Malignant Fungating Wounds Research Articles

Factors Contributing to Bleeding in Breast Cancer Wounds: A Literature Review

Aims: In Indonesia, breast cancer ranks first in the number of new cases; there is a significant increase in the number of cases every year. Complications of breast cancer include bleeding that affects quality of life, psychology, activity limitations, anemia, increased treatment time, economic burden, and the threat of death. Breast cancer is often found in advanced stages, increasing the risk of bleeding. The literature review analyzes research articles that discuss factors associated with breast cancer wound bleeding. Methods: Inclusion criteria include articles discussing breast cancer bleeding, cancer in general, cancer wounds, themes relevant to research, research can be a quantitative, qualitative, mixed method, meta-analysis, in English and Indonesian, from 2013 to 2023, full text. Keywords in the database are "risk factors," bleeding, breast cancer, and malignant wound. Literature searches use journal databases, namely Pubmed and ScienceDirect. This research uses the author's literature review method to analyze, evaluate, and criticize published research results. Results: Fifteen articles met the inclusion criteria, most of them retrospective, examining factors of anticoagulation therapy on breast cancer bleeding, articles examining bleeding factors in several types of cancer, and five articles examining factors of post-operative breast cancer bleeding. Conclusion: Breast cancer wound bleeding factors are chemotherapy, radiation, comorbidities, malignant fungating wounds, BMI≥40, dressings, thrombocytopenia, reconstructive surgery, advanced stage, infection, and therapy (anticoagulants, anti-inflammatory pain relief, NSAIDs). Suggestions for further research are analyzing various bleeding factors, examining which factors are most related to bleeding, and looking at the pattern of relationships between several factors in bleeding.

Improving malignant fungating wound management among oncology nurses: a best practice implementation project.

Appropriate malignant fungating wound (MFW) care is challenging for oncology nurses, leading to increased stress, compromised care quality, and poor patient outcomes. This study aimed to address best practice barriers and develop evidence-based guidelines for MFW care. This project was guided by the JBI Evidence Implementation Framework, which follows a seven-phase process. Both nurses' skills and patient charts were audited to determine compliance with best practices for comprehensive MFW assessment, wound photo records, use of validated wound assessment tools, appropriate wound care, and patient pain and satisfaction. Bandura's social learning theory was used to guide the development of an online education program and an objective structured clinical examination for skill improvement to prompt behavior change in nurses. A follow-up audit was conducted to measure improvements in knowledge, skills, and self-efficacy among nurses to validate the effectiveness of the intervention. The project resulted in improvements in all four evidence-based practice criteria: (1) comprehensive MFW assessments increased from 27% to 98%; (2) the inclusion of wound photos in medical records increased from 50% to 100%; (3) use of a validated wound assessment tool increased from 0% to 100%; and (4) appropriate interventions to manage wounds and maintain patients' quality of life increased from 50% to 90%. The project integrated a flexible education program, multidisciplinary collaboration, and leadership support to empower nurses to effectively manage MFWs. In addition, Bandura's social learning theory was used to influence nurses' behavior and bring about sustainable changes to organizational culture and practices. http://links.lww.com/IJEBH/A205.

A survey of UK nurses about their care of people with malignant fungating wounds

PurposeTo gain an understanding of the nursing professionals who treat people with malignant fungating wounds (MFW) in the UK and their current practices, including perceived barriers and facilitators to providing MFW care. MethodAn online anonymous questionnaire was created with questions about the role of nursing professionals who reported caring for patients with MFW, the number of people with MFW they regularly cared for, treatment aims, treatments used, and challenges faced. These questions were developed with professional input and piloted. Using a convenience sampling method, we collected responses from UK nurses by distributing the questionnaire via social media and through relevant professional organisations. The questionnaire was constructed in QualtricsXM software and analysed using SPSS. ResultWe received 154 questionnaire responses, with three-quarters from tissue viability nurses and the rest from community and other specialist nurses. The most important treatment aim reported was pain management, followed by odour management. Almost all respondents used antimicrobial and standard dressings for these patients, with a range of products reported. Poor access to MFW care training and lack of local and national guidelines were reported as barriers to providing care for people with MFW. Availability of dressings, access to training, and good communication processes were reported as facilitators. ConclusionThis is the first study to explore MFW wound care practices in the UK. A range of nurses are involved in care delivery with variations in the treatments used. Lack of access to MFW care training, resources, and standardised guidelines may impede care delivery.

