Caregiver & Elder Care News
Eight signs of impending death of cancer patients
identified to help caretakers
May aid caretakers, physicians to
prepare, help patients, families make difficult personal decisions
9, 2015 – Death is an unpleasant subject but its inevitability has
become well recognized by the time we reach our senior years. It is
something most senior citizens have had to deal with up close and
personal. A new study in the journal Cancer that identifies the eight
highly specific physical and cognitive signs associated with imminent
death in cancer patients. Their goal is to help clinicians and
caretakers who are often responsible for communicating with the families
of the dying and helping make key decisions.
The findings by researchers at The
University of Texas MD Anderson Cancer Center - published in the journal
Cancer - could offer clinicians the ability to better communicate
with patients and families. They may also guide both the medical team
and caregivers on complex decision making, such as discontinuation of
tests and therapy, plans for hospital discharge and hospice referral.
Previous studies in end-of-life
care have focused on physicians prognosticating better. However,
according to David Hui, M.D., assistant professor, Palliative Care and
Rehabilitation Medicine, research on how to tell if a patient has
entered the final days of life has been minimal. Knowing with a high
degree of confidence that death is imminent could have significant
implications for clinical practice. It may also help families and
caregivers make more informed decisions.
"In the past, studies trying to
understand the signs associated with impending death were conducted in
people who were recognized as dying, so there's a potential bias built
into this model. With our study, we observed a list of signs in patients
from the time they were admitted to the palliative care unit. They were
observed systematically, twice a day, without knowing if the patient
would die or be discharged," says Hui, the study's corresponding author.
The study shows that very simple
observations by doctors and care teams can help make a very important
diagnosis and may inform both the patient and the family so that they
can make difficult personal decisions, he explained.
For the prospective study, Hui and
colleagues at MD Anderson and Barretos Cancer Hospital (an MD Anderson
Sister Institution in Brazil) observed 357 cancer patients admitted to
the respective palliative care units, of which 57 percent ultimately
The researchers systematically
observed 52 physical and cognitive signs -- identified by Hui and
colleagues in previous research -- twice a day from the patient's
admission to discharge or death. Of those 52 signs, the researchers
identified the eight most highly associated with impending death within
● nonreactive pupils;
● decreased response to verbal stimuli;
● decreased response to visual stimuli;
● inability to close eyelids;
● drooping of the nasolabial fold (commonly
known as "smile lines");
● neck hyperextension;
● grunting of vocal cords; and
● upper gastrointestinal bleeding.
"When cancer patients reach the
last days of life, this is an extremely emotional time for families -
their stress levels cannot be understated," says Hui.
"Knowing when death is imminent
would provide more information so caregivers can plan appropriately. For
clinicians, having this information could help reassure families that we
are providing the best care possible."
Hui stresses that this research is
not yet practice-changing, but is an important step in understanding
these eight signs and their relation to impending death. Also, says Hui,
the findings are only representative of imminent cancer death and should
not be generalized to other causes of death.
Follow up studies in different
settings are planned: Hui and colleagues will look at the reliability of
the identified signs, as well as evaluate this research in other
countries and in the hospice setting.
In addition to Hui, other authors
on the study include: from MD Anderson, Eduardo Bruera, M.D., professor
and chair, and Swati Bansal, both of Palliative Care and Rehabilitation
Medicine; and Gary Chisholm, Biostatistics. From Barretos Cancer
Hospital, authors include: Renata dos Santos, M.D., and Camila Souza