Clinical Signs of Impending Death in Cancer Patients
| Autor: | Raphael de Almeida Leite, Rony Dev, Pedro Emilio Perez-Cruz, Julieta Fajardo, Eduardo Bruera, Sriram Yennu, Fabiola de Lourdes Gonõaves de Freitas Seriaco, Kelly Kilgore, Camila Souza Crovador, Stacy Hall, Gary B. Chisholm, Michael D. Swartz, Maria Salete de Angelis Nascimento, Xiaoying Yu, Suresh K. Reddy, Carlos Eduardo Paiva, Renata dos Santos, Swati Bansal, David Hui, Thiago Buosi Silva |
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| Rok vydání: | 2014 |
| Předmět: |
Cancer Research
medicine.medical_specialty Palliative care Patients Physical examination Neoplasms Internal medicine Humans Medicine Death rattle Physical Examination medicine.diagnostic_test business.industry Palliative Care Cancer Apnea medicine.disease Dysphagia Confidence interval Surgery Death Oncology Symptom Management and Supportive Care Breathing medicine.symptom business |
| Zdroj: | The Oncologist. 19:681-687 |
| ISSN: | 1549-490X 1083-7159 |
| DOI: | 10.1634/theoncologist.2013-0457 |
| Popis: | 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 (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. |
| Databáze: | OpenAIRE |
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