Clinical signs of impending death in cancer patients

David Hui, Renata dos Santos, Gary Chisholm, Swati Bansal, Thiago Buosi Silva, Kelly Kilgore, Camila Souza Crovador, Xiaoying Yu, Michael D. Swartz, Pedro Emilio Perez-Cruz, Aphael de Almeida Leite, Maria Salete de Angelis Nascimento, Suresh Reddy, Fabiola Seriaco, Sriram Yennu, Carlos Eduardo Paiva, Rony Dev, Stacy Hall, Julieta Fajardo, Eduardo Bruera

Research output: Contribution to journalArticle

44 Citations (Scopus)

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 low specificity (<90%) and positive LR (<5) for impending death. In contrast, apnea periods, Cheyne-Stokes breathing, death rattle, peripheral cyanosis, pulselessness of radial artery, respiration with mandibular movement, and decreased urine output occurred mostly in the last 3 days of life and at lower frequency. Five of these signs had high specificity (>95%) and positive LRs for death within 3 days, including pulselessness of radial artery (positive LR: 15.6; 95% confidence interval [CI]: 13.7-17.4), respiration with mandibular movement (positive LR: 10; 95% CI: 9.1-10.9), decreased urine output (positive LR: 15.2; 95% CI: 13.4-17.1), Cheyne-Stokes breathing (positive LR: 12.4; 95% CI: 10.8-13.9), and death rattle (positive LR: 9; 95% CI: 8.1-9.8). Conclusion. We identified highly specific physical signs associated with death within 3 days among cancer patients.

Original languageEnglish (US)
Pages (from-to)681-687
Number of pages7
JournalOncologist
Volume19
Issue number6
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Neoplasms
Confidence Intervals
Respiration
Radial Artery
Aptitude
Deglutition Disorders
Consciousness
Palliative Care
Brazil
Urine

Keywords

  • Death
  • Diagnosis
  • Neoplasms
  • Palliative care
  • Physical examination
  • Sensitivity
  • Sign
  • Specificity

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Hui, D., dos Santos, R., Chisholm, G., Bansal, S., Silva, T. B., Kilgore, K., ... Bruera, E. (2014). Clinical signs of impending death in cancer patients. Oncologist, 19(6), 681-687. https://doi.org/10.1634/theoncologist.2013-0457

Clinical signs of impending death in cancer patients. / Hui, David; dos Santos, Renata; Chisholm, Gary; Bansal, Swati; Silva, Thiago Buosi; Kilgore, Kelly; Crovador, Camila Souza; Yu, Xiaoying; Swartz, Michael D.; Perez-Cruz, Pedro Emilio; Leite, Aphael de Almeida; Nascimento, Maria Salete de Angelis; Reddy, Suresh; Seriaco, Fabiola; Yennu, Sriram; Paiva, Carlos Eduardo; Dev, Rony; Hall, Stacy; Fajardo, Julieta; Bruera, Eduardo.

In: Oncologist, Vol. 19, No. 6, 2014, p. 681-687.

Research output: Contribution to journalArticle

Hui, D, dos Santos, R, Chisholm, G, Bansal, S, Silva, TB, Kilgore, K, Crovador, CS, Yu, X, Swartz, MD, Perez-Cruz, PE, Leite, ADA, Nascimento, MSDA, Reddy, S, Seriaco, F, Yennu, S, Paiva, CE, Dev, R, Hall, S, Fajardo, J & Bruera, E 2014, 'Clinical signs of impending death in cancer patients', Oncologist, vol. 19, no. 6, pp. 681-687. https://doi.org/10.1634/theoncologist.2013-0457
Hui D, dos Santos R, Chisholm G, Bansal S, Silva TB, Kilgore K et al. Clinical signs of impending death in cancer patients. Oncologist. 2014;19(6):681-687. https://doi.org/10.1634/theoncologist.2013-0457
Hui, David ; dos Santos, Renata ; Chisholm, Gary ; Bansal, Swati ; Silva, Thiago Buosi ; Kilgore, Kelly ; Crovador, Camila Souza ; Yu, Xiaoying ; Swartz, Michael D. ; Perez-Cruz, Pedro Emilio ; Leite, Aphael de Almeida ; Nascimento, Maria Salete de Angelis ; Reddy, Suresh ; Seriaco, Fabiola ; Yennu, Sriram ; Paiva, Carlos Eduardo ; Dev, Rony ; Hall, Stacy ; Fajardo, Julieta ; Bruera, Eduardo. / Clinical signs of impending death in cancer patients. In: Oncologist. 2014 ; Vol. 19, No. 6. pp. 681-687.
@article{16096e5a3ab84c53ad91d97d461b6340,
title = "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 low specificity (<90{\%}) and positive LR (<5) for impending death. In contrast, apnea periods, Cheyne-Stokes breathing, death rattle, peripheral cyanosis, pulselessness of radial artery, respiration with mandibular movement, and decreased urine output occurred mostly in the last 3 days of life and at lower frequency. Five of these signs had high specificity (>95{\%}) and positive LRs for death within 3 days, including pulselessness of radial artery (positive LR: 15.6; 95{\%} confidence interval [CI]: 13.7-17.4), respiration with mandibular movement (positive LR: 10; 95{\%} CI: 9.1-10.9), decreased urine output (positive LR: 15.2; 95{\%} CI: 13.4-17.1), Cheyne-Stokes breathing (positive LR: 12.4; 95{\%} CI: 10.8-13.9), and death rattle (positive LR: 9; 95{\%} CI: 8.1-9.8). Conclusion. We identified highly specific physical signs associated with death within 3 days among cancer patients.",
keywords = "Death, Diagnosis, Neoplasms, Palliative care, Physical examination, Sensitivity, Sign, Specificity",
author = "David Hui and {dos Santos}, Renata and Gary Chisholm and Swati Bansal and Silva, {Thiago Buosi} and Kelly Kilgore and Crovador, {Camila Souza} and Xiaoying Yu and Swartz, {Michael D.} and Perez-Cruz, {Pedro Emilio} and Leite, {Aphael de Almeida} and Nascimento, {Maria Salete de Angelis} and Suresh Reddy and Fabiola Seriaco and Sriram Yennu and Paiva, {Carlos Eduardo} and Rony Dev and Stacy Hall and Julieta Fajardo and Eduardo Bruera",
year = "2014",
doi = "10.1634/theoncologist.2013-0457",
language = "English (US)",
volume = "19",
pages = "681--687",
journal = "Oncologist",
issn = "1083-7159",
publisher = "AlphaMed Press",
number = "6",

