Topical Management of Bleeding From Malignant Wounds Caused by Breast Cancer: A Systematic Review

Firmino, Flávia; Villela-Castro, Diana Lima; Santos, Juliano dos; Santos, Vera Lúcia Conceição de Gouveia

doi:10.1016/j.jpainsymman.2020.10.020

Cited by 20 publications

(15 citation statements)

References 12 publications

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“…However, cleaning itself can be painful, so careful consideration of the expected benefits/harms is required. Choosing the right bandage is also important for pain relief [ 5 , 13 , 14 , 15 , 16 , 28 ].…”

Section: Resultsmentioning

confidence: 99%

Treatment Algorithm for Cancerous Wounds: A Systematic Review

Furka

Simkó

Kostyál

et al. 2022

Cancers

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Background: In advanced cancer stage the incidence of cancerous wounds is about 5%, and the estimated life expectancy is not more than 6 to 12 months. Without interdisciplinary and individualized treatment strategy, symptoms progress, and adversely influence quality of life. Methods: Authors collected different treatment algorithms for cancerous wound published by wide scale of medical expertise, and summarized surgical, oncological, radiation oncological, nursing and palliative care aspects based on radiological information. Results: Interdisciplinary approach with continuous consultation between various specialists can solve or ease the hopeless cases. Conclusions: This distressing condition needs a comprehensive treatment solution to alleviate severe symptoms. Non-healing fungating wounds without effective therapy are severe socio-economic burden for all participants, including patients, caregivers, and health services. In this paper authors collected recommendations for further guideline that is essential in the near future.

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Section: Resultsmentioning

confidence: 99%

Treatment Algorithm for Cancerous Wounds: A Systematic Review

Furka

Simkó

Kostyál

et al. 2022

Cancers

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“…Fungating tumours can be the rst sign of cancer, but they are more often a late manifestation of advanced cancer [8,9]. Fungating tumours might present as either a crater-like ulcer (destructive process) or raised nodules similar in appearance to a cauli ower [10].…”

Section: Introductionmentioning

confidence: 99%

Symptoms and prognoses of patients with end-stage fungating breast cancer in palliative care units: the multicentre, prospective, observational EASED study

Takeda

Ishiki

Oyamada³

et al. 2023

Preprint

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Purpose: We investigated the symptoms and prognoses of patients with fungating breast cancer in the palliative care unit setting. Methods: This study was a sub-group analysis of a multicentre, prospective, observational study. Patients admitted to 23 palliative care units in Japan between January and December 2017 were enrolled. Data of patients with breast cancer were extracted. Wecompared demographic characteristics, symptoms, and prognoses by breast cancer skin lesion status. The primary outcome was overall survival. Secondary outcomes included Palliative Prognostic Index (PPI) score, details about skin lesions, and symptom burden. Results:Of 1,896 patients, 131 (6.9%) had breast cancer. In this cohort, 44 (33.6%) patients had skin lesions. Most skin lesions (88%) were on the backand chest. Some skin lesions were associated with skin redness, erosion, necrosis, or fistula. Symptoms included bleeding, exudate, odour, and pain. Twenty-eight patients (63.6%) needed dressing changes and 14 (31.8%) patients experienced bleeding. None died due to bleeding. In the skin lesion group, 32 (72.8%) patients had used opioids equivalent to 38 mg of oral morphine daily, compared to 25 mg in 57 (65.5%) in the non-skin lesion group (p = 0.26). Median PPI scores at hospital admission were 4.5 versus 6.5 (p = 0.08). Median survival was 23 versus 21 days (p = 0.48). Conclusion: Patients with skin lesions had a distinct symptom burden and tended to use a higher dose of opioids. The effect of skin lesions on survival was unclear.

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“…Adapting such treatments where necessary, to enable their delivery in the community, could facilitate end of life choices such as a preference to remain at home. Where treatments aimed at the underlying cause are inappropriate or ineffective, bleeding is often treated palliatively with haemostatic dressings, tranexamic acid or topical epinephrine (epinephrine) 2 3…”

Section: Introductionmentioning

confidence: 99%

Bleeding management in palliative medicine: subcutaneous tranexamic acid - retrospective chart review

Howard

Curtin

2022

BMJ Support Palliat Care

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ObjectivesTo investigate the efficacy and safety of subcutaneously (SC) administered tranexamic acid.MethodsA retrospective chart review of the use of SC tranexamic acid in a single palliative care centre. We reviewed the use of this approach since it was introduced in our locality 2 years ago. All clinical notes, medication administration records and infusion monitoring documentation were examined to ascertain therapeutic aim, efficacy and tolerability.ResultsSC tranexamic acid was administered to 22 patients. The most common causes of bleeding were coagulopathy (5), bleeding tumours (9) and thrombocytopaenia (5). The therapeutic aim was either to prevent (6) or treat (16) bleeding and was achieved in 17/22 patients. During this 2-year period, our experience evolved resulting in a greater use of short bolus infusions to achieve more rapid control of bleeding events. Both short and continuous SC infusions were well tolerated with no instances of SC site reactions. One patient developed a suspected arterial thrombus in the last hours of life around the time of converting from oral (PO) to SC tranexamic acid.ConclusionsSC administration of tranexamic acid appears to be an effective and well tolerated alternative option for the palliative management of bleeding when the PO and intravenous routes are not available. Further research is needed to clarify tranexamic acid’s safety in palliative populations.

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Topical Management of Bleeding From Malignant Wounds Caused by Breast Cancer: A Systematic Review

Cited by 20 publications

References 12 publications

Treatment Algorithm for Cancerous Wounds: A Systematic Review

Treatment Algorithm for Cancerous Wounds: A Systematic Review

Symptoms and prognoses of patients with end-stage fungating breast cancer in palliative care units: the multicentre, prospective, observational EASED study

Bleeding management in palliative medicine: subcutaneous tranexamic acid - retrospective chart review

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