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Professional Management
Reviewed: December 2006
Assessment Should Include:
- Have all options for treatment been explored (surgery, chemotherapy, radiation therapy, hormonal therapy)?
- The goal in relation to the care of the wound.
- Impact on life: frequent dressing changes; hospital admissions/visits; treatment; altered body image; social isolation; intimate relationships.
- Location of the wound and how hard it may be to dress.
- Presence of odour, exudate, pain, and bleeding.
- The amount and quality of the exudate and how satisfied the person is with the current dressing.
- Self report of pain related to the wound and/or dressing change. The use of a numeric scale (0-10) is essential here.
- Surrounding skin for redness and itchiness
How Do We Treat It?
- The aim of treatment is rarely to heal: care is focused on reducing the impact of symptoms and maximizing the comfort of the individual with the wound.
- Quality of life is the guiding principle of planing your care.
- Determine your goal in relation to the care of the wound.
- Manage the symptoms of odour, bleeding and exudate with the use of primary and secondary dressings. Primary dressings can be used to manage odour, bleeding, pain and tissue that has died. Secondary dressings can be used to contain the exudate.
- Determine if the dressing is as comfortable as possible and that it can stay in place for a desired period of time.
- Ensure that the dressing materials are accessible for you and are user-friendly.
- Ensure that you have access to appropriate social support in order to decrease stress and anxiety.
Medical Options
- Radiation, chemotherapy and hormonal therapy may help to reduce the symptoms associated with malignant wounds and need to be considered. The most commonly used treatment modality is external beam radiotherapy. This treatment will destroy malignant cells, reduce the size of the wound and alleviate symptoms such as exudate, bleeding and pain.
- Use of topical and/or system antibiotics to treat clinical wound infections. Topical preparations may be most effective due to the decreased perfusion and vasculature throughout malignant wounds which decreases the effectiveness of systemic therapy.
- Antimicrobial ointments containing metronidazole can be helpful in reducing odour. Use the gel for at least 7 days. If needed, adding systemic metronidazole at a lower than recommended dose, 200mg taken twice a day - lower dose may reduce the side effects associated with this medication.
- Pain can be managed with opiates, for example morphine or hydromorphone. There is also limited evidence to support the use of topical opioids and other analgesics.
When to Call the Doctor
- If you see pressure sores (cracked, scaly, blistered, broken skin
- If a pressure sore is getting larger
- If a cut becomes very red, sore, or swollen
- If skin gets very rough, red, or painful
- If a rash develops or hives appear
- If pus comes out of a wound or cut
- If severe itching lasts more than a few days
- If a rash becomes worse after applying ointment or cream
- If swelling spreads up legs or arms
- If your abdomen becomes swollen
The BC Cancer Agency maintains a database on commonly used unconventional therapies available to cancer patients.
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