Symptoms Associated with Malignant Wounds: A Prospective Case Series

A significant proportion of cancer patients develop malignant wounds. Malignant wounds are generally nonhealable and are managed with palliative methods. Palliative wound care encompasses the pain and symptom management of such wounds. Sixty-seven of 472 cancer patients from a prospective sequential case series of palliative medicine consultations demonstrated malignant wounds at the time of referral and were studied to determine the most common symptoms and anatomic sites associated with malignant wounds. Data were collected from patients' own reports of up to three wound-related symptoms. Overall, 67.7% of malignant wounds were associated with at least one of the following eight symptoms: pain, mass effect, esthetic distress, exudation, odor, pruritus, bleeding, and crusting; 21.9% of wounds were associated with two or more symptoms; and 11.5% of wounds were associated with three symptoms. The symptom point prevalence was 31.3% for pain, 23.9% for mass effect, 19.4% for esthetic distress, 17.9% for exudation, 11.9% for odor, 6% for pruritus, 6% for bleeding, and 1.5% for crusting. Breast cancer patients had the highest prevalence of malignant wounds (47.1%). The anterior chest wall and breast was the site of 31.2% of wounds. The perineum and genitalia presented with the highest ratio of symptoms per wound (2.2). The results of this study reflect that malignant wounds are associated with a significant symptomatic burden, and reinforces the need for thorough clinical assessment and evaluation of symptoms. Further research is required to define the optimal methods of pain and symptom management for malignant wounds.