A research group from The University of Texas MD Anderson Cancer Center recently identified eight specific physical and cognitive signs linked to imminent death in cancer patients. The results were published in the Cancer journal under the title “Bedside clinical signs associated with impending death in patients with advanced cancer: Preliminary findings of a prospective, longitudinal cohort study.”
These findings can improve the way clinicians communicate with both patients and families, and the clinical decisions made toward each specific patient.
The lead author of the study, Dr. David Hui, explained that precisely knowing if a patient has entered the last days of life is fundamental, as it has high implications for clinical practice and might be crucial for caregivers and families to make more informed and educated decisions.
Dr. Hui stated in a news release, “In the past, studies trying to understand the signs associated with impending death were conducted in people who were recognized as dying, so there’s a potential bias built into this model. With our study, we observed a list of signs in patients from the time they were admitted to the palliative care unit. They were observed systematically, twice a day, without knowing if the patient would die or be discharged.”
In this study, the team followed a total of 357 cancer patients admitted to the palliative care unit, of which 57 percent died. Researchers evaluated 52 cognitive and physical signs previously identified by Hui and his team, twice daily, every day, from the moment patients entered the unit until they passed away. Of these 52 signs, 8 were associated with impending death within a 3 day period. Those signs included decreased response to visual stimuli, decreased response to verbal stimuli, nonreactive pupils, incapacity to close eyelids, neck hyperextension, drooping of the nasolabial fold, upper gastrointestinal bleeding and grunting of vocal cords.
“When cancer patients reach the last days of life, this is an extremely emotional time for families — their stress levels cannot be understated. Knowing when death is imminent would provide more information so caregivers can plan appropriately. For clinicians, having this information could help reassure families that we are providing the best care possible,” added Dr. Hui.