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Tam SH, Lai WS, Kao CY, Fang SY. "Maintain Professionalism": Nurses' Experiences in Caring for Patients with Malignant Fungating Wounds in Taiwan. J Pain Symptom Manage 2024; 68:69-77.e1. [PMID: 38621610 DOI: 10.1016/j.jpainsymman.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 03/30/2024] [Accepted: 04/04/2024] [Indexed: 04/17/2024]
Abstract
CONTEXT Malignant 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. OBJECTIVES To explore the experiences in caring for patients with MFWs among nurses in Taiwan. METHODS Qualitative 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. RESULTS Four 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. CONCLUSION The 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.
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Affiliation(s)
- Sin Hang Tam
- Medical Oncology and Palliative Care (S.H.T.), St George's University Hospitals NHS Foundation Trust, London, UK
| | - Wei-Sue Lai
- Department of Nursing, College of Medicine (W.S.L., C.Y.K., S.Y.F.), National Cheng Kung University, Tainan, Taiwan
| | - Chi-Yin Kao
- Department of Nursing, College of Medicine (W.S.L., C.Y.K., S.Y.F.), National Cheng Kung University, Tainan, Taiwan
| | - Su-Ying Fang
- Department of Nursing, College of Medicine (W.S.L., C.Y.K., S.Y.F.), National Cheng Kung University, Tainan, Taiwan; Department of Nursing (S.Y.F.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Liu X, Xie JQ, Liao ZY, Wei MJ, Lin H. Changes in wound symptoms and quality of life of patients with newly diagnosed malignant fungating wounds. J Wound Care 2024; 33:262-270. [PMID: 38573899 DOI: 10.12968/jowc.2024.33.4.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
OBJECTIVE 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. METHOD 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Xin Liu
- Nursing department, First people's Hospital of NanNing, NanNing 530022, China
| | - Jin-Qin Xie
- Nursing department, Guangxi Medical University Affiliated Cancer Hospital, NanNing 530021, China
| | - Zhao-Yu Liao
- Nursing department, First people's Hospital of NanNing, NanNing 530022, China
| | - Mei-Juan Wei
- Department of Oncology, Affiliated Hospital of Youjiang Medical College for Nationalities, BaiSe 533099, China
| | - Hua Lin
- Nursing department, First people's Hospital of NanNing, NanNing 530022, China
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Harano H, Matsunuma R, Tanaka-Yagi Y, Ito M, Tasaki J, Egawa A, Yamaguchi T. Malodour from oral malignant fungating wound: sprayed metronidazole - case report. BMJ Support Palliat Care 2024; 13:e966-e967. [PMID: 36944483 DOI: 10.1136/spcare-2022-004137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 03/07/2023] [Indexed: 03/23/2023]
Abstract
Metronidazole gel or ointment is recommended for the treatment of malodour from malignant fungating wounds. However, this medication may not settle adequately in oral lesions because its texture causes discomfort and it tends to be washed out by saliva. We report a case of malodour due to an oral lesion that was well controlled with sprayed metronidazole.
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Affiliation(s)
- Haruka Harano
- Palliative Care, Kobe University Graduate School of Medicine School of Medicine, Kobe, Japan
- Palliative Care, Konan Medical Center, Kobe, Japan
| | | | | | - Madoka Ito
- Palliative Care, Konan Medical Center, Kobe, Japan
| | | | - Aki Egawa
- Palliative Care, Konan Medical Center, Kobe, Japan
| | - Takashi Yamaguchi
- Palliative Care, Kobe University Graduate School of Medicine School of Medicine, Kobe, Japan
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Tilley CP, Yu G, Comfort C, Li Z, Axelrod D, Colon-Cavallito K, Wholihan D, Fu MR. Impact of Co-occurring Cancer-Related and Wound-Specific Symptoms on Functional Performance Among Patients With Advanced Cancer and Malignant Fungating Wounds: An Exploratory, Observational Study. J Wound Ostomy Continence Nurs 2023; 50:451-457. [PMID: 37966073 DOI: 10.1097/won.0000000000001017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
PURPOSE The purpose of this study was to examine the impact of co-occurring symptoms in patients with advanced cancer and malignant fungating wounds (MFWs) on palliative and functional performance, and the feasibility of collecting self-reported data in this population. DESIGN This was an exploratory, observational study. Quantitative surveys and qualitative semistructured interviews using a phenomenological approach were employed. SUBJECTS AND SETTING The sample comprised 5 adults with advanced breast, oral, and ovarian cancer and MFWs. Participants were recruited from an urban outpatient cancer center, hospice, and wound center located in the Northeastern United States. METHODS Demographic and clinical characteristics were collected, and self-reported symptom and functional performance data measured. Descriptive statistics, T scores, confidence intervals, and standard deviation were calculated for quantitative data. One-to-one semistructured interviews were conducted by the first author to gain deeper understanding of participants' symptom experience. Qualitative data were analyzed using an iterative and inductive thematic data analysis method to identify major themes. RESULTS The mean cancer-related and wound-specific symptom occurrence was 17 (SD = 5.56) and 4 (SD = 1.26), respectively. Distressing, extensive co-occurring symptom burdens were experienced by all participants; they also reported poor functional performance and diminished palliative performance. Qualitative findings supported quantitative results. CONCLUSIONS Findings suggest that co-occurring cancer-related and wound-specific symptoms have incremental and negative impact on functional performance. The use of multiple data collection methods was feasible, including self-reported data in this advanced cancer population.
