ArticleThe oncologist2014
Clinical signs of impending death in cancer patients.
Registry-linked trialOpen access · bronzeAbstract read
In one paragraph
Article in The oncologist, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04779567 (Randomized Double-blind Controlled Study to Assess the Efficacy of Intravenous Acetaminophen Associated With Strong Opioids in the Management of Acute Pain in Adult Cancer Patients), which is not on this map. Cited by 81 papers, 4 of them syntheses that pooled it.
0numbers the graph read from it
0cells of the map it votes in
81citing papers in PubMed, 4 pooled it
8.7field-weighted citation impact, top 2% of its field
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Randomized Double-blind Controlled Study to Assess the Efficacy of Intravenous Acetaminophen Associated With Strong Opioids in the Management of Acute Pain in Adult Cancer Patients
Who cites it
81 citing papers in PubMed, 4 syntheses or guidelines pooled it, 231 citations in OpenAlex.
- Prognostic evaluation in patients with advanced cancer in the last months of life: ESMO Clinical Practice Guideline.ESMO open · 2023Guideline
- What is the impact of clinically assisted hydration in the last days of life? A systematic literature review and narrative synthesis.BMJ supportive & palliative care · 2021Pooled it
- Identification and evaluation of observational measures for the assessment and/or monitoring of level of consciousness in adult palliative care patients: A systematic review for I-CAN-CARE.Palliative medicine · 2020Pooled it
- Oropharyngeal Dysphagia Evaluation Tools in Adults with Solid Malignancies Outside the Head and Neck and Upper GI Tract: A Systematic Review.Dysphagia · 2018Pooled it
- Clinical features of audible upper airway secretions ("death rattle") in patients with cancer in the last days of life.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2024Trial
- Characteristics and patient-reported outcomes associated with dropout in severely affected oncological patients: an exploratory study.BMC medical research methodology · 2021Trial
- Association Between Plasma Brain Natriuretic Peptide and Overall Survival in Patients With Advanced Cancer: Preliminary Findings.Journal of pain and symptom management · 2019Trial
- Abdominal CT findings on the day of death in patients with solid organ malignancies.Abdominal radiology (New York) · 2026Article
- Translation, cross-cultural adaptation and preliminary psychometric evaluation of the Victoria Respiratory Congestion Scale into Spanish.BMC palliative care · 2026Article
- Prediction of 48-h Intensive Care Unit Mortality in Hospitalized Cancer Patients: Performance of the EPIC Deterioration Index and Sequential Organ Failure Assessment Score.Journal of intensive care medicine · 2026Article
- Challenges in the End-of-Life Care for Patients With Severe Persistent Mental Illness: A Case Series.Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society · 2026Article
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- Longitudinal changes in delirium motor subtypes among patients with advanced cancer in inpatient hospice and palliative care units: A secondary analysis of a multicenter cohort study.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2025Observational
- Health Outcomes and Symptom Intensity Over Time among Cancer Patients Receiving Palliative Care in Vietnam: A Prospective Cohort Study.Asian Pacific journal of cancer prevention : APJCP · 2025Article
- Nursing contribution to end-of-life care decision-making in patients with neurological diseases on an acute hospital ward: documentation of signs and symptoms.BMC nursing · 2025Article
- Prognostic factors and development of the practical prediction score for 7-day mortality of palliative patients in the emergency department.Scientific reports · 2025Article
- Pharmacological Strategies for Providing Patients With Delirium Relief From Terminal Dyspnea: A Secondary Data Analysis.Cancer medicine · 2025Observational
- Upper arm movements in the last days of life: A new possible sign of impending death.Palliative & supportive care · 2025Article
- Determining timeframes to death for imminently dying patients: a retrospective cohort study.BMC palliative care · 2025Article
21 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
20 authors at 4 institutions in 3 countries.
David HuiDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil; Division of Biostatistics, University of Texas Health Science Center at Houston, Houston, Texas, USA; Programa Medicina Paliativa, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile dhui@mdanderson.org.