“Maintain Professionalism”: Nurses’ Experiences in Caring for Patients with Malignant Fungating Wounds in Taiwan

ContextMalignant fungating wounds (MFWs) occur among 5%–15% of patients with terminal cancers, the uncontrollable symptoms result in serious psychosocial issues, thereby reducing the quality of life. Caring for MFWs impacts caregivers, including healthcare personnel. While existing studies are patient-focused, the impact of care experiences and associated support for nurses has not been examined. ObjectivesTo explore the experiences in caring for patients with MFWs among nurses in Taiwan. MethodsQualitative study with a phenomenological approach by thematic analysis was conducted with semi-structured interviews. About 15 nurses who cared for patients with MFWs at local district hospitals in Southern Taiwan. ResultsFour themes were identified to describe the phenomenon: (1) Fear of Unpredictability (2) Maintaining Professionalism (3) Feeling Helpless (4) Rationalizing the Negatives. The themes illustrated the distress of managing physical symptoms and highlighted how nurses strived to promote comfort for patients. Nurses felt helpless about the incurable nature of MFWs but found a way to suppress their feelings. ConclusionThe findings suggested the need for addressing the emotional well-being of nurses who take care of patients with MFWs. Future studies should identify effective coping strategies for nurses’ health when caring for this population.

Changes in wound symptoms and quality of life of patients with newly diagnosed malignant fungating wounds.

This study examined changes in wound symptoms and the health-related quality of life (HRQoL) of patients with newly diagnosed malignant fungating wounds, and explored the factors that impacted the changes in HRQoL. This prospective longitudinal study included patients from three hospitals in China who had been diagnosed with malignant fungating wounds. Questionnaires were used to assess patients' HRQoL and their wound symptoms at the time of diagnosis (T0), as well as at one, three and six (T1, T2 and T3, respectively) months following the treatment period. Factors related to changes in HRQoL were analysed using generalised estimating equation models. A total of 162 patients were included in the study. The patients reported low overall HRQoL. In three health-related dimensions (functional status, social relations and mental health), patients reported lower functional status at the time of wound diagnosis (T0), which then increased slowly with treatment over time. A lower QoL was associated with odour, exudate, bleeding, pruritus, a low performance status and the need for the dressing of wounds. The HRQoL of patients with malignant fungating wounds exhibited significant changes across different periods. It is thus of great importance to formulate pragmatic, patient and family-centred palliative wound care management strategies.

Caring for Patients With Malignant Fungating Wounds: A Scoping Literature Review.

The aim of this scoping literature review was to identify current knowledge related to management of malignant fungating wounds (MFWs), gaps in this knowledge, and areas for future research. This was a scoping literature review. Six electronic databases (Embase, MEDLINE, Cochrane (CENTRAL), CINAHL, Scopus, and Web of Science) were searched spanning the years 1987 and 2022. The initial electronic database search retrieved 6041 studies. The search is based on 60 articles published between 1987 and 2022, along with 14 additional studies were based on search of reference lists of key articles. Studies were divided into 2 main domains; the vast majority (65 of 72, 87.8%) focused on symptom impact, measurement, and management. The remaining articles (n = 9, 12.2%) focused on caring for patients with MFW; these studies focused on nursing care experiences and competencies, along with lay caregiver experiences. Findings indicated that instruments have been developed to evaluate symptoms of MFW but only a few have been validated. Most of the studies reviewed evaluated the influence of MFW on physical and psychosocial function. Local and systematic symptom managements such as modern dressings, wound care strategies, surgery, and radiotherapy as well as chemotherapy were found to be effective in alleviating symptoms. Findings also indicated that families and nurses encounter obstacles and burdens when caring for patients with MFW; limited studies were retrieved that investigated the competence and needs of nurses in their caring journey. Future studies should focus on: (1) using better designs to evaluate and compare topical agents and dressings to control odor, (2) validating assessment tools specific to MFW, (3) qualitative studies designed to enhance understanding family and nurses' experiences, and (4) improving the nurse's ability to care for patients with MFWs and their responses to managing these challenging patients.

Caring for Patients With Malignant Fungating Wounds: A Scoping Literature Review.

Caring for Patients With Malignant Fungating Wounds: A Scoping Literature Review.

Therapeutic Management of Malignant Wounds: An Update.