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Affiliation(s)
- Charles P Tilley
- Charles P. Tilley, PhD, ANP-BC, ACHPN, CWOCN, WOCNF, NYU Rory Meyers College of Nursing, New York, New York, and Calvary Hospital, Bronx, New York
- Gary Yu, PhD, NYU Rory Meyers College of Nursing, New York, New York
- Christopher Comfort, MD, Calvary Hospital, Bronx, New York
- Zujun Li, MD, Department of Surgery, NYU School of Medicine, New York, New York, and NYU Clinical Cancer Center, New York, New York
- Deborah Axelrod, MD, Department of Surgery, NYU School of Medicine, New York, New York, and NYU Clinical Cancer Center, New York, New York
- Kim Colon-Cavallito, FNP-BC, CWCN, Calvary Hospital, Bronx, New York
- Dorothy Wholihan, DNP, AGPCNP-BC, ACHPN, FAAN, NYU Rory Meyers College of Nursing, New York, New York
- Mei Rosemary Fu, PhD, RN, FAAN, University of Missouri-Kansas City, Kansas City, Missouri
| | - Gary Yu
- Charles P. Tilley, PhD, ANP-BC, ACHPN, CWOCN, WOCNF, NYU Rory Meyers College of Nursing, New York, New York, and Calvary Hospital, Bronx, New York
- Gary Yu, PhD, NYU Rory Meyers College of Nursing, New York, New York
- Christopher Comfort, MD, Calvary Hospital, Bronx, New York
- Zujun Li, MD, Department of Surgery, NYU School of Medicine, New York, New York, and NYU Clinical Cancer Center, New York, New York
- Deborah Axelrod, MD, Department of Surgery, NYU School of Medicine, New York, New York, and NYU Clinical Cancer Center, New York, New York
- Kim Colon-Cavallito, FNP-BC, CWCN, Calvary Hospital, Bronx, New York
- Dorothy Wholihan, DNP, AGPCNP-BC, ACHPN, FAAN, NYU Rory Meyers College of Nursing, New York, New York
- Mei Rosemary Fu, PhD, RN, FAAN, University of Missouri-Kansas City, Kansas City, Missouri
| | - Christopher Comfort
- Charles P. Tilley, PhD, ANP-BC, ACHPN, CWOCN, WOCNF, NYU Rory Meyers College of Nursing, New York, New York, and Calvary Hospital, Bronx, New York
- Gary Yu, PhD, NYU Rory Meyers College of Nursing, New York, New York
- Christopher Comfort, MD, Calvary Hospital, Bronx, New York
- Zujun Li, MD, Department of Surgery, NYU School of Medicine, New York, New York, and NYU Clinical Cancer Center, New York, New York
- Deborah Axelrod, MD, Department of Surgery, NYU School of Medicine, New York, New York, and NYU Clinical Cancer Center, New York, New York
- Kim Colon-Cavallito, FNP-BC, CWCN, Calvary Hospital, Bronx, New York
- Dorothy Wholihan, DNP, AGPCNP-BC, ACHPN, FAAN, NYU Rory Meyers College of Nursing, New York, New York
- Mei Rosemary Fu, PhD, RN, FAAN, University of Missouri-Kansas City, Kansas City, Missouri
| | - Zujun Li
- Charles P. Tilley, PhD, ANP-BC, ACHPN, CWOCN, WOCNF, NYU Rory Meyers College of Nursing, New York, New York, and Calvary Hospital, Bronx, New York
- Gary Yu, PhD, NYU Rory Meyers College of Nursing, New York, New York
- Christopher Comfort, MD, Calvary Hospital, Bronx, New York
- Zujun Li, MD, Department of Surgery, NYU School of Medicine, New York, New York, and NYU Clinical Cancer Center, New York, New York
- Deborah Axelrod, MD, Department of Surgery, NYU School of Medicine, New York, New York, and NYU Clinical Cancer Center, New York, New York
- Kim Colon-Cavallito, FNP-BC, CWCN, Calvary Hospital, Bronx, New York
- Dorothy Wholihan, DNP, AGPCNP-BC, ACHPN, FAAN, NYU Rory Meyers College of Nursing, New York, New York
- Mei Rosemary Fu, PhD, RN, FAAN, University of Missouri-Kansas City, Kansas City, Missouri
| | - Deborah Axelrod
- Charles P. Tilley, PhD, ANP-BC, ACHPN, CWOCN, WOCNF, NYU Rory Meyers College of Nursing, New York, New York, and Calvary Hospital, Bronx, New York
- Gary Yu, PhD, NYU Rory Meyers College of Nursing, New York, New York
- Christopher Comfort, MD, Calvary Hospital, Bronx, New York
- Zujun Li, MD, Department of Surgery, NYU School of Medicine, New York, New York, and NYU Clinical Cancer Center, New York, New York
- Deborah Axelrod, MD, Department of Surgery, NYU School of Medicine, New York, New York, and NYU Clinical Cancer Center, New York, New York
- Kim Colon-Cavallito, FNP-BC, CWCN, Calvary Hospital, Bronx, New York
- Dorothy Wholihan, DNP, AGPCNP-BC, ACHPN, FAAN, NYU Rory Meyers College of Nursing, New York, New York
- Mei Rosemary Fu, PhD, RN, FAAN, University of Missouri-Kansas City, Kansas City, Missouri
| | - Kim Colon-Cavallito
- Charles P. Tilley, PhD, ANP-BC, ACHPN, CWOCN, WOCNF, NYU Rory Meyers College of Nursing, New York, New York, and Calvary Hospital, Bronx, New York
- Gary Yu, PhD, NYU Rory Meyers College of Nursing, New York, New York
- Christopher Comfort, MD, Calvary Hospital, Bronx, New York
- Zujun Li, MD, Department of Surgery, NYU School of Medicine, New York, New York, and NYU Clinical Cancer Center, New York, New York
- Deborah Axelrod, MD, Department of Surgery, NYU School of Medicine, New York, New York, and NYU Clinical Cancer Center, New York, New York
- Kim Colon-Cavallito, FNP-BC, CWCN, Calvary Hospital, Bronx, New York
- Dorothy Wholihan, DNP, AGPCNP-BC, ACHPN, FAAN, NYU Rory Meyers College of Nursing, New York, New York
- Mei Rosemary Fu, PhD, RN, FAAN, University of Missouri-Kansas City, Kansas City, Missouri
| | - Dorothy Wholihan
- Charles P. Tilley, PhD, ANP-BC, ACHPN, CWOCN, WOCNF, NYU Rory Meyers College of Nursing, New York, New York, and Calvary Hospital, Bronx, New York
- Gary Yu, PhD, NYU Rory Meyers College of Nursing, New York, New York
- Christopher Comfort, MD, Calvary Hospital, Bronx, New York
- Zujun Li, MD, Department of Surgery, NYU School of Medicine, New York, New York, and NYU Clinical Cancer Center, New York, New York
- Deborah Axelrod, MD, Department of Surgery, NYU School of Medicine, New York, New York, and NYU Clinical Cancer Center, New York, New York
