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Eight physical signs associated with impending death in patients with cancer
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Eight physical signs, such as nonreactive pupils and a decreased response to verbal and visual stimuli, were associated with death within 3 days for patients with advanced cancer, according to study results.
David Hui, MD, MSc, assistant professor in the department of palliative care and rehabilitation medicine at the University of Texas MD Anderson Cancer Center, and colleagues previously identified five symptoms that occurred only in the last days of life, including pulselessness of the radial artery, decreased urine output, Cheyne-Stokes breathing, respiration with mandibular movement and death rattle.
David Hui
The current analysis included 357 patients (median age, 58 years; range, 18-88) with advanced cancer who were admitted to an acute palliative care unit. Fifty-five percent of patients were female, and 65% were Hispanic.
Researchers monitored patients for an additional 52 physical signs every 12 hours from admission until death or discharge. Median stay at the acute palliative care unit was 6 days (interquartile range, 4-9).
Overall, 203 patients (57%) died while they were admitted in the acute palliative care unit.
Eight symptoms had a high specificity and a high positive likelihood ratio (LR) — defined as greater than 5 — for their association with death within 3 days.
These symptoms — which occurred in 5% to 78% of the patients — included nonreactive pupils (positive LR, 16.7; 95% CI, 14.9-18.6); decreased response to verbal (positive LR, 8.3; 95% CI, 7.7-9) or visual stimuli (positive LR, 6.7; 95% CI, 6.3-7.1); an inability to close eyelids (positive LR, 13.6; 95% CI, 11.7-15.5); drooping of the nasolabial fold (positive LR, 8.3; 95% CI, 7.7-8.9); hyperextension of the neck (positive LR, 7.3; 95% CI, 6.7-8); grunting of vocal cords (positive LR, 11.8; 95% CI, 10.3-13.4); and upper gastrointestinal bleeding (positive LR, 10.3; 95% CI, 9.5-11.1).
“This study shows that simple bedside observations can potentially help us to recognize if a patient has entered the final days of life,” Hui said in a press release. “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.” – by Alexandra Todak
Disclosure: The researchers report no relevant financial disclosures.
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