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Abstract
Malignant wounds are a complication of cancer, and usually occur in those individuals with advanced disease. When healing ceases to be the goal, treatment is centred around symptom control and improving quality of life. Caring for individuals with malignant wounds presents challenges for patients, their families and nurses alike. This article discusses the holistic management of malignant wounds, with an emphasis on the control of both physical and psychosocial symptoms of wound management, as well as the impact that this may have on all those involved. Common physical symptoms of malignant wounds include malodour, bleeding, pain, exudate and pruritis. Psychosocial symptoms may result in social isolation and depression. All these symptoms have a huge impact, not only on patients and their families, but also on healthcare professionals both during and after care. Managing these symptoms requires a multidisciplinary approach to facilitate the best possible outcomes for patients and their caregivers.
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Affiliation(s)
- Lynn Cornish
- Tissue Viability Specialist Lead St. Margaret's Hospice, Somerset
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Freitas de Castro MC, Santos WAD, Fuly PDSC, Caldeira dos Santos MLS, Ribeiro Garcia T. Intervenções de enfermagem para pacientes oncológicos com odor fétido em ferida tumoral. AQUICHAN 2017. [DOI: 10.5294/aqui.2017.17.3.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivo: identificar intervenciones de enfermería para el diagnóstico de olor fétido en herida tumoral. Métodos: revisión integradora de la literatura a partir de las bases de datos MEDLINE, CINAHL, LILACS e Cochrane, que resultó en la selección de 48 artículos científicos acerca de la temática investigada. Resultados: con base en las evidencias empíricas identificadas en los artículos incluidos en el estudio, se elaboraron 24 intervenciones de enfermería para el control y la reducción del olor fétido en heridas tumorales. Conclusiones: las intervenciones de enfermería presentadas en el estudio posibilitan la promoción de la calidad de vida al paciente con herida tumoral en cuidado paliativo. Como sugerencia posterior al Consejo Internacional de Enfermeros, se deben validar clínicamente para que su inserción se realice en el subconjunto terminológico cuidados paliativos para una muerte digna, de la Clasificación Internacional para la Práctica de Enfermería (CIPE®).
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Neloska L, Damevska K, Kuzmanova A, Pavleska L, Kostov M, Zovic BP. Dermatologische Erkrankungen bei Palliativpatienten: eine prospektive Studie an 271 Patienten. J Dtsch Dermatol Ges 2017; 15:621-628. [PMID: 28591438 DOI: 10.1111/ddg.13236_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/26/2016] [Indexed: 01/25/2023]
Affiliation(s)
- Lenche Neloska
- Institut für Gerontologie "13ter November", Skopje, Republik Mazedonien
| | - Katerina Damevska
- Abteilung für Dermatologie, Medizinische Fakultät, Universität "St. Kyrill und Method", Skopje, Republik Mazedonien
| | | | - Lidija Pavleska
- Institut für Gerontologie "13ter November", Skopje, Republik Mazedonien
| | - Milenko Kostov
- Abteilung für Neurochirurgie, Medizinische Fakultät, Skopje, Republik Mazedonien
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Neloska L, Damevska K, Kuzmanova A, Pavleska L, Kostov M, Zovic BP. Dermatological diseases in palliative care patients: a prospective study of 271 patients. J Dtsch Dermatol Ges 2017; 15:621-627. [PMID: 28513987 DOI: 10.1111/ddg.13236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/26/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Numerous risk factors place palliative care patients at an increased risk of skin infections, dermatitis, and pressure sores. Furthermore, worsening of chronic skin disorders can be expected, as well as the development of treatment-induced and malignancy-related dermatoses. The objective of the present study was to investigate the prevalence and treatment of dermatological conditions in patients receiving hospital-based palliative care. METHODS Two hundred seventy-one palliative patients were enrolled. All assessments were conducted by dermatologists. Skin lesions were classified into seven categories: infections, skin tumors, dermatitis, chronic wounds, nail and hair disorders, pruritus, and other unclassified conditions. Treatment modalities were classified as topical only or systemic. RESULTS Overall, 1,267 dermatological conditions were recorded, 49 % of which were hospital-acquired. All patients had at least one dermatological condition, and more than 50 different dermatological disorders were noted. The most common group of skin disorders was dermatitis (18.3 % of all dermatological conditions), followed by nail and hair disorders (17.5 %). Almost 16 % of dermatological conditions were treated systemically. CONCLUSIONS Dermatological conditions are a common and clinically significant problem for palliative patients. The inclusion of dermatologists in multidisciplinary palliative teams should prove helpful in the management of these patients.
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Affiliation(s)
- Lenche Neloska
- Gerontology Institute "13 November", Skopje, Republic of Macedonia
| | - Katerina Damevska
- Department of Dermatology, Medical Faculty, University "Ss Cyrilius and Methodius", Skopje, Republic of Macedonia
| | | | - Lidija Pavleska
- Gerontology Institute "13 November", Skopje, Republic of Macedonia
| | - Milenko Kostov
- Department of Neurosurgery, Medical Faculty, Skopje, Republic of Macedonia
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George R, Prasoona TS, Kandasamy R, Cherian R, Celine T, Jeba J, Murali S, Mathew D. Improving malodour management in advanced cancer: a 10-year retrospective study of topical, oral and maintenance metronidazole. BMJ Support Palliat Care 2017; 7:286-291. [PMID: 28174164 DOI: 10.1136/bmjspcare-2016-001166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 12/07/2016] [Accepted: 01/19/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To explore the relative effectiveness of topical or oral metronidazole used for malodour in necrotic cancers and to propose a protocol for metronidazole usage in managing malodour. METHODS A retrospective case note review of the management of malodour over 10 years comparing outcomes with topical, intermittent and maintenance oral metronidazole. RESULTS Among 179 patients treated for malodour, the commonest primaries were cervical (45%), and head and neck cancers (40%). Outcomes were poor during the period when only topical or intermittent oral metronidazole was used. Topical use gradually decreased (97% vs 55%) and the proportion of patients receiving maintenance oral metronidazole increased (0% in 2003-2004 vs 93% in 2011). Concurrently, there was reduction in documented malodour (12.5% of visits per patient in 2003-2004 vs 1.5% in 2011, p<0.01). CONCLUSIONS Our data support formulary guidelines recommending maintenance metronidazole for recurrent malodour. Dimethyl trisulfide, a product of anaerobic necrosis causes malodour and can attract maggot-producing flies to decaying tissues. Therefore, to reduce anaerobic malodour in vulnerable settings, we propose a ladder for metronidazole titration. High-risk patients should start with 400 mg thrice daily ×7 days and continue 200 mg once daily. The SNIFFF severity (Smell-Nil, Faint, Foul or Forbidding) can guide follow-up dosage: 200 mg once daily to continue for nil or faint smell; breakthrough courses of 400 mg thrice daily ×1 week for foul smell and 2 weeks for forbidding smell, followed by 200 mg once daily.The effectiveness and limitations of maintenance metronidazole and the SNIFFF ladder should be prospectively evaluated.
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Affiliation(s)
- Reena George
- Palliative Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Ramu Kandasamy
- Palliative Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Renitha Cherian
- Palliative Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Thangarathi Celine
- Palliative Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jenifer Jeba
- Palliative Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shakila Murali
- Palliative Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - David Mathew
- Nuclear Medicine Department, Christian Medical College, Vellore, Tamil Nadu, India
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Gibson S, Green J. Review of patients' experiences with fungating wounds and associated quality of life. J Wound Care 2013; 22:265-6, 268, 270-2, passim. [PMID: 23702724 DOI: 10.12968/jowc.2013.22.5.265] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the evidence exploring the experiences of patients with fungating wounds and associated quality of life, and to subsequently provide recommendations to how these implications may be addressed in practice. METHOD Using a systematic approach, a comprehensive literature search was conducted to investigate the most appropriate and relevant evidence regarding the experiences of patients with fungating wounds. RESULTS Studies unveiled the enormity of the unrelenting, unique and devastating consequences that these wounds have on an individual’s life and that every domain of their life is negatively affected. CONCLUSION These findings must galvanise nurses to become aware of the extent of the devastation experienced and aspects of life affected by these wounds. The issues raised have multifaceted and challenging implications for practice; however, all aspects need to be addressed and satisfied in an attempt to improve the quality of life of individuals with fungating wounds.
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Affiliation(s)
- S Gibson
- Critical Care Unit, University Hospital of North Staffordshire, Stoke-on-Trent, UK.
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Affiliation(s)
- Kelli J Bergstrom
- The James Cancer Hospital and Solove Research Institute, 300 W 10th St, Columbus, OH 43210, USA.