- Kim Colon-Cavallito, FNP-BC, CWCN, Calvary Hospital, Bronx, New York
- Dorothy Wholihan, DNP, AGPCNP-BC, ACHPN, FAAN, NYU Rory Meyers College of Nursing, New York, New York
- Mei Rosemary Fu, PhD, RN, FAAN, University of Missouri-Kansas City, Kansas City, Missouri
| | - Mei Rosemary Fu
- Charles P. Tilley, PhD, ANP-BC, ACHPN, CWOCN, WOCNF, NYU Rory Meyers College of Nursing, New York, New York, and Calvary Hospital, Bronx, New York
- Gary Yu, PhD, NYU Rory Meyers College of Nursing, New York, New York
- Christopher Comfort, MD, Calvary Hospital, Bronx, New York
- Zujun Li, MD, Department of Surgery, NYU School of Medicine, New York, New York, and NYU Clinical Cancer Center, New York, New York
- Deborah Axelrod, MD, Department of Surgery, NYU School of Medicine, New York, New York, and NYU Clinical Cancer Center, New York, New York
- Kim Colon-Cavallito, FNP-BC, CWCN, Calvary Hospital, Bronx, New York
- Dorothy Wholihan, DNP, AGPCNP-BC, ACHPN, FAAN, NYU Rory Meyers College of Nursing, New York, New York
- Mei Rosemary Fu, PhD, RN, FAAN, University of Missouri-Kansas City, Kansas City, Missouri
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Scientific and Clinical Abstracts From WOCNext® 2023: Las Vegas, Nevada ♦ June 4-7, 2023. J Wound Ostomy Continence Nurs 2023; 50:S1-S78. [PMID: 37632270 DOI: 10.1097/won.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Gethin G, Vellinga A, McIntosh C, Sezgin D, Probst S, Murphy L, Carr P, Ivory J, Cunningham S, Oommen AM, Joshi L, Ffrench C. Systematic review of topical interventions for the management of odour in patients with chronic or malignant fungating wounds. J Tissue Viability 2023; 32:151-157. [PMID: 36376189 DOI: 10.1016/j.jtv.2022.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/06/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022]
Abstract
Chronic wounds adversely affect the quality of life of individuals and odour is a well-recognised associated factor. Odour can affect sleep, well-being, social interactions, diet and potentially wound healing. This systematic review aims to examine the effectiveness of topical interventions in the management of odour associated with chronic and malignant fungating wounds. A systematic review guided by PRISMA recommendations of randomised controlled trials where odour intensity/odour is the primary outcome was undertaken. Inclusion criteria were adults (18 years and over) with chronic venous, arterial, diabetic or pressure ulcers or with malignant fungating wounds where odour has been managed through topical application of pharmacological/non-pharmacological agents. Searches were conducted in CENTRAL, CINAHL, EMBASE, MEDLINE, Scopus, and Web of Science. Eligibility screening, risk of bias assessment and data extraction was completed by authors working independently. Searches retrieved 171 titles and abstracts (157 post de-duplication). Thirteen studies were retained for full text review of which five (n = 137 individuals) examining the following treatments remained: metronidazole (n = 4), silver (n = 1). Meta-analysis was not possible but individual studies suggest improved outcomes (i.e., reduced odour) using metronidazole. Treatment options to manage wound odour are limited and hampered by lack of clinical trials, small sample sizes, and absence of standardised outcomes and consistent measurement. Whereas metronidazole and silver may have a role in controlling wound odour, robust and well-designed interventions with rigorous procedures and standardised odour outcomes are necessary to evaluate their contribution.
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Affiliation(s)
- G Gethin
- School of Nursing and Midwifery, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland; Geneva School of Health Science, HES-SO University of Applied Sciences and Arts, Western, Switzerland; Faculty of Medicine Nursing and Health Sciences, Monash University, Australia; CÚRAM, SFI Research Centre for Medical Devices, Ireland.
| | - A Vellinga
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland.
| | - C McIntosh
- Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland; Discipline of Podiatric Medicine, School of Health Science, University of Galway, Galway, Ireland.
| | - D Sezgin
- School of Nursing and Midwifery, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland.
| | - S Probst
- Geneva School of Health Science, HES-SO University of Applied Sciences and Arts, Western, Switzerland; Faculty of Medicine Nursing and Health Sciences, Monash University, Australia; Care Directorate, University Hospital Geneva, Switzerland.
| | - L Murphy
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - P Carr
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - J Ivory
- School of Nursing and Midwifery, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland; Irish Research Council (IRC), Government of Ireland, Dublin, Ireland; Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospital, Galway, Ireland
| | - S Cunningham
- Advance Glycoscience Research Cluster, School of Natural Sciences, University of Galway, Galway, Ireland; CÚRAM, SFI Research Centre for Medical Devices, Ireland
| | - A M Oommen
- Advance Glycoscience Research Cluster, School of Natural Sciences, University of Galway, Galway, Ireland; CÚRAM, SFI Research Centre for Medical Devices, Ireland
| | - Lokesh Joshi
- Advance Glycoscience Research Cluster, School of Natural Sciences, University of Galway, Galway, Ireland; CÚRAM, SFI Research Centre for Medical Devices, Ireland
| | - C Ffrench
- School of Nursing and Midwifery, University of Galway, Galway, Ireland; CÚRAM, SFI Research Centre for Medical Devices, Ireland; Centre for Pain Research, University of Galway, Ireland.