}

TY - JOUR

T1 - Clinical signs of impending death in cancer patients

AU - Hui, David

AU - dos Santos, Renata

AU - Chisholm, Gary

AU - Bansal, Swati

AU - Silva, Thiago Buosi

AU - Kilgore, Kelly

AU - Crovador, Camila Souza

AU - Yu, Xiaoying

AU - Swartz, Michael D.

AU - Perez-Cruz, Pedro Emilio

AU - Leite, Aphael de Almeida

AU - Nascimento, Maria Salete de Angelis

AU - Reddy, Suresh

AU - Seriaco, Fabiola

AU - Yennu, Sriram

AU - Paiva, Carlos Eduardo

AU - Dev, Rony

AU - Hall, Stacy

AU - Fajardo, Julieta

AU - Bruera, Eduardo

PY - 2014

Y1 - 2014

N2 - 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 (<90%) and positive LR (<5) for impending death. In contrast, apnea periods, Cheyne-Stokes breathing, death rattle, peripheral cyanosis, pulselessness of radial artery, respiration with mandibular movement, and decreased urine output occurred mostly in the last 3 days of life and at lower frequency. Five of these signs had high specificity (>95%) and positive LRs for death within 3 days, including pulselessness of radial artery (positive LR: 15.6; 95% confidence interval [CI]: 13.7-17.4), respiration with mandibular movement (positive LR: 10; 95% CI: 9.1-10.9), decreased urine output (positive LR: 15.2; 95% CI: 13.4-17.1), Cheyne-Stokes breathing (positive LR: 12.4; 95% CI: 10.8-13.9), and death rattle (positive LR: 9; 95% CI: 8.1-9.8). Conclusion. We identified highly specific physical signs associated with death within 3 days among cancer patients.

AB - 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 (<90%) and positive LR (<5) for impending death. In contrast, apnea periods, Cheyne-Stokes breathing, death rattle, peripheral cyanosis, pulselessness of radial artery, respiration with mandibular movement, and decreased urine output occurred mostly in the last 3 days of life and at lower frequency. Five of these signs had high specificity (>95%) and positive LRs for death within 3 days, including pulselessness of radial artery (positive LR: 15.6; 95% confidence interval [CI]: 13.7-17.4), respiration with mandibular movement (positive LR: 10; 95% CI: 9.1-10.9), decreased urine output (positive LR: 15.2; 95% CI: 13.4-17.1), Cheyne-Stokes breathing (positive LR: 12.4; 95% CI: 10.8-13.9), and death rattle (positive LR: 9; 95% CI: 8.1-9.8). Conclusion. We identified highly specific physical signs associated with death within 3 days among cancer patients.

KW - Death

KW - Diagnosis

KW - Neoplasms

KW - Palliative care

KW - Physical examination

KW - Sensitivity

KW - Sign

KW - Specificity

UR - http://www.scopus.com/inward/record.url?scp=84901919075&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84901919075&partnerID=8YFLogxK

U2 - 10.1634/theoncologist.2013-0457

DO - 10.1634/theoncologist.2013-0457

M3 - Article

VL - 19

SP - 681

EP - 687

JO - Oncologist

JF - Oncologist

SN - 1083-7159

IS - 6

ER -