Predicting imminent death from cancer: A difficult, but important discussion

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177851075 (1)At a time when physician-assisted suicide, healthcare costs, and fundamental changes in the way patients will or will not receive coverage are being considered, a new study provides a valuable tool for predicting when death from cancer is imminent. This information can be very useful in managing how a patient spends their last days. Not only will it help doctors to better manage time and resources, but families will also be better equipped to make decisions regarding care.

Researchers led by Dr. David Hui from the MD Anderson Cancer Center in Houston observed 357 cancer patients admitted to two acute palliative care units at the MD Anderson Cancer Center in Houston and the Barretos Cancer Hospital in Brazil. Following admission, patients were monitored every 12 hours. They were followed until death or discharge from the hospital. Researchers identified eight physical symptoms that strongly suggested a patient would die within three days. These symptoms were:

  • Decreased response to verbal stimuli
  • Decreased response to visual stimuli
  • Nonreactive pupils
  • Drooping of nasolabial fold
  • Hyperextension of neck
  • In ability to close eyelids
  • Grunting of vocal cords
  • Upper gastrointestinal bleeding

Researchers emphasized that most of these symptoms were related to neurocognitive and neuromuscular function deterioration. They add, These signs were commonly observed in the last 3 days of life with a frequency in patients between 38% and 78%. Our findings highlight that the progressive decline in neurological function is associated with the dying process. Limitations of the study include that it was specifically cancer patients so results cannot be generalized to other populations and the study was relatively small. However, researchers hope that the results of this study as well as future studies will help them to develop diagnostic tools to assist clinical decision-making and educational materials for both health care professionals and patients families.

ACSH s Dr. Gil Ross adds, These signs will serve to empower families at the end of their loved ones life when they may feel that there is nothing more they can do. This small tool can really help to give families and patients more information so that they feel they are doing all that they can to ensure patients are most comfortable at the end of their lives.