Management Of Malignant Wounds Research Articles

Guideline-based Care for patients with malignant lesions : The new S3 guideline for patients with incurable cancer

The German Association of Palliative Care developed an evidence-based guideline about the management of malignant wounds in adult patients with incurable cancer. There is alack of evidence-based guidelines about fungating wounds and aconfusing wide range of available wound dressings. The goal of the guideline is to reduce the suffering of patients with malignant wounds and stabilize or improve their quality of life. The guideline is constructed following the German Instrument for Methodological Guideline Appraisal (DELBI): Asystematic review was carried out for guidelines and reviews. Awound expert group discussed these research findings and suggested recommendations which were adapted and consented by representatives of 62 medical and health professionals associations.The guideline has 34recommendations, thereof nine (26%) are evidence based with an evidence level from 2+ to 4 (according to SIGN). The assessment chapter comprises specific assessment tools for malignant wounds, odor and wound-related quality of life. Three recommendations address the psychosocial support of patients and their family caregivers and aim to reduce the impact of the wound on their emotional wellbeing, caregiver burden and social participation. The pain recommendations focus on apreventive atraumatic dressing change, positioning, systemic pain medication (anticipated, rescue and baseline) and local application of morphine or local anesthetics. The guideline gives recommendations on odor management (metronidazole, active coal and antiseptic dressings) and management of exudate (super absorber). The recommendations on prevention and management of bleeding (antifibrinolytica, haemostyptica) are vital for patients and caregivers. This guideline is one of the first evidence-based and consented guideline on malignant wound care and has the potential to improve the palliation of patients who suffer from there malignant wounds.

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Malignant wounds as a result of cancer are under-recognized for the physical and emotional distress they cause patients and their families. Unfortunately, there is a lack of valid and reliable screening and assessment tools to aid in the management of malignant wounds. This study aims to validate a patient-reported outcome measurement tool, Malignant Wound Assessment Tool - Research (MWAT-R). Eight patients were recruited and interviewed using the cognitive interviewing methodology to validate this tool. Patients' understanding and overall impression of the MWAT-R were explored. Our findings showed that the wording and response options posed challenges for patients in completing the tool. Overall, participants felt that questions captured the key issues related to dealing with a malignant wound and accounted for the patients' perspective. Establishing the content and face validity of the MWAT-R from the patients' perspectives using cognitive interviews has provided further evidence to the validity of this tool.

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

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.

8 Impact and Management of Malignant Wounds

8 Impact and Management of Malignant Wounds

Malignant wound management: what dressings do nurses use?

This paper reports on the findings from the first part of a three-phase project that aimed to identify nursing strategies used in the management of malignant wounds. The difficulties relating to the management of these wounds and the significant physical and psychological impact on patients are described. A quantitative postal survey aiming to identify the types of dressing used in the care of malignant wounds was sent to specialist nurses working in oncology and palliative care in New South Wales, Australia. Additional qualitative data showed that the major issues were coping with odour and meeting the financial costs of the dressing products. The long list of products compiled for this research demonstrates the complexities nurses face when selecting dressings for the management of malignant wounds. Furthermore, there are no clear recommendations to guide nursing practice. This study provides a framework for subsequent phases of the project and will hopefully lead to the development of guidelines for best practice in malignant wound management.