A recent study published in the journal Cancer evaluated clinical signs that are potentially indicative of imminent death in patients with advanced cancers, such as lung cancer. The study is entitled “Bedside clinical signs associated with impending death in patients with advanced cancer: Preliminary findings of a prospective, longitudinal cohort study.”
The diagnosis of imminent death in cancer patients is a sensitive issue, although it can be important for the patient and family and also for physicians, as it allows them to make timely decisions regarding hospital bureaucracy and proper treatment. In the final days of a patient’s life, daily bloodwork and administration of certain medication becomes less critical; at this stage, the patient’s comfort and care should be the priority. Important personal decisions can also be made in this time-frame, like informing close family members so that they can travel or fly in on time.
Unfortunately, it is difficult for healthcare professionals to correctly estimate when a patient is dying or when this possibility should be brought up to the family. In order to address this issue, researchers have analyzed physical alterations in the final days of life of a total of 357 patients suffering from advanced cancer, and admitted in acute palliative care units at MD Anderson Cancer Center in Houston and Barretos Cancer Hospital in Brazil.
The team collected data regarding 52 bedside physical signs every 12 hours since the patient was admitted till his/her death or discharge. A significant percentage (57%) of patients succumbed during the study. Eight specific physical signs were found to be predictive of the patient’s death within three days: decreased response to verbal stimuli and visual stimuli, non-reactive pupils, inability to close eyelids, grunting of vocal cords, drooping of the nasolabial fold (making the face look more relaxed), hyperextension of the neck (the head tilts back when the patient is lying down) and upper gastrointestinal bleeding.
“This study shows that simple bedside observations can potentially help us to recognize if a patient has entered the final days of life,” said the study’s lead author Dr. David Hui in a news 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.”
The team is now preparing educational materials to aid healthcare professionals and families to recognize patient’s signs suggestive that he/she has entered the final days of life. An impending death diagnostic tool is also being developed centered on the eight physical signs to assist on clinical decision making.