End-Stage Cancer Patients Diagnosed with a Femoral Pathological Fracture on Admission to Palliative Care Units.

Background: Femoral pathological fractures (PFs) due to bone metastasis result in exacerbation of pain, gait disturbance, and reduced general condition. Surgery may be considered depending on the situation, but is not suggested often, and treatment is difficult toward the end of life. Objective: Terminal cancer patients with a femoral PF admitted to a palliative care unit (PCU) were retrospectively evaluated. Measurement: Seven cancer patients diagnosed with a femoral PF at a PCU on admission, in Japan, were examined for clinical background, physical symptoms, and psychiatric symptoms. In addition, the responses of the patients' families and medical staff were examined. This study was approved by the ethics board of our hospital. Results: A total of 28.6% of patients were hospitalized from home, and the trigger for PF could not be confirmed in 85.7% of patients. In all cases, surgery was not recommended, given the poor prognosis. Opioid drugs were used for pain in all patients, and 85.7% of patients were able to relieve their symptoms. Delirium was observed in 71.4% of cases, and treatment with antipsychotics was required in all cases. Family grief also emerged as a problem, and the staff was burdened; hence, we addressed this at the death conference. Conclusions: Even for femoral PFs in cancer patients with a limited prognosis, it is necessary to perform tests and control pain. In addition, it is important to support the mental distress of patients and their families in a short period; medical staff should be trained to support the families after the patients' death.