Malignant fungating wounds (MFW) are severe skin conditions generating tremendous distress in oncological patients with advanced cancer stages because of pain, malodor, exudation, pruritus, inflammation, edema, and bleeding. The classical therapeutic approaches such as surgery, opioids, antimicrobials, and application of different wound dressings are failing in handling pain, odor, and infection control, thus urgently requiring the development of alternative strategies. The aim of this review was to provide an update on the current therapeutic strategies and the perspectives on developing novel alternatives for better malignant wound management. The last decade screened literature evidenced an increasing interest in developing natural treatment alternatives based on beehive, plant extracts, pure vegetal compounds, and bacteriocins. Promising therapeutics can also be envisaged by involving nanotechnology due to either intrinsic biological activities or drug delivery properties of nanomaterials. Despite recent progress in the field of malignant wound care, the literature is still mainly based on in vitro and in vivo studies on small animal models, while the case reports and clinical trials (less than 10 and only one providing public results) remain scarce. Some innovative treatment approaches are used in clinical practice without prior extensive testing in fungating wound patients. Extensive research is urgently needed to fill this knowledge gap and translate the identified promising therapeutic approaches to more advanced testing stages toward creating multidimensional wound care strategies.

Management of malignant cutaneous wounds in oncologic patients

PurposeNeoplastic wounds may develop as a result of primary tumor growth in the skin, due to metastasis, or due to skin invasion by tumors emerging from deeper levels. Malignant wounds may present as a crater-like ulcer, or as raised nodules with a cauliflower-like appearance. They are associated with malodor, necrosis, pain, bleeding, and secondary infection. The aim of our study is to better characterize fungating wounds and their management.MethodsWe retrospectively reviewed the database of the Wound Care Unit of the University of Bologna in order to identify individuals affected by neoplastic wound, between January 2019 and February 2021.ResultsWe identified 9 females and 2 males with a mean age of 63 years; all were referred by the Oncology Unit. Management differed depending on the characteristics of the patients and the ulcers. Complete healing of the wound, following the parallel complete remission of the lymphoproliferative neoplasia, was observed in one individual. Among the others, one died because of breast cancer, while cutaneous lesions in 2 individuals deteriorated after 1 year of follow-up. Remission/relapse of the ulcer following the treatment course administered for the lymphoma were observed in one patient.ConclusionsTreatment of malignant fungating wounds is challenging. Considering the neoplastic nature of the wounds, complete healing or improvement cannot be expected with the application of classically prescribed dressing for wounds. A mostly palliative treatment, focusing on maintaining the patient’s quality of life, is a reasonable choice.

The Effectiveness of Topical Metronidazole Management for Malignant Fungating Wound Odor: Nursing Perspective

The Effectiveness of Topical Metronidazole Management for Malignant Fungating Wound Odor: Nursing Perspective

Malignant Fungating Wounds of the Head and Neck: Management and Antibiotic Stewardship.

ObjectiveMalignant fungating wounds (MFWs) are unfortunate and underreported manifestations of some advanced head and neck cancers. The management of MFWs is complex and challenging. MFWs are often mistaken for infectious processes/abscesses and treated indiscriminately with oral or intravenous antibiotics. Our aim is to promote awareness of MFWs and provide education on their management. We summarize their cost-effective and evidence-based therapies and highlight antibiotic stewardship with respect to their management.Data SourcesA literature review was performed of PubMed, Cochrane Review, SCOPUS, Embase, and Google Scholar databases regarding topical and systemic treatments for MFWs.Review MethodsFull-text articles were identified with the following terms: fungating, ulcerative, wound, tumor, malignancy, antibiotics, topical, dressings, radiotherapy, head, neck, scalp, face, lip, and ear. Treatment recommendations were extrapolated, categorically summarized, and retrospectively assigned with an evidence level based on the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation).ConclusionsIn the absence of systemic signs and symptoms of infections, MFWs should not be treated as conventional infections or abscesses, with prophylactic oral or intravenous antibiotics. Topical treatments such as ointments and wound dressings are the mainstay in terms of managing the unsightly appearance and fetid odor from these entities.Implications for PracticeMFWs are most often not amenable to definitive/curative surgical or nonsurgical therapy, but consultation with a head and neck oncologic specialist will help to determine if the underlying malignancy requires surgery, radiation therapy, or palliative treatment.

Life Experience of Breast Cancer Patients with Malignant Fungating Wounds

Life Experience of Breast Cancer Patients with Malignant Fungating Wounds

Efficacy of dispersed fibrous carbon sorbent in treatment of malignant fungating wounds.