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Farzaliyev F, Steinau HU, Ring A, Hamacher R, Thiel T, Lauer H, Podleska LE. Outcome of Surgery as Part of Palliative Care of Patients with Symptomatic Advanced or Metastatic Extra-Abdominal High-Grade Soft Tissue Sarcoma. Palliat Med Rep 2023; 3:64-70. [PMID: 36941924 PMCID: PMC10024585 DOI: 10.1089/pmr.2022.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 03/19/2023] Open
Abstract
Background The modern multimodal treatment of malignant tumors has increased disease-specific survival and decreased the burden of tumor-associated complications. The main focus of palliative surgery is not based primarily on quantitative success parameters of tumor response but is instead mainly on the question of quality of life. Aim The current study was conducted to analyze the clinical and oncological outcomes of palliative patients with soft tissue sarcoma. Design Of 309 patients with extra-abdominal high-grade soft tissue sarcoma treated between August 2012 and December 2014, our retrospective analysis revealed 33 palliative patients for this study. All patients were evaluated and managed by a multidisciplinary team with expertise and experience in sarcoma treatment. The survival analysis was made using the Kaplan-Meier method. Results The main sarcoma symptoms were pain (27.3%) and ulcerated tumors or shortly before ulceration (24.2%). Thirteen patients (39.4%) were operated on with negative margins, 15 (45.5%) with positive margins, 2 with tumor debulking (6.1%), and 3 patients (9.1%) were treated only with palliative hyperthermic isolated limb perfusion. Ten pedicle flaps were performed after sarcoma resection. The median operation time was 85 minutes (range, 37-216 minutes). The median hospitalization stay was 9.5 days (range, 3-27 days). No patients died during hospitalization. Twelve-month disease-free survival was 48.5% (95% confidence interval: 45.4-51.6). Conclusions Palliative surgery of metastatic or advanced soft tissue sarcoma can improve the wound care and quality of life. Closed noninfected wounds enable further treatment options, such as chemotherapy, immunotherapy, and radiotherapy. This surgery should be considered during the discussion on interdisciplinary tumor boards.
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Affiliation(s)
- Farhad Farzaliyev
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Klinik, Eberhard Karls University, Tuebingen, Germany
- Address correspondence to: Farhad Farzaliyev, MD, Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Klinik, Eberhard Karls University Tuebingen, Schnarrenbergstraße 95, Tübingen 72076, Germany, ,
| | - Hans-Ulrich Steinau
- Department of Tumor Orthopedics and Sarcoma Surgery, University Hospital Essen, Essen, Germany
| | - Andrej Ring
- Department of Plastic and Reconstructive Surgery, St. Rochus Hospital, Castrop-Rauxel, Germany
| | - Rainer Hamacher
- Department of Medical Oncology, Sarcoma Center, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Tobias Thiel
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Klinik, Eberhard Karls University, Tuebingen, Germany
| | - Henrik Lauer
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Klinik, Eberhard Karls University, Tuebingen, Germany
| | - Lars Erik Podleska
- Department of Tumor Orthopedics and Sarcoma Surgery, University Hospital Essen, Essen, Germany
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Kashihara T, Ogata D, Okuma K, Nakamura S, Nakayama H, Mori T, Takahashi A, Namikawa K, Takahashi A, Takahashi K, Kaneda T, Inaba K, Murakami N, Okamoto H, Nakayama Y, Yamazaki N, Igaki H. Clinical significance of local control of primary tumour in definitive radiotherapy for scalp angiosarcomas. Skin Res Technol 2023; 29:e13243. [PMID: 36404577 PMCID: PMC9838744 DOI: 10.1111/srt.13243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/05/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Scalp angiosarcoma is a rare and aggressive cancer. Definitive radiotherapy is a treatment option for localised scalp angiosarcoma patients. Although definitive surgical resection reportedly prolongs overall survival (OS), whether initial local treatment effect affects OS when definitive radiotherapy is administered is unclear. Therefore, this study analysed whether local recurrence within 6 months of irradiation correlates with OS and cancer-specific survival (CSS). Furthermore, how local control affects patients' quality of life was investigated. MATERIALS AND METHODS Thirty-one localised scalp angiosarcoma patients who had received definitive radiotherapy at our institution between October 2010 and July 2021 were analysed retrospectively. The most commonly used dose fractionation was 70 Gy in 35 fractions (83.9%). Local recurrence within 6 months of radiotherapy and other clinical factors were examined in univariate and subsequent multivariate analyses for correlation with OS and CSS. RESULTS The median follow-up period was 16 months (range, 6-45 months). Local recurrence was detected in 16 patients (51.6%), 12 of whom had recurrence within 6 months. In multivariate analyses, the presence of local recurrence within 6 months of radiotherapy was significantly associated with OS and CSS (p = 0.003, 0.0001, respectively). Ten of the 16 patients with local recurrence had severe symptoms such as bleeding, pain, difficulty opening the eye and malodour. CONCLUSIONS The initial local treatment effect was significantly associated with OS and CSS after definitive radiotherapy. Furthermore, local recurrence after radiotherapy resulted in a variety of symptoms, including bleeding and pain, which reduced the patient's quality of life.
