Clinical Signs of Impending Death in Cancer Patients

• Published in: The oncologist (Dayton, Ohio) Ohio), 2014-06, Vol.19 (6), p.681-687
• Main Authors: Hui, David, Santos, Renata, Chisholm, Gary, Bansal, Swati, Silva, Thiago Buosi, Kilgore, Kelly, Crovador, Camila Souza, Yu, Xiaoying, Swartz, Michael D., Perez‐Cruz, Pedro Emilio, Leite, Raphael de Almeida, Nascimento, Maria Salete de Angelis, Reddy, Suresh, Seriaco, Fabiola, Yennu, Sriram, Paiva, Carlos Eduardo, Dev, Rony, Hall, Stacy, Fajardo, Julieta, Bruera, Eduardo
• Format: Article
• Language: English
• Subjects: Death; Diagnosis; Humans; Neoplasms; Neoplasms - diagnosis; Neoplasms - mortality; Neoplasms - pathology; Palliative Care; Patients; Physical Examination; Sensitivity; Signs; Specificity; Symptom Management and Supportive Care
• ISSN: 1083-7159; 1549-490X
• DOI: 10.1634/theoncologist.2013-0457

Background. The physical signs of impending death have not been well characterized in cancer patients. A better understanding of these signs may improve the ability of clinicians to diagnose impending death. We examined the frequency and onset of 10 bedside physical signs and their diagnostic performance for impending death. Methods. We systematically documented 10 physical signs every 12 hours from admission to death or discharge in 357 consecutive patients with advanced cancer admitted to two acute palliative care units. We examined the frequency and median onset of each sign from death backward and calculated their likelihood ratios (LRs) associated with death within 3 days. Results. In total, 203 of 357 patients (52 of 151 in the U.S., 151 of 206 in Brazil) died. Decreased level of consciousness, Palliative Performance Scale ≤20%, and dysphagia of liquids appeared at high frequency and >3 days before death and had low specificity (3天，对濒死的特异性较低（