Terminal lucidity in women with advanced gynecologic cancer: a case series and focused review of the literature

Abstract

Terminal lucidity (TL) is characterized by an unexpected, transient restoration of mental clarity, coherent communication, or purposeful behaviour shortly before death. Although reported in patients with neurodegenerative disorders, psychiatric illness, and pediatric oncology, TL has not previously been described in women with advanced gynaecological malignancies. We retrospectively reviewed 20 consecutive deaths among women with advanced gynaecological cancers at a tertiary gynaecologic oncology centre during 2025. Three patients fulfilled predefined criteria for TL and demonstrated an unexpected return of coherent communication and meaningful interaction following profound cognitive or functional decline. In each case, the episode occurred within 48 hours of death, allowing patients to communicate with family members and express personal wishes. Families uniformly interpreted the episodes as evidence of recovery despite the subsequent rapid clinical deterioration. These observations suggest that TL may occur in advanced gynaecological cancer and shares characteristic features with reports from neurological, palliative care, and pediatric oncology populations. Greater recognition of this phenomenon may facilitate appropriate counselling of families and improve end-of-life care, although prospective studies are needed to better define its incidence, underlying mechanisms, and clinical significance.