Can we tell when someone with lung cancer who is at the end of life might die?

By analysing the urine of patients, it is possible with high accuracy to determine their likelihood of death, allowing them and their families to better prepare for their end of life and giving clinicians more information on which to decide their care and medication.

Dr Elinor Chapman, a lecturer at Bangor University and honorary research associate at Liverpool University contributed towards a study which showed how metabolic changes taking place within the last 30 days of a patient dying can be measured to give a prediction of death, with accuracy increasing as the time of death nears.

Dr Chapman who leads on teaching cancer case studies to graduate medical students and worked on the research while at Liverpool University said,

“Clinicians tell of how difficult it is to answer patient and loved one’s questions surrounding when someone is going to die, which is vital for giving the best possible care. It was a privilege to bring my scientific background to work on such a novel project, which offers the hope of being able to help with these questions.”

Co-author Dr Seamus Coyle, consultant in palliative medicine at The Clatterbridge Cancer Centre and an Honorary Senior Clinical Lecturer at the University of Liverpool, said,

“Despite decades of cancer research and 5,000 years of medicine, we do not know how cancer kills, and predicting when someone dies of lung cancer is largely down to the judgement of a clinician as there is no accurate test available to determine this.

“By studying volatile organic compounds in urine we have created a model to predict with high probability when these patients will die.

“Knowing when a patient is likely to die is the start of good end of life care and allows for families and patients to plan more accurately and to support their loved one through the dying process. It also better informs clinicians so they can make more appropriate decisions about the patient.”

Urine from 144 lung cancer patients from across Merseyside were analysed to find potential biomarkers for dying. In a series of tests, 37 volatile organic compounds within the urine samples were shown to change to such an extent that significant predictions of death could be made, stratifying patients into having a low, medium and high risk of dying. The results within 30 days were shown to have “excellent” probability values.

Co-author Prof Chris Probert, a consultant gastroenterologist at the Royal Liverpool Hospital and Professor of Gastroenterology at the University of Liverpool, said,

“Nearly 10 million people worldwide died from cancer in 2020 and lung cancer, with the highest mortality, was responsible for 1.8million deaths. Predicting when patients with advanced cancer are likely to die is challenging and no accurate test is available to determine this. However, early recognition that a person may be dying is central to all the priorities for improving peoples’ experience of care in the last days and hours of life.

“This is the first study to use a metabolomics approach to investigate the dying process in the last weeks of life. The findings provide evidence to support the hypothesis that there are specific metabolic changes associated with the dying process in cancer.”

This work was funded by the Wellcome Trust UK and North West Cancer Research UK. The Clinical Research Network: North West Coast provided staff and resource to deliver this study.

The Network’s Clinical Director, Prof Enitan Carrol also commented: “The passing of a loved one is such a difficult time for families and carers. This study is of fundamental importance in helping clinicians to support people and their families in their last few days of life.

“We are grateful to all the researchers, patients and family members who took part to make this possible. We are very proud to see palliative care research from our region making a global impact.”

To read the report, see: https://www.mdpi.com/1422-0067/24/2/1591