Cancer Res Treat.  2022 Jul;54(3):631-643. 10.4143/crt.2021.1573.

Prognostication of the Last Days of Life

• Mori M
• Morita T
• Bruera E
• Hui D

• KMID: 2531310
• DOI: http://doi.org/10.4143/crt.2021.1573

Abstract

Accurate prediction of impending death (i.e., last few days of life) is essential for terminally-ill cancer patients and their families. International guidelines state that clinicians should identify patients with impending death, communicate the prognosis with patients and families, help them with their end-of-life decision-making, and provide sufficient symptom palliation. Over the past decade, several national and international studies have been conducted that systematically investigated signs and symptoms of impending death as well as how to communicate such a prognosis effectively with patients and families. In this article, we summarize the current evidence on prognostication and communication regarding the last days of life of patients with cancer, and future directions of clinical research.

Keyword

Prognostication; Impending death; Communication

Figure

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  Fig. 1 A diagnostic model for impending death based on the IPOD study. Late signs included in this recursive partitioning model were: death rattle, respiration with mandibular movement, peripheral cyanosis, Cheyne-Stokes breathing, pulselessness of radial artery, decreased response to verbal stimuli, decreased response to visual stimuli, nonreactive pupils, drooping of nasolabial fold, hyperextension of neck, inability to close eyelids, grunting of vocal cords, and upper gastrointestinal bleed. APCU, acute palliative care unit; IPOD, Investigating the Process of Dying; PPS, Palliative Performance Scale. Reference: Hui et al. Cancer. 2015;121:3914-21 [44].

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  Fig. 2 A diagnostic model for impending death among patients with PPS ≤ 20% based on the EASED study (P3did-DT). A recursive partitioning model for impending death within 3 days in cancer patients who developed PPS ≤ 20% during admission at palliative care units. The entire dataset of 15 clinical signs of 1,396 patients were used for analyses. Clinical signs included in this model were: decreased level of consciousness (RASS ≤ −2), dysphagia of liquids, death rattle, respiration with mandibular movement, peripheral cyanosis, Cheyne-Stokes breathing, pulselessness of radial artery, decreased response to verbal stimuli, decreased response to visual stimuli, apnea periods, drooping of nasolabial fold, hyperextension of neck, inability to close eyelids, grunting of vocal cords, and decreased urine output. EASED, East-Asian cross-cultural collaborative Study to Elucidate the Dying process; P3did-DT, prediction of 3-day impending death-decision tree; PPS, Palliative Performance Scale; RASS, Richmond Agitation-Sedation Scale. Reference: Mori et al. Cancer Med. 2021;10:7988-95 [11].

Reference

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