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Affiliation(s)
- Tairo Kashihara
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku Tokyo, Japan
| | - Dai Ogata
- Department of Dermatologic Oncology, National Cancer Center Hospital, Chuo-ku Tokyo, Japan
| | - Kae Okuma
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku Tokyo, Japan
| | - Satoshi Nakamura
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku Tokyo, Japan
| | - Hiroki Nakayama
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku Tokyo, Japan
| | - Taisuke Mori
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Chuo-ku Tokyo, Japan
| | - Akira Takahashi
- Department of Dermatologic Oncology, National Cancer Center Hospital, Chuo-ku Tokyo, Japan
| | - Kenjiro Namikawa
- Department of Dermatologic Oncology, National Cancer Center Hospital, Chuo-ku Tokyo, Japan
| | - Ayaka Takahashi
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku Tokyo, Japan
| | - Kana Takahashi
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku Tokyo, Japan
| | - Tomoya Kaneda
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku Tokyo, Japan
| | - Koji Inaba
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku Tokyo, Japan
| | - Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku Tokyo, Japan
| | - Hiroyuki Okamoto
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku Tokyo, Japan
| | - Yuko Nakayama
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku Tokyo, Japan
| | - Naoya Yamazaki
- Department of Dermatologic Oncology, National Cancer Center Hospital, Chuo-ku Tokyo, Japan
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku Tokyo, Japan
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Yukuyama MN, Ferreira Guimaraes LM, Segovia RS, Lameu C, de Araujo GLB, Löbenberg R, de Souza A, Bazán Henostroza MA, Folchini BR, Peroni CM, Saito Miyagi MY, Oliveira IF, Rinaldi Alvarenga JF, Fiamoncini J, Bou-Chacra NA. Malignant wound – The influence of oil components in flubendazole-loaded nanoemulsions in A549 lung cancer xenograft-bearing mice. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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da Costa Ferreira SA, Serna González CV, Thum M, da Costa Faresin AA, Woo K, de Gouveia Santos VLC. Topical therapy for pain management in malignant fungating wounds: A scoping review. J Clin Nurs 2022. [PMID: 36055976 DOI: 10.1111/jocn.16508] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/04/2022] [Accepted: 08/05/2022] [Indexed: 10/14/2022]
Abstract
AIMS AND OBJECTIVES To map and synthesise the existing literature on topical therapies for malignant fungating wounds pain management and the gaps involved. BACKGROUND Most cancer patients with malignant fungating wounds suffer from wound-related pain, affecting their quality of life. Unfortunately, even though pain is a relevant symptom in cancer and palliative care, little is currently known about topical treatments' availability and impact on pain management. DESIGN A scoping review following JBI® methodology METHODS: Searches were performed in CINAHL, LILACS, Embase, Web of Science, PubMed, Cochrane, NICE, Scopus, JBISRIR and grey literature, in English, Portuguese and Spanish, with no time limit. Two authors independently reviewed all citations and a third was called in case of divergence, and studies in adults with malignant fungal wounds reporting topical pain interventions were included. In addition, a data extraction tool for synthesis and thematic analysis was developed. This study followed the PRISMA-ScR Checklist. RESULTS Seventy publications were selected from 796 records retrieved from databases. The studies mainly included non-systematic reviews and case studies with only six clinical trials. According to the narrative synthesis, twenty therapies were identified, including the use of wound dressings (58.6%), analgesic drugs (55.7%), topical antimicrobials (25.7%), skin barriers (15.7%), cryotherapy (5.7%) and negative pressure wound therapy (4.3%). Therapies were recommended to be applied to the wound bed or the periwound skin. In 68.5% of the studies, a standardised assessment for pain was not described. CONCLUSIONS Topical therapies applied to malignant fungating wounds or periwound areas had been examined for pain management. However, their effectiveness was analysed in a few interventional studies, indicating the need for further primary studies to inform evidence-based practice. IMPLICATION FOR PRACTICE Highlighted topical therapies for clinical practice consideration are opioids, anaesthetics and antimicrobials, with positive results described in randomised clinical trials. This study did not include patients.
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Affiliation(s)
| | - Carol Viviana Serna González
- School of Nursing-EEUSP, University of São Paulo - Adult Health Nursing Graduate Program-PROESA, Sao Paulo, Brazil
| | - Magali Thum
- School of Nursing-EEUSP, University of São Paulo - Adult Health Nursing Graduate Program-PROESA, Sao Paulo, Brazil
| | | | - Kevin Woo
- Faculty of Health Sciences, School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Vera Lúcia Conceição de Gouveia Santos
- Medical-Surgical Nursing Department Research Group of Enterostomal Therapy Nursing Stomatherapy-GPET, Sao Paulo, University of São Paulo, School of Nursing-EEUSP, Sao Paulo, Brazil
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11
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Batista JVC, Uecker A, Holandino C, Boylan F, Maier J, Huwyler J, Baumgartner S. A Scoping Review on the Therapeutic Potential of Resin From the Species Larix decidua Mill. [Pinaceae] to Treat Ulcerating Wounds. Front Pharmacol 2022; 13:895838. [PMID: 35721139 PMCID: PMC9204203 DOI: 10.3389/fphar.2022.895838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/17/2022] [Indexed: 11/29/2022] Open
Abstract
Malignant ulcerating wounds or neoplastic lesions are a considerable burden for patients suffering from advanced cancer. These wounds have no effective treatment and are very difficult to manage. The present review summarizes evidence in support of a hypothesis put forward in anthroposophic medicine, which suggests a beneficial role of resin from the species Larix decidua Mill. [Pinaceae] for treating such wounds. A systematic search strategy was performed using the databases PubMed, EMBASE and SciFinder. The included publications described the chemical composition of this species, as well as in vitro, in vivo, and ex vivo experiments using plant extracts and isolated compounds. The results show that among the phytochemical classes, terpenoids were the major components of this species, especially in the resin. The summarized biological experiments revealed antimicrobial, antioxidant and anti-inflammatory effects, with promising potential for the extracts and isolated compounds. However, the molecular mechanisms and toxicological effects are as of yet not conclusively evaluated. From the data of our study, we can conclude that L. decidua might indeed have a promising potential for the treatment of malignant wounds, but definitive information that can prove its effectiveness is still lacking. We therefore suggest that future efforts should be dedicated to the evaluation of L. decidua resin's therapeutic use considering its antiseptic action and proposed wound healing properties.