To evaluate the influence of dispersed fibrous carbon sorbent (DFCS) on malignant fungating wounds (MFWs) in Guerin's carcinoma-bearing rats with an assessment of wound bacterial microflora. The study was performed on female Wistar rats inoculated subcutaneously with Guerin T8carcinoma into the upper interscapular region. On day 20, the tumors were infected by injecting the suspension of S. aureus 8325-4. After 24h, gauze dressings were applied daily to the wounds in the control group and DFCS in the experimental one. The state of the wounds was assessed by visual control with photo monitoring, odor control on a verbal rating scale and microbiological analysis of qualitative and quantitative characteristics of wound microbiota. On the 3rd day after the start of dressings, the number of S. aureus of 8325-4strain was significantly higher in the wounds of rats in control group than experimental one (5.14± 0.27vs 3.43± 0.33lg CFU/ml). The total number of Staphylococci in the DFCS-treated wounds did not differ statistically from the number of S. aureus 8325-4strain whereas in control ones were higher by an order of magnitude. On the 10th day the total number of Staphylococci and S. aureus 8325-4in particular, remained consistently high in the wounds of the control rats, while was almost five orders of magnitude lower and represented mainly by S. aureus 8325-4in the experimental ones. The total number of aerobic and optionally anaerobic microorganisms was significantly lower as well. A greater variety of microorganisms in the gauze-covered wounds, as well as an their increased number were accompanied by enhancement of the wound odor from "noticeable" to "strong". There was an appearance of a "barely noticeable" odor in only one animal from the experimental group. The study has demonstrated the ability of DFCS to control substantially the bacterial microflora as well as malodor of MWFs in vivo. The results obtained can contribute to solving the problem of improving the quality of palliative care for patients with malignant and other chronic wounds.

Systematic review of topical interventions for the management of odour in patients with chronic wounds or malignant fungating wounds: a study protocol

Background: Chronic wounds including venous, arterial, diabetic and pressure ulcers affect up to 2.21 per 1000 population. Malignant fungating wounds affect up to 6.6% of oncology patients. These wounds impact patients and health care systems significantly. Microbes colonising chronic wounds can produce volatile molecules with unpleasant odours. Wound odour adversely affects quality of life, yet management strategies are inconsistent. Clinicians express uncertainty regarding the current range of odour management agents, which therefore requires evaluation for effectiveness. Objective: To determine the effects of topical agents in the management of odour in patients with chronic and malignant fungating wounds. Methods: Searches of Embase, Medline, CINAHL, Cochrane CENTRAL, PubMed, Web of Science, Scopus, and the clinicaltrials.gov and WudracT trial registries from inception to present will be conducted without language limits. Randomised controlled trials including adults with venous, arterial, mixed arterio-venous, diabetic, decubitus or malignant fungating wounds, investigating topical agents to manage odour are eligible. Reference lists of included studies and identified systematic reviews will be scanned, and unpublished studies will be sought in the BASE database, in conference proceedings and through contacting authors. Two reviewers will independently scan titles/abstracts and full text articles against predetermined eligibility criteria, with discrepancies resolved by discussion between reviewers or through third-party intervention. Two reviewers will independently extract data from included studies. Disagreements will be resolved by discussion between reviewers or through third-party intervention. Bias risk and evidence quality will be assessed with the Cochrane Risk of Bias Tool 2 and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system. Meta-analysis will be applied where appropriate. Otherwise, data will be synthesised narratively. Discussion: Wound odour management typically takes a trial-and-error approach. Clinicians are critical of odour management agent effectiveness. This review will evaluate the range of available agents to inform practice and research. PROSPERO registration: CRD42021267668 (14/08/2021)

Local Management of Malignant and Unresectable Fungating Wounds: PEBO Assessment.

