A Liverpool doctor has developed a model to predict death after publishing research that could save people from the guilt of not getting to say goodbye.
Dr Séamus Coyle, 53, believes he's just ten years away from developing a bedside test to predict when lung cancer patients will die. As a consultant in palliative medicine at The Clatterbridge Cancer Centre, he's called in to deal with symptoms from treatment at an early stage in patients' care.
He originally specialised in oncology - cancer care - before finding he got "profound satisfaction" from sharing his knowledge with patients and their families, and helping with their symptoms. He told the ECHO: "You cannot change what they're going through, but within that, you can make all the difference and make it easier."
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But there was one thing he didn't know - when they would die. Dr Coyle, originally from Sligo, Ireland, 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.
"What happens is people become unwell, the GP says 'It might be an infection, we'll give them antibiotics'. They're brought in, they're really unwell, their symptoms are worse, and there's that period of uncertainty.
"You go, 'It might be an infection, we don't know what's going on, we think they're unwell, they could be dying, they could be in the last weeks of life'. It's that vague, if you're lucky."
This gap in knowledge sometimes means people die without loved ones around them because they didn't know they were so close to death. Dr Coyle said: "They don't get a chance to say goodbye and that's really important. People live with that kind of guilt for the rest of their life."
He added: "But imagine you had something that says, 'Actually, you're shutting down, your family needs to be here'."
In a paper published in the International Journal of Molecular Sciences, Dr Coyle and other researchers have shown this may be possible by providing evidence of chemical changes in urine in final weeks before people die.
Co-author Professor Chris Probert, a consultant gastroenterologist at the Royal Liverpool Hospital and professor of gastroenterology at the University of Liverpool, described it as "the first study to use a metabolomics approach to investigate the dying process in the last weeks of life".
He 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 people’s experience of care in the last days and hours of life."
The researchers took urine samples from 144 advanced lung cancer patients and measured metabolic changes - associated with chemical processes needed for life - within the last 30 days of dying. Dr Coyle, also an honorary senior clinical lecturer at the University of Liverpool, said: "We look at the components of smell. Basically when you take urine and boil it to 60 degrees, everything that boils off is what's called the volatile organic compound - things you smell."
By studying these volatile organic compounds, they found evidence of "specific metabolic changes associated with the dying process in cancer". From this, they were able to create a model to predict "with high probability" when the patients will die, within four weeks of death. Accuracy increased closer to death.
Such a prediction allows can let people decide whether they die at home, in a hospice or at hospital, and who is with them in their final moments. It also gives "clinicians more information on which to decide their care and medication", according to Clatterbridge.
Dr Coyle said: "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."
By working with a Wirral-based research and development company, Dr Coyle thinks they'll "quite possibly have bedside tests or tests that can be used in a hospital within 10 years".
The next steps include recruiting hundreds of people with lung cancer study assessing whether the test is "robust". A further study will need to explore the ethics and feasibility of rolling out the tests. Dr Coyle believes the same approach can be used to predict death from other causes.
The research was funded by the Wellcome Trust UK and North West Cancer Research UK. Dr Elinor Chapman, an honorary research associate at Liverpool University and lecturer at Bangor University, contributed contributed to the research.
Staff and resources were also delivered by the NIHR Clinical Research Network: North West Coast, where Dr Coyle is lead for palliative care research. The Network's clinical director, Professor Enitan Carrol, said: "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."
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