Clinical Signs of Impending Death in Cancer Patients (DRAFT)

Abstract

In this prospective, longitudinal, cohort study, the authors systematically characterized the frequency, onset, and diagnostic performance of 62 clinical signs for impending death in 357 advanced cancer patients admitted to two acute palliative care units. “Early signs” (e.g., Palliative Performance Scale <20%, Richmond Agitation Sedation Scale ≤–2) had a high frequency over the last 3 days but low positive predictive ratios (LRs) for impending death within 3 days. In contract, “late signs” (e.g., death rattle, respiration with mandibular movement, peripheral cyanosis) had a low frequency but high specificity and high positive LR. In addition, seven neurological signs (e.g., decreased response to verbal stimuli, drooping of nasolabial fold, grunting of vocal cords) and upper gastrointestinal bleeding had high positive LRs for impending death within 3 days. Upon further validation, these signs may assist clinicians in formulating the diagnosis of impending death and patients and families in preparing ahead.