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Affiliation(s)
- João V. C. Batista
- Hiscia Institute, Society for Cancer Research, Arlesheim, Switzerland
- Department of Pharmaceutical Sciences, Division of Pharmaceutical Technology, University of Basel, Basel, Switzerland
| | - Annekathrin Uecker
- Institute of Integrative Medicine, University of Witten/Herdecke, Witten, Germany
| | - Carla Holandino
- Departamento de Fármacos e Medicamentos, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fabio Boylan
- School of Pharmacy and Pharmaceutical Sciences, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Jakob Maier
- Hiscia Institute, Society for Cancer Research, Arlesheim, Switzerland
| | - Jörg Huwyler
- Department of Pharmaceutical Sciences, Division of Pharmaceutical Technology, University of Basel, Basel, Switzerland
| | - Stephan Baumgartner
- Hiscia Institute, Society for Cancer Research, Arlesheim, Switzerland
- Institute of Integrative Medicine, University of Witten/Herdecke, Witten, Germany
- Institute of Complementary and Integrative Medicine, University of Bern, Bern, Switzerland
- *Correspondence: Stephan Baumgartner,
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12
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Luo B, Xiao Y, Jiang M, Wang L, Ge Y, Zheng M. Successful Management of Exudate and Odor Using a Pouch System in a Patient with Malignant Facial Wound: A Case Report. Asia Pac J Oncol Nurs 2022; 9:236-241. [PMID: 35571624 PMCID: PMC9096734 DOI: 10.1016/j.apjon.2022.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/15/2022] [Indexed: 11/25/2022] Open
Abstract
Malignant fungating wounds are associated with heavy exudate and malodor, and can thus have a devastating impact on the physical, psychological, and functional health of patients at the end of life. Management is typically limited to the use of more absorbent dressings and frequent changing of dressings. However, this method is associated with a large amount of time needed for wound care, and does not always resolve the problem of malodor. Herein, we report the use of an inexpensive ostomy pouch to manage facial fungating wounds caused by maxillary gingival carcinoma. The pouches are adhered to the skin, and collect a large amount of malodorous exudate for days without leaking. Fewer dressing changes and the absence of malodor result in an improved quality of life for the patient and family.
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Tarus A, Cornetta K, Morogo D, Nyongesa J, Elias H, Boit JM. Palliative Care Needs in Breast Cancer Patients Entering Inpatient Hospice in Western Kenya. J Pain Symptom Manage 2022; 63:71-77. [PMID: 34333098 DOI: 10.1016/j.jpainsymman.2021.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/01/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022]
Abstract
CONTEXT Breast cancer in Kenya is associated with a high mortality due to late stage disease at presentation and limited access to specialty care. OBJECTIVES To understand the symptom burden in breast cancer patients entering hospice in Western Kenya and utilize the data to meet the growing need for palliative care and hospice services. METHODS We conducted a quality improvement exercise to assess the needs of Kenyan women admitted to inpatient hospice with the diagnosis of breast cancer. A retrospective chart review was undertaken to collect and collate demographic, physical and symptom data from a standardized admission form and the medical record. RESULTS Between 2011-2019, 62 women with breast cancer were admitted for care. The median age was 50.0 years (range 23-86) and the median time from diagnosis to admission one year (range 0-4). Only 20% had received surgical treatment for breast cancer. Pain was the predominant symptom on admission (98%) and breast wounds were the most common physical finding. Approximately 50% voiced worry, depression, and stress with <10% voicing spiritual distress. The mean length of stay was 42.6 days (median 10, range 1-1185). While over 70% died in hospice, 27% were discharged home. CONCLUSIONS The low rate of surgical intervention leads to painful breast wounds that were a major factor for many women seeking hospice admission. The findings challenge our team to maintain expertise in pain and wound management but to also include breast cancer awareness in our rural outreach services.
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Affiliation(s)
- Allison Tarus
- Living Room Ministries International (A.T., D.M., J.N., J.M.B.), Eldoret, Kenya
| | - Kenneth Cornetta
- Department of Medical and Molecular Genetics, Indiana University School of Medicine (K.C.), Indianapolis, Indiana, USA; Department of Medical and Molecular Genetics, Moi University School of Medicine (K.C.), Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Daniel Morogo
- Living Room Ministries International (A.T., D.M., J.N., J.M.B.), Eldoret, Kenya
| | - Jackline Nyongesa
- Living Room Ministries International (A.T., D.M., J.N., J.M.B.), Eldoret, Kenya
| | - Hussein Elias
- Department of Family Medicine, Moi University School of Medicine (H.E.), Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Juli M Boit
- Living Room Ministries International (A.T., D.M., J.N., J.M.B.), Eldoret, Kenya.
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14
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Butler K, Vellinga A, Ivory JD, Cunningham S, Joshi L, Oommen A, Sezgin D, Carr P, Gethin G. Systematic review of topical interventions for the management of odour in patients with chronic wounds or malignant fungating wounds: a study protocol. HRB Open Res 2021. [DOI: 10.12688/hrbopenres.13323.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
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)
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15
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Delaney AE, Qiu JM, Lee CS, Lyons KS, Vessey JA, Fu MR. Parents' Perceptions of Emerging Adults With Congenital Heart Disease: An Integrative Review of Qualitative Studies. J Pediatr Health Care 2021; 35:362-376. [PMID: 33581995 DOI: 10.1016/j.pedhc.2020.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 11/30/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND As the primary caregivers for children with congenital heart disease (CHD), parents' perceptions are important for emerging adults to achieve independence. This integrative review of qualitative studies aimed to describe parents' perceptions of emerging adults with CHD. METHOD Seven electronic databases were searched. Data extraction and quality assessment were performed. A meta-synthesis was conducted to inductively develop essential themes from five included studies. RESULTS Three essential themes encompassing the parents' perspective of emerging adults with CHD were: (1) concerns about emerging adults' ability to be independent; (2) concerns about emerging adults' future; and (3) impact of disease on family. The themes depicted parents' concerns and worries about their children's ability to successfully achieve independence, especially in disease self-management and life goals. DISCUSSION This review highlights parents' concerns about their emerging adult children's independence. Understanding these concerns allows for developing interventions to facilitate emerging adults' independence and ease parents' worries.
