Your browser is no longer supported

For the best possible experience using our website we recommend you upgrade to a newer version or another browser.

Your browser appears to have cookies disabled. For the best experience of this website, please enable cookies in your browser

We'll assume we have your consent to use cookies, for example so you won't need to log in each time you visit our site.
Learn more

Eight signs ‘can predict’ impending death in cancer patients


Researchers say they have identified eight highly specific physical signs that are associated with death within three days in cancer patients.

They highlight that while the diagnosis of an impending death is “always sad”, identifying when it is likely can be important for clinicians planning discharge, hospice referral and treatment.

They also noted that very few studies had examined the signs of impending death, making it difficult for healthcare professionals to make a diagnosis with confidence and to communicate this with the family.

“Simple bedside observations can potentially help us to recognize if a patient has entered the final days of life”

David Hui

The University of Texas study recorded the physical changes in the final days of life in 357 cancer patients who were admitted to acute palliative care units in two cancer centres – one in the US and one in Brazil.

The study authors documented 52 physical signs every 12 hours from admission to death or discharge. During the study, 57% of the patients died.

They identified eight bedside physical signs that, if present, strongly suggest that a patient will die within three days.

These are non-reactive pupils, decreased response to verbal stimuli, decreased response to visual stimuli, inability to close eyelids, drooping of the nasolabial fold, hyperextension of the neck, grunting of vocal cords, and upper gastrointestinal bleed.

These signs may help nurses and doctors to make the diagnosis of impending death, they said online in the journal Cancer.

“This study shows that simple bedside observations can potentially help us to recognize if a patient has entered the final days of life,” said lead author Dr David Hui.

“Upon further confirmation of the usefulness of these ‘tell-tale’ signs, we will be able to help doctors, nurses, and families to better recognize the dying process, and in turn, to provide better care for the patients in the final days of life,” he added.

The researchers are in the process of validating their results to see if they hold true in other healthcare settings, such as the home and inpatient hospices.


Eight bedside signs that strongly suggest a patient will die within three days

Non-reactive pupils

Decreased response to verbal stimuli

Decreased response to visual stimuli

Inability to close eyelids

Drooping of the nasolabial fold (which makes the face appear more relaxed)

Hyperextension of the neck (in which the head tilts back when the patient is lying down)

Grunting of vocal cords

Upper gastrointestinal bleed


Readers' comments (2)

  • The extreme physical signs mentioned in the article I would feel is fairly obvious to deduce from an experienced nurses perspective!! that death is imminent. I would imagine the other 43% were within the next 12 hours. But anything that can help provide clarity to staff communicating with families, especially when they are in denial phase of grieving process, can only be a useful tool. But delicate timely handling around this time will always be incredibly difficult. On a personal level my dealings with our local hospice were fantastic and every town should have one. Having only ever experienced death , in a professional capacity in a hosp setting. Despite trying to enable the most dignified outcomes hosp is really not the place fpr end stage care.

    Unsuitable or offensive? Report this comment

  • Pussy

    Who would have thought it?

    Unsuitable or offensive? Report this comment

Have your say

You must sign in to make a comment

Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions. Links may be included in your comments but HTML is not permitted.