Malignant fungating wounds (MFWs) represent a major problem for public health. The most common symptoms associated with MFWs are pain, exudate, bleeding and odor. The aim of the study was to optimize the local management and dressing of MFWs. We developed a standardized 4- step approach to MFWs based on Pain, Exudate, Bleeding and Odor management in a case series of 24 patients: we call this the PEBO approach. We analyzed etiologies, localization, Quality of Life (QoL), pain and clinical signs and symptoms. We assessed the ulcers at baseline, after two weeks and after one month. In our study, most patients showed an improvement in the QoL using PEBO approach, although some experienced a deterioration in their general clinical conditions. Non-cytolesive cleansing, atraumatic dressings were applied to allow pain relief. Non-adherent dressings were combined with a secondary dressing in the case of exudate. Achieving hemostasis with dressing or medication is a priority in MFW management. Antibacterial dressings and odor absorbent dressings were used for odor absorption. Surgical debridement, adherent dressing and occlusive dressings were avoided. Dressing changes were programmed twice a week for four weeks. PEBO simplified the complex aspects of this type of ulcer, and could help physicians, nurses, and also the rest of the team, including the patients themselves and their family, in the multidisciplinary palliative care of MFWs.

The Microbiome and Metabolome of Malignant Fungating Wounds: A Systematic Review of the Literature From 1995 to 2020.

Malignant fungating wounds (MFWs) afflict up to 14% of patients with advanced cancer. The bacterial community structures of MFW may influence the development and severity of wound symptoms. The purpose of this systematic review was to evaluate existing evidence regarding the relationship between microbiome and symptoms of MFWs. A systematic review of the published literature from January 1995 to January 2020 was conducted. An established quality assessment tool was used to assess the quality of the included studies. We searched 4 major electronic databases and retrieved 724 articles; 7 met inclusion criteria. Seven studies were included; the overall quality of the included 7 studies was ranked as adequate. Findings from the studies provided an incomplete characterization of the microbiome and metabolome of MFW; none included modern genomic technologies. Twenty different species of aerobes and 14 species of anaerobes were identified, with inconsistent identification of biofilms and multi-drug-resistant bacteria. Symptom occurrence increased with the number of bacteria species (P = .0003) and the presence of at least 1 anaerobe (P = .0006) in malignant wound beds. Cancer wound-derived odor was associated with dimethyl trisulfide and 4 fatty acid volatiles. Periwound and moisture-associated skin damage were associated with higher putrescine levels in exudates. Understanding the role of microbiota of MFW in developing or amplifying the severity of wound symptoms is the first step toward development of more precise and effective topical interventions.

INSTRUCTIONS: The Microbiome and Metabolome of Malignant Fungating Wounds: A Systematic Review of the Literature From 1995 to 2020

Journal of Wound, Ostomy and Continence Nursing: March/April 2021 - Volume 48 - Issue 2 - p E2 doi: 10.1097/WON.0000000000000757

Poster Presentation

Poster Presentation

Nursing of a Non-Hodgkin's Lymphoma Patient with a Facial Malignant Fungating Wound

Nursing of a Non-Hodgkin's Lymphoma Patient with a Facial Malignant Fungating Wound

Frequency and Management of Hemorrhagic Malignant Wounds: A Retrospective, Single-Center, Observational Study

ContextThe prevalence of bleeding episodes in malignant wounds (MW) is poorly documented, with no distinction between minor and potentially severe bleedings. This affects the quality of care. ObjectivesAssessing the frequency and management of hemorrhagic malignant wounds at Institut Curie hospital, an anti cancer center. MethodsRetrospective study conducted from the medical records of patients followed up by the Research and Wound Care Unit from Curie Institute (Paris, France), between 2017 and 2018. Patients >18 years of age, seen at least once by the Unit, and with an MW > 10 cm2 were included. ResultsNinety patients were included, 74.4% female and 25.6% male, with a median age of 64 years (32-92). The most frequent etiologies were breast cancer (52.2%), sarcomas (12.2%), squamous cell carcinoma ear, nose and throat (11%), and pelvic cancer (8.9%). The median survival of patients after their first consultation was 5.6 months (95% CI: 4.6-8.4). Minor bleedings were observed in 38.9% of situations. Bleedings were significantly higher in malignant fungating wounds (P < 0.01). They were treated by the application of alginate or nonadherent dressings. The presence of at least one minor bleeding significantly increased the risk of more severe bleedings (P < 0.001). Hemorrhagic episodes were reported in 18.9% of patients, and 2.2% of patients died as a result of these bleeding episodes. Hemorrhages were fully controlled by hemostatic dressings in 70.6% of cases. The appearance of bleeding (minor or hemorrhagic) was significantly associated with survival (P < 0.001). ConclusionMWs with bleedings appear to be associated with a poor prognosis and could be a reason for early palliative care even if the patient's general condition is preserved. Palliative care must incorporate wound care skills to provide the most appropriate solutions to this anxiety-provoking symptom.