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16
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Tilley CP, Fu MR, Qiu JM, Comfort C, Crocilla BL, Li Z, Axelrod D. The Microbiome and Metabolome of Malignant Fungating Wounds: A Systematic Review of the Literature From 1995 to 2020. J Wound Ostomy Continence Nurs 2021; 48:124-135. [PMID: 33690246 DOI: 10.1097/won.0000000000000749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE 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. METHODS 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. SEARCH STRATEGY We searched 4 major electronic databases and retrieved 724 articles; 7 met inclusion criteria. FINDINGS/CONCLUSIONS 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. IMPLICATIONS 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.
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Affiliation(s)
- Charles P Tilley
- Charles P. Tilley, MS, ANP-BC, ACHPN, CWOCN, Rory Meyers College of Nursing, New York University, New York; Calvary Hospital, Brooklyn, New York
- Mei R. Fu, PhD, RN, FAAN, Rory Meyers College of Nursing, New York University, New York
- Mei R. Fu, PhD, RN, FAAN, William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
- Mei R. Fu, PhD, RN, FAAN, The Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts
- Jeanna M. Qiu, AB, Harvard Medical School, Medical Student, Boston, Massachusetts
- Christopher Comfort, MD, Calvary Hospital, Brooklyn, New York
- Brooke L. Crocilla, BSN, St Peter's Hospital, Albany, New York
- Zujun Li, MD, The Perlmutter Cancer Center, NYU Langone Health, New York
- Deborah Axelrod, MD, The Perlmutter Cancer Center, NYU Langone Health, New York; Department of Surgery, New York University School of Medicine, New York
| | - Mei R Fu
- Charles P. Tilley, MS, ANP-BC, ACHPN, CWOCN, Rory Meyers College of Nursing, New York University, New York; Calvary Hospital, Brooklyn, New York
- Mei R. Fu, PhD, RN, FAAN, Rory Meyers College of Nursing, New York University, New York
- Mei R. Fu, PhD, RN, FAAN, William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
- Mei R. Fu, PhD, RN, FAAN, The Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts
- Jeanna M. Qiu, AB, Harvard Medical School, Medical Student, Boston, Massachusetts
- Christopher Comfort, MD, Calvary Hospital, Brooklyn, New York
- Brooke L. Crocilla, BSN, St Peter's Hospital, Albany, New York
- Zujun Li, MD, The Perlmutter Cancer Center, NYU Langone Health, New York
- Deborah Axelrod, MD, The Perlmutter Cancer Center, NYU Langone Health, New York; Department of Surgery, New York University School of Medicine, New York
| | - Jeanna M Qiu
- Charles P. Tilley, MS, ANP-BC, ACHPN, CWOCN, Rory Meyers College of Nursing, New York University, New York; Calvary Hospital, Brooklyn, New York
- Mei R. Fu, PhD, RN, FAAN, Rory Meyers College of Nursing, New York University, New York
- Mei R. Fu, PhD, RN, FAAN, William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
- Mei R. Fu, PhD, RN, FAAN, The Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts
- Jeanna M. Qiu, AB, Harvard Medical School, Medical Student, Boston, Massachusetts
- Christopher Comfort, MD, Calvary Hospital, Brooklyn, New York
- Brooke L. Crocilla, BSN, St Peter's Hospital, Albany, New York
- Zujun Li, MD, The Perlmutter Cancer Center, NYU Langone Health, New York
- Deborah Axelrod, MD, The Perlmutter Cancer Center, NYU Langone Health, New York; Department of Surgery, New York University School of Medicine, New York
| | - Christopher Comfort
- Charles P. Tilley, MS, ANP-BC, ACHPN, CWOCN, Rory Meyers College of Nursing, New York University, New York; Calvary Hospital, Brooklyn, New York
- Mei R. Fu, PhD, RN, FAAN, Rory Meyers College of Nursing, New York University, New York
- Mei R. Fu, PhD, RN, FAAN, William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
- Mei R. Fu, PhD, RN, FAAN, The Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts
- Jeanna M. Qiu, AB, Harvard Medical School, Medical Student, Boston, Massachusetts
- Christopher Comfort, MD, Calvary Hospital, Brooklyn, New York
- Brooke L. Crocilla, BSN, St Peter's Hospital, Albany, New York
- Zujun Li, MD, The Perlmutter Cancer Center, NYU Langone Health, New York
- Deborah Axelrod, MD, The Perlmutter Cancer Center, NYU Langone Health, New York; Department of Surgery, New York University School of Medicine, New York
| | - Brooke L Crocilla
- Charles P. Tilley, MS, ANP-BC, ACHPN, CWOCN, Rory Meyers College of Nursing, New York University, New York; Calvary Hospital, Brooklyn, New York
- Mei R. Fu, PhD, RN, FAAN, Rory Meyers College of Nursing, New York University, New York
- Mei R. Fu, PhD, RN, FAAN, William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
- Mei R. Fu, PhD, RN, FAAN, The Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts
- Jeanna M. Qiu, AB, Harvard Medical School, Medical Student, Boston, Massachusetts
- Christopher Comfort, MD, Calvary Hospital, Brooklyn, New York
- Brooke L. Crocilla, BSN, St Peter's Hospital, Albany, New York
- Zujun Li, MD, The Perlmutter Cancer Center, NYU Langone Health, New York
- Deborah Axelrod, MD, The Perlmutter Cancer Center, NYU Langone Health, New York; Department of Surgery, New York University School of Medicine, New York
| | - Zujun Li
- Charles P. Tilley, MS, ANP-BC, ACHPN, CWOCN, Rory Meyers College of Nursing, New York University, New York; Calvary Hospital, Brooklyn, New York
- Mei R. Fu, PhD, RN, FAAN, Rory Meyers College of Nursing, New York University, New York
- Mei R. Fu, PhD, RN, FAAN, William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
- Mei R. Fu, PhD, RN, FAAN, The Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts
- Jeanna M. Qiu, AB, Harvard Medical School, Medical Student, Boston, Massachusetts
- Christopher Comfort, MD, Calvary Hospital, Brooklyn, New York
- Brooke L. Crocilla, BSN, St Peter's Hospital, Albany, New York
- Zujun Li, MD, The Perlmutter Cancer Center, NYU Langone Health, New York
