SymptomManagement and Supportive Care Clinical Signs of Impending Death in Cancer Patients

Background. The physical signs of impending death have not been well characterized in cancer patients. A better under-standing 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 fromdeath backward and calculated their likelihood ratios (LRs) associatedwith deathwithin 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