Clinical Epidemiology and Ageing

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

Nicodème M, Dureau S, Chéron M, Kriegel I, Trenchand M, Bauër P, Fromantin I J Pain Symptom Manage. 2021;62(1):134-140.

CONTEXT: The 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.

OBJECTIVES: Assessing the frequency and management of hemorrhagic malignant wounds at Institut Curie hospital, an anti cancer center.

METHODS: Retrospective 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 cm were included.

RESULTS: Ninety 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).

CONCLUSION: MWs 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.

MeSH terms: Adult; Aged; Aged, 80 and over; Female; France; Hemorrhage; Hospice and Palliative Care Nursing; Humans; Male; Middle Aged; Palliative Care; Retrospective Studies; Wounds and Injuries
DOI: 10.1016/j.jpainsymman.2020.11.031