- Deborah Axelrod, MD, The Perlmutter Cancer Center, NYU Langone Health, New York; Department of Surgery, New York University School of Medicine, New York
| | - Deborah Axelrod
- Charles P. Tilley, MS, ANP-BC, ACHPN, CWOCN, Rory Meyers College of Nursing, New York University, New York; Calvary Hospital, Brooklyn, New York
- Mei R. Fu, PhD, RN, FAAN, Rory Meyers College of Nursing, New York University, New York
- Mei R. Fu, PhD, RN, FAAN, William F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
- Mei R. Fu, PhD, RN, FAAN, The Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts
- Jeanna M. Qiu, AB, Harvard Medical School, Medical Student, Boston, Massachusetts
- Christopher Comfort, MD, Calvary Hospital, Brooklyn, New York
- Brooke L. Crocilla, BSN, St Peter's Hospital, Albany, New York
- Zujun Li, MD, The Perlmutter Cancer Center, NYU Langone Health, New York
- Deborah Axelrod, MD, The Perlmutter Cancer Center, NYU Langone Health, New York; Department of Surgery, New York University School of Medicine, New York
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Jones KF, Fu MR, Merlin JS, Paice JA, Bernacki R, Lee C, Wood LJ. Exploring Factors Associated With Long-Term Opioid Therapy in Cancer Survivors: An Integrative Review. J Pain Symptom Manage 2021; 61:395-415. [PMID: 32822751 DOI: 10.1016/j.jpainsymman.2020.08.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/06/2020] [Accepted: 08/11/2020] [Indexed: 12/14/2022]
Abstract
CONTEXT The prevalence of chronic pain in cancer survivors is double that of the general U.S. POPULATION Opioids have been the foundation of cancer pain management for decades; however, there is a paucity of literature on long-term opioid therapy (LTOT) in cancer survivors. An understanding of factors related to LTOT use in cancer survivors is needed to address chronic pain and balance opioid harms in the expanding population of cancer survivors. OBJECTIVES To analyze the research of LTOT utilization and factors associated with persistent opioid use in cancer survivors. METHODS A five-stage integrative review process was adapted from Whittemore and Knafl. Data sources searched included Web of Science, PubMed, Embase, Cochrane, and Google Scholar. Quantitative research studies from 2010 to present related to cancer survivors managed on LTOT were included. Editorials, reviews, or abstracts were excluded. RESULTS After reviewing 315 articles, 21 articles were included. We found that there were several definitions of LTOT in the reviewed studies, but the duration of opioid use (i.e., more than three months after completion of curative treatment) was the most common. The reviewed literature describes a relationship between LTOT and important biopsychosocial factors (cancer type, socioeconomic factors, and comorbidities). CONCLUSION The studies in this review shed light on the factors associated with LTOT in cancer survivors. LTOT was common in certain populations of cancer survivors and those with a collection of patient-specific characteristics. This review suggests that there is a critical need for specialized research on chronic cancer pain and opioid safety in cancer survivors.
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Affiliation(s)
- Katie Fitzgerald Jones
- Boston College, William F. Connell School of Nursing, Chestnut Hill, Massachusetts, USA.
| | - Mei R Fu
- Boston College, William F. Connell School of Nursing, Chestnut Hill, Massachusetts, USA
| | - Jessica S Merlin
- University of Pittsburg School of Medicine, Pittsburg, Pennsylvania, USA
| | - Judith A Paice
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Christopher Lee
- Boston College, William F. Connell School of Nursing, Chestnut Hill, Massachusetts, USA
| | - Lisa J Wood
- Boston College, William F. Connell School of Nursing, Chestnut Hill, Massachusetts, USA
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Qiu JM, DelVecchio Good MJ. Making the best of multidisciplinary care for patients with malignant fungating wounds: A qualitative study of clinicians' narratives. Palliat Med 2021; 35:179-187. [PMID: 33094681 DOI: 10.1177/0269216320966498] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Malignant fungating wounds occur in advanced cancer patients, often in the last 6 to 12 months of life, when malignant cells breach the skin, causing a non-healing wound. Little is known about the perspectives of clinicians who treat these patients or how collaboration is facilitated among different specialties. OBJECTIVE To understand the experiences and perceived roles of clinicians who treat patients with malignant fungating wounds from a multidisciplinary perspective. DESIGN A qualitative study using narrative interviews was conducted and data was analyzed to identify themes that encompass the experiences of clinicians who treat patients malignant fungating wounds and put these experiences in a temporal context. SETTING/SUBJECTS Ten clinicians who treat patients with malignant fungating wounds (n = 10) from various metropolitan research hospitals were interviewed. The clinicians were of different disciplines, including physicians and nurses, and different specialties, including palliative care, oncology, and wound care. RESULTS Three themes emerged that described how clinicians of varying disciplines and specialties understood their roles and navigated the transition from curative to palliative care for patients with malignant fungating wounds: (1) making the best of fragmented care (2) collaboration between oncology and wound care (3) transitioning from curative to palliative care. CONCLUSION Findings of the study present a timeline of clinical care for patients, with different specialties taking the lead at different points in clinical time. Recognizing when collaboration between specialties is essential, as well as when communication fails, or clinicians have differing perspectives is important to facilitate the best care possible for patients.
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