Impact and management of malignant wounds
Dr Betina Lund-Nielsen – University of Copenhagen, Denmark
Betina, this whole question of wound healing, wounds with cancer, we often don’t really think about it, do we? How important is this in cancer care?
I think it’s very important. I have been working with this for more than ten years and seen patients going in and out of the hospital and really not getting the care they needed. That was because many doctors say we can do nothing about it.
How many patients get a wound?
5-10% of all cancer patients will get a cancer wound where the cancer is growing outside the body and eats the breast or part of the face or something like that.
So what’s that like?
The wounds are very big, they smell awful, they are exudating, they can be infected with all kinds of bacteria, they can bleed and they can give pain, very much pain, for the patients.
I imagine that patients, and even doctors and nurses, may think that there’s not a lot they can do about it, it’s a cancer, it’s growing, you can’t really interfere. But can you do something?
Yes you can do something. When you say, many say, you can’t do it’s because you can’t heal them but you can do a lot to all these things the patients are experiencing – the exudation, the odour, you can do something about that. So it is palliative care and with the palliative care you can do much to help the patient.
Walk me through the things that you do because I also want to ask you about the study that you’ve done. But tell me, what are the basics of helping a patