palliative care for patients with external malignant tumors · ing their care. patients with...
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8 OSTOMY WOUND MANAGEMENT DECEMBER 2010 www.o-wm.com
Fungating tumors can present physical and emotional chal-lenges to patients, families, and caregivers. Approximately 5%
to 10% of patients with cancer will develop a fungating tumor;these tumors and metastatic lesions can develop at any point dur-ing their care. Patients with external malignant tumors may haveto deal with pain, odor, excess drainage, maceration, compromisedbody image, and impaired mobility. The aim of therapy is to alle-viate as many of these symptoms as possible because many of thesetumors cannot be surgically removed. The management goal is topromote patient quality of life and independence; care is usuallypalliative and the fungating tumor is not expected to heal.
Dressings such as alginatesand foams often are selected tohelp manage exudate andbleeding. Hemostatic powderis helpful to control bleeding.Antibacterial solutions may beused as cleansing agents togently debride necrotic tissueand to help kill micro-organ-isms in the wound. Wounddrainage pouches are oftenbeneficial when dressings
must be changed frequently when the skin shows signs of mac-eration or other damage or odor is objectionable.
Successful management of external malignant tumors involvesthe combined effort of all members of the healthcare team, in-cluding patients and their caregivers, along with the correct useof appropriate products. ■
Resources Wound care for pediatric, burn, bariatric and cancer patients. In: Baharestani
M, Blackett A, Conner-Kerr TA et al (eds). The Wound Care Handbook.Mundelein, IL: Medline Industries Inc.;2007:142-163.
Goldberg M, McGinn-Byer M. Oncology-related skin damage. In: Bryant R,Nix D (eds). Acute and Chronic Wounds. Current Management Concepts.3rd ed. St. Louis, Missouri: Mosby Inc.; 2007:471–489.
Dowsett C. Malignant fungating wounds: assessment and management. Br JCommunity Nurs. 2002;7(8):394.
Palliative Care For Patients With External Malignant Tumors Linda Woodward, RN, BSN, OCN, CWOCNWound, Ostomy, Continence NurseThe University of Texas MD Anderson Cancer CenterHouston, TX
Pearls for Practice is made possible through the support of Ferris Mfg. Corp, Burr Ridge, IL (www.polymem.com). The opinions and statements of the clinicians providingPearls for Practice are specific to the respective authors and are not necessarily those of Ferris Mfg. Corp., OWM, or HMP Communications. This article was not subjectto the Ostomy Wound Management peer-review process.
Commentary from Ferris Mfg. Corp. Marjolin’s ulcer is a wound that commonly develops
from a squamous cell carcinoma that has undergone ma-lignant changes at its edges.¹ These malignant woundscan be quite painful and odorous; they produce largeamounts of exudate. Often, the goal is to manage thesymptoms and provide palliative care.
In a representative case study,² a young man with alarge infected Marjolin’s ulcer on his heel sought relieffrom persistent pain, odor, and drainage. He was unableto sleep during the night. PolyMem® dressings were cho-sen because they are very absorbent, continuouslycleanse and atraumatically debride the wound, and helpdecrease the pain by reducing the spread of the inflam-matory response into the surrounding tissues. PolyMemWic® cavity filler was applied between the layers of theulcer tissue and then covered by a secondary PolyMemdressing. The built-in wound cleansing properties of thedressing combined with the glycerol in PolyMem helpedcontrol the odor. The patient’s pain diminished rapidlyand he was able to sleep through the night. Once stabi-lized, the Marjolin’s ulcer was excised to a full-thicknesswound and covered with a PolyMem dressing. Hiswounds started to granulate but unfortunately his cancerreturned, resulting in a below-the-knee amputation. ■
References1. Baranoski S, Ayello EA. Wound Care Essentials: Practice Principles.
Ambler, PA: Lippincott Williams & Wilkins;2004. 2. Benskin L. Polymeric Membrane Dressings Provide Excellent Bene-
fits for Palliative Care. Poster presented at the 41st Annual WOCNConference. St. Louis, MO. June 6–10, 2009.
Share your Pearls for Practice.If your Pearl is selected for publication, you will receive cash
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March 30: After the application ofthe PolyMem dressings, whichwere changed daily to address co-pious drainage and to control odor.
April 6: Tissue excised to thebone.
PEARLS FOR PRACTICE
Malignant fibrous histiocytoma,a common soft tissue sarcoma.
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