Identifying Signs of Impending Death in Cancer Patients

Eight signs now identified.

The evidence base for identifying signs of impending death among people with cancer is limited. Researchers at The University of Texas MD Anderson Cancer Center in Houston, TX and Barretos Cancer Hospital (an MD Anderson affiliated hospital in Brazil) conducted a prospective study to identify specific physical and cognitive signs associated with imminent death. They observed 357 patients with cancer admitted to palliative care units, and observed the deaths of 57% of these patients. A total of 52 physical and cognitive signs identified in previous research were assessed twice a day from the time of the patient's admission to discharge or death. Of those 52 signs, eight were more highly associated with impending death within three days. These signs include are nonreactive pupils; decreased response to verbal stimuli; decreased response to visual stimuli; inability to close eyelids; drooping of the nasolabial fold; neck hyperextension; grunting of vocal cords; and upper gastrointestinal bleeding.

These signs are well recognized by nurses, and my experience concurs with their findings. The researchers hope that better understanding signs and symptoms of impending death can guide decision making, such as discontinuing treatment, planning for hospice referral, and ultimately, planning for death of the patient.


Hui D, dos Santos R, Chisholm G et al. Bedside clinical signs associated with impending death in patients with advanced cancer: Preliminary findings of a prospective, longitudinal cohort study. Cancer 2015; published online before print 2/9/15, DOI: 10.1002/cncr.29048.

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