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da Costa Santos CM, de Mattos Pimenta CA, Nobre MRC. A systematic review of topical treatments to control the odor of malignant fungating wounds. J Pain Symptom Manage 2010; 39:1065-76. [PMID: 20538188 DOI: 10.1016/j.jpainsymman.2009.11.319] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Revised: 10/26/2009] [Accepted: 11/10/2009] [Indexed: 11/29/2022]
Abstract
CONTEXT Malignant fungating wounds (MFW) result from cutaneous infiltration by carcinogenic cells. Fetid odor, profuse exudate, pain, and infection are common symptoms that add to the physical and psychological suffering of patients with MFW. The topical treatment of MFW remains controversial. OBJECTIVES To collect evidence about topical treatments to control the odor of MFW. METHODS Fourteen sources of data were used, without restriction in terms of language, period, or study design. The patient, intervention, comparison, and outcome strategy for the development of research questions yielded 334 descriptors related to oncology, MFW, topical treatments, medications, and symptoms of these lesions. Data from the abstracts of these articles were extracted by two independent researchers and decisions were reached by consensus among them. Through an analysis of these abstracts, studies that broached the topic of MFW odor were selected. These studies were analyzed in their entirety and were classified according to quality, levels of evidence, and grade of recommendation. RESULTS Of 11,111 studies identified, 325 (2.93%) made reference to the control of some symptoms of MFW by means of topical interventions: 12.4% related to odor, 16.8% to exudate, 17.8% to bleeding, 31.0% to pain, and 22.0% to MFW-related infection. Within the 59 studies that analyzed odor control, seven were clinical trials (35%), five were case series (25%), and eight (40%) were case studies. Eleven topical treatments were identified. Topical metronidazole and Mesalt dressing yielded 2b level of evidence or B grade of recommendation. Activated carbon dressing and curcumin ointment yielded 2c level of evidence or B grade of recommendation. C and D grades of recommendation were observed for seven topical treatments: topical arsenic trioxide, essential oils, green tea extract, hydropolymer dressings, antiseptic solutions, hydrogels, and debridement enzymes. The variety of interventions and of the methodological quality of the studies did not allow for meta-analysis. CONCLUSION Of the 59 studies of odor, 20 fulfilled all the criteria for inclusion. Few studies of high quality were found, and the principal methodological flaws were the design of the studies, the sample size, and the absence of scales to measure odor. Grade B evidence for the treatment of MFW was found with topical metronidazole, Mesalt dressing, activated carbon dressing, and curcumin ointment.
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Quel est le profil psychologique de patients porteurs de plaies tumorales négligées ? Résultats d’une étude qualitative exploratoire. PSYCHO-ONCOLOGIE 2010. [DOI: 10.1007/s11839-010-0243-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kakimoto M, Tokita H, Okamura T, Yoshino K. A Chemical Hemostatic Technique for Bleeding from Malignant Wounds. J Palliat Med 2010; 13:11-3. [DOI: 10.1089/jpm.2009.0238] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Masaki Kakimoto
- Department of Surgery, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan
| | - Hiromi Tokita
- Department of Surgery, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan
| | - Takashi Okamura
- Department of Surgery, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan
| | - Koji Yoshino
- Department of Dermatology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
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Alexander S. Malignant fungating wounds: managing pain, bleeding and psychosocial issues. J Wound Care 2009; 18:418-25. [DOI: 10.12968/jowc.2009.18.10.44603] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Alexander S. Malignant fungating wounds: epidemiology, aetiology, presentation and assessment. J Wound Care 2009; 18:273-4, 276-8, 280. [DOI: 10.12968/jowc.2009.18.7.43110] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Piggin C, Jones V. Malignant fungating wounds: an analysis of the lived experience. J Wound Care 2009; 18:57-8, 60-4. [DOI: 10.12968/jowc.2009.18.2.38744] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lo SF, Hu WY, Hayter M, Chang SC, Hsu MY, Wu LY. Experiences of living with a malignant fungating wound: a qualitative study. J Clin Nurs 2008; 17:2699-708. [DOI: 10.1111/j.1365-2702.2008.02482.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Maund M. Use of an ionic sheet hydrogel dressing on fungating wounds: two case studies. J Wound Care 2008; 17:65-8. [DOI: 10.12968/jowc.2008.17.2.28180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lo SF, Hsu MY, Hu WY. Using wound bed preparation to heal a malignant fungating wound: a single case study. J Wound Care 2007; 16:373-6. [DOI: 10.12968/jowc.2007.16.9.27867] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S-F Lo
- Department of Nursing, Tzu Chi College of Technology and Doctoral Program Student, School and Graduate Institute of Nursing, National Taiwan University, Taipei, Taiwan
| | - M-Y Hsu
- Department of Nursing, Tzu Chi Medical Centre and Master Student, Postgraduate Institute of Nursing Tzu Chi University, Taiwan
| | - W-Y Hu
- School of Nursing Science, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
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Piggin C, Jones V. Malignant fungating wounds: an analysis of the lived experience. Int J Palliat Nurs 2007; 13:384-91. [DOI: 10.12968/ijpn.2007.13.8.24537] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
OBJECTIVE To review the pathophysiology and assessment of malignant wounds and management techniques aimed at controlling pain, odor, exudate, and local bleeding. DATA SOURCES Current research and published literature. CONCLUSION Assessment of malignant wounds, selection of appropriate dressings, related symptom management, and patient and family support are vital aspects of cutaneous wound management in advanced cancer. IMPLICATIONS FOR NURSING PRACTICE A thorough understanding of the care of malignant wounds will assist oncology nurses achieving palliative goals of care including optimal symptom management, odor and drainage control, and emotional support.
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Affiliation(s)
- Susie Seaman
- Sharp Grossmont Hospital Wound Healing Center, La Mesa, CA 91942, USA.
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