Utilising existing community-based supportive care and aged care resources for older patients with cancer—Updated results of the Care Coordination in the Older Adult with Cancer (CCOAC) project

Abstract

Purpose of the Study: The management of malignant wounds is a challenge for the supportive care team. Patients have an impaired quality of life due to the presence of the skin lesion. The discomfort related to odour, pain, risk of infection and bleeding is frequently observed in this type of wound. The goal of the wound care (curative or palliative) depends on the patient's response to anticancer treatments and the surgical possibilities, sometimes limited in geriatric oncology. The odours due to necrosis and microbial flora especially impact the distress for patients, families and caregivers. Objectives: The objectives of this study are to investigate the bacterial profile of malignant breast cancer wounds and suggest the most appropriate approach to manage two important symptoms: the odours and the risk of infection. Methods: Followed case studies of malignant wounds of older patients and compared the clinical aspect and impact with the results of the bacterial flora. Results and Discussion: Many antimicrobial products and antibiotics are proposed to reduce the growth of bacteria and the odours, but there is no evidence of their efficiencies (except metronidazole), and potential adverse effects. Only very few studies exist. In our experience, the malignant wounds were colonised by multiple bacterial species and the most common resident were Staphylococcus aureus andPseudomonas aeruginosa. The anaerobic bacteriawere present inmany cases (e.g.: Peptostreptococcus, Fusobacteriumnecrophorum). The odours seem dependent of: the number of bacteria, the presence of anaerobic germs and special bacteria like Proteus mirabilis or Peptostreptococcus. Antimicrobial dressings seemed to be inefficient and charcoal dressing completely controls odours in only 50% of cases. Conclusions: Contrary to other chronic wounds, malignant wounds are under the influence of the progression of the cancer and the effects of the treatments (e.g.: chemotherapy/aplasia). Our findings suggest that planktonic bacteria, biofilm, and bacterial volatiles interact in dynamic context. No one dressing could control odours and colonisation, so it is necessary to know, use and adapt all the products and wound care to each situation, in order to limit the prescription of antibiotics. Moreover, peculiarities of this elderly population must be considered: frequency of dressings, inpatient or outpatient, comorbidities, and personal hygiene. A multidisciplinary cooperation between the geriatrician, the oncologist and the nurses is essential.