Temporal distribution of deaths in cancer patients admitted to a palliative care unit

The timing of death has received much attention, particularly in the area o f sudden cardiac death. Many studies have demonstrated that sudden cardiac death and other sudden deaths follow a circadian pattern. Deaths have also been reported to vary around dates that are especially meaningful to patien ts and families. To test these reported observations in a cancer palliative care population, we reviewed the date and time of death of 626 consecutive patients admitted to the palliative care unit of a western Canadian hospit al. All patients were adults with advanced metastatic or locally recurrent cancer. A circadian distribution in the time of deaths was observed; 225 de aths occurred between 20:00 and 06:00 (261 deaths expected) versus 401 deat hs between 06:00 and 20:00 (365 deaths expected) (p=0.0037). The distributi on of deaths did not change significantly according to day of the week or m onth of the year. Based on patient birthday, 41 deaths occurred during the three weeks before a birthday (33.5 deaths expected) versus 26 deaths durin g the three weeks after a birthday (33.5 deaths expected) (p=0.067). There appear to be fewer deaths during the evening and night; there does not appe ar to be a decline in deaths before the patient's birthday; and any tempora l distribution of deaths in this population appears to be minimal.