD Anderson Cancer Center and Barretos Cancer Hospital in Barretos, Brazil. Patients’ characteristics were monitored and documented every 12 hours until hospital discharge or death.

Fifty-seven percent of patients died at the cancer center after admission. The eight most prominent physical signs had a high specificity of more than 95% and occurred in 5% to 78% of patients within their last 3 days of life. Seven of the signs were related to deterioration in neurocognitive functions. One sign was a bleeding complication.

The eight signs identified were nonreactive pupils, a decreased response to verbal stimuli, a decreased response to visual stimuli, an inability to close eyelids, drooping of the nasolabial fold, hyperextension of the neck, grunting of vocal cords, and upper gastrointestinal bleeding.

The average age of patients was 58 years; 55% were women and 65% were of Hispanic origin. A total of 101 (28%) patients had gastrointestinal cancer. The median duration of the cancer center admission was 6 days.

According to the authors, there have been few studies that analyzed the signs of impending death among cancer patients. Yet, these signs indicate that treatments should be stopped and focus should be shifted to hospice and comforting care.

“This study shows that simple bedside observations can potentially help us to recognize if a patient has entered the final days of life. Upon further confirmation of the usefulness of these ‘tell-tale’ signs, we will be able to help doctors, nurses, and families to better recognize the dying process, and in turn, to provide better care for the patients in the final days of life,” said Hui in a statement.

The authors emphasized that studying physical signs of imminent death outside of cancer is necessary, as the signs identified in this study may not be universal to those dying of other causes. Additionally, the cancer patients included in this study were admitted into hospital care with severe symptoms. Therefore, these physical signs need to be assessed in other healthcare settings and patient populations.

The authors are next putting together educational materials for both families and clinicians and nurses to facilitate the identification of these signs of the final days of life, as well as a tool to diagnose impending death to help support end-of-life clinical decisions.