Renata dos SantosDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil; Division of Biostatistics, University of Texas Health Science Center at Houston, Houston, Texas, USA; Programa Medicina Paliativa, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Gary ChisholmDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil; Division of Biostatistics, University of Texas Health Science Center at Houston, Houston, Texas, USA; Programa Medicina Paliativa, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Swati BansalDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil; Division of Biostatistics, University of Texas Health Science Center at Houston, Houston, Texas, USA; Programa Medicina Paliativa, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Thiago Buosi SilvaDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil; Division of Biostatistics, University of Texas Health Science Center at Houston, Houston, Texas, USA; Programa Medicina Paliativa, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Kelly KilgoreDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil; Division of Biostatistics, University of Texas Health Science Center at Houston, Houston, Texas, USA; Programa Medicina Paliativa, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Camila Souza CrovadorDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil; Division of Biostatistics, University of Texas Health Science Center at Houston, Houston, Texas, USA; Programa Medicina Paliativa, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Xiaoying YuDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil; Division of Biostatistics, University of Texas Health Science Center at Houston, Houston, Texas, USA; Programa Medicina Paliativa, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Michael D SwartzDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil; Division of Biostatistics, University of Texas Health Science Center at Houston, Houston, Texas, USA; Programa Medicina Paliativa, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Pedro Emilio Perez-CruzDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil; Division of Biostatistics, University of Texas Health Science Center at Houston, Houston, Texas, USA; Programa Medicina Paliativa, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Raphael de Almeida LeiteDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil; Division of Biostatistics, University of Texas Health Science Center at Houston, Houston, Texas, USA; Programa Medicina Paliativa, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Maria Salete de Angelis NascimentoDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil; Division of Biostatistics, University of Texas Health Science Center at Houston, Houston, Texas, USA; Programa Medicina Paliativa, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Suresh ReddyDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil; Division of Biostatistics, University of Texas Health Science Center at Houston, Houston, Texas, USA; Programa Medicina Paliativa, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Fabiola SeriacoDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil; Division of Biostatistics, University of Texas Health Science Center at Houston, Houston, Texas, USA; Programa Medicina Paliativa, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Sriram YennuDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil; Division of Biostatistics, University of Texas Health Science Center at Houston, Houston, Texas, USA; Programa Medicina Paliativa, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Carlos Eduardo PaivaDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil; Division of Biostatistics, University of Texas Health Science Center at Houston, Houston, Texas, USA; Programa Medicina Paliativa, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Rony DevDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil; Division of Biostatistics, University of Texas Health Science Center at Houston, Houston, Texas, USA; Programa Medicina Paliativa, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Stacy HallDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil; Division of Biostatistics, University of Texas Health Science Center at Houston, Houston, Texas, USA; Programa Medicina Paliativa, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Julieta FajardoDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil; Division of Biostatistics, University of Texas Health Science Center at Houston, Houston, Texas, USA; Programa Medicina Paliativa, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Eduardo BrueraDepartments of Palliative Care and Rehabilitation Medicine and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Palliative Care, Barretos Cancer Hospital, Barretos, Brazil; Division of Biostatistics, University of Texas Health Science Center at Houston, Houston, Texas, USA; Programa Medicina Paliativa, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.
The University of Texas MD Anderson Cancer Center · USHospital de Câncer de Barretos · BRThe University of Texas Health Science Center at Houston · USPontificia Universidad Católica de Chile · CL
Funding
Tumor Evolution and Metastasis ProgramP30CA016672 · NCI · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI Kathrin Milbury · 1985 to 2026
$290.8MParenteral Hydration in Advanced Cancer Patients: A Randomized Controlled TrialR01CA122292 · NCI · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI BRUERA, EDUARDO · 2006 to 2009
$2.2MMethylphenidate for Fatigue in Advanced Cancer PatientsR01NR010162 · NINR · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI BRUERA, EDUARDO · 2006 to 2009
$1.3MMorphine versus Methadone as First Line Strong Opioid for Cancer PainR01CA124481 · NCI · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI BRUERA, EDUARDO · 2007 to 2009
$1.2MNCI NIH HHS CA 016672NCI NIH HHS P30 CA016672NCI NIH HHS R01 CA122292NCI NIH HHS R01CA122292-01NCI NIH HHS R01 CA124481NCI NIH HHS R01CA124481-01NINR NIH HHS R01 NR010162NINR NIH HHS R01NR010162-01A1
Abstract
backgroundThe 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.
methodsWe 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.
resultsIn 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 (<90%) and positive LR (<5) for impending death. In contrast, apnea periods, Cheyne-Stokes breathing, death rattle, peripheral cyanosis, pulselessness of radial artery, respiration with mandibular movement, and decreased urine output occurred mostly in the last 3 days of life and at lower frequency. Five of these signs had high 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).
conclusionWe identified highly specific physical signs associated with death within 3 days among cancer patients.
Indexed as
DeathPhysical ExaminationHumansNeoplasmsPalliative CarePatientsDeathDiagnosisNeoplasmsPalliative carePhysical examinationSensitivitySignsSpecificity
Identifiers
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Registered trials
NCT04779567ClinicalTrials.gov
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.