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Clinical changes in terminally ill cancer patients and death within 48 h: when should we refer patients to a separate room?

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Abstract

Background

There is scant research concerning the prediction of imminent death, and current studies simply list events “that have already occurred” around 48 h of the death. We sought to determine what events herald the onset of dying process using the length of time from “any change” to death.

Methods

This is a prospective observational study with chart audit. Inclusion criteria were terminal cancer patients who passed away in a palliative care unit. The analysis was limited to 181 patients who had medical records for their final week. Commonly observed events in the terminally ill were determined and their significant changes were defined beforehand. We selected the statistically significant changes by multiple logistic regression analysis and evaluated their predictive values for “death within 48 h.”

Results

The median age was 67 years and there were 103 male patients. After adjusting for age, sex, primary cancer site, metastatic site, and cancer treatment, multiple logistic regression analyses for association between the events and “death within 48 h” revealed some significant changes: confused mental state, decreased blood pressure, increased pulse pressure, low oxygen saturation, death rattle, and decreased conscious level. The events that had higher predictability for death within 48 h were decreased blood pressure and low oxygen saturation, and the positive and negative predictive values of their combination were 95.0 and 81.4 %, respectively.

Conclusion

The most reliable events to predict impending death were decreased blood pressure and low oxygen saturation.

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Acknowledgments

Dr. Hwang was supported by grant no. 10037283 Industrial Strategic Technology Development Program funded by the Ministry of Knowledge Economy, Republic of Korea.

Conflict of interest

We have no conflicts of interest concerning this article. We also have full control of all primary data and agree to allow the journal to review our data if requested.

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Authors and Affiliations

  1. Department of Family Medicine, Gachon University Gil Hospital, 1198 Guwol-dong, Namdong-gu, Incheon, South Korea

    In Cheol Hwang & Kyoung Kon Kim

  2. Department of Statistics, Dongguk University, Seoul, South Korea

    Hong Yup Ahn

  3. Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea

    Sang Min Park

  4. Department of Family Medicine, Yonsei University College of Medicine, Seoul, South Korea

    Jae Yong Shim

Authors
  1. In Cheol Hwang
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  2. Hong Yup Ahn
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  3. Sang Min Park
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  4. Jae Yong Shim
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  5. Kyoung Kon Kim
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Corresponding author

Correspondence to In Cheol Hwang.

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Hwang, I.C., Ahn, H.Y., Park, S.M. et al. Clinical changes in terminally ill cancer patients and death within 48 h: when should we refer patients to a separate room?. Support Care Cancer 21, 835–840 (2013). https://doi.org/10.1007/s00520-012-1587-4

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  • DOI: https://doi.org/10.1007/s00520-012-1587-4

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