Clinical Signs of Impending Death in Cancer Patients

Abstract

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

Prevalence of oral mucositis, dry mouth, and dysphagia in advanced cancer patients

“…At the end of life, swallowing problems can be as high as 79 %, and these difficulties may not only result in discomfort for patients but also can raise concern for caregivers [4]. Dysphagia of liquids, decreased level of consciousness, and poor performance status appeared at high frequency with a positive likelihood ratio for impending death [22]. Similarly, dysphagia had prognostic significance for 1-2-week survival [23,24].…”

Distancing sedation in end-of-life care from physician-assisted suicide and euthanasia

“…Claessens et al and Hui et al reveal that most patients tend to experience varying levels of consciousness as part of the natural dying process, which tends to occur 7-10 days prior to death. (25,26) This point is important given that Kohara et al (27) and Mercadante et al (28) both showed that CSD tends to be applied 2-3.4 days before death, suggesting that most patients would already be experiencing varying levels of sedation and cognitive impairment before CSD is applied. (25)(26)(27)(28) 5.…”

“…(25,26) This point is important given that Kohara et al (27) and Mercadante et al (28) both showed that CSD tends to be applied 2-3.4 days before death, suggesting that most patients would already be experiencing varying levels of sedation and cognitive impairment before CSD is applied. (25)(26)(27)(28) 5. Variations in level of consciousness to sedation: Lipuma's key argument is that CSD results in the negation of higher brain function, which he believes is integral to a meaningful existence.…”

End-of-life diagnosis, communication, and the search for “Infectin,” “Clottin,” and “Heart Arrestin”

“…Recent research suggests that physical signs such as pulselessness of the radial artery, respiration with mandibular movement, decreased urine output, Cheyne-Stokes breathing, and death rattle are more associated with a high likelihood of death within 3 days. 4 Sitting during the medical visit 5 and examining the patient 6 are perceived by patients as highly positive and compassionate aspects of care and will help alleviate some of the distress associated with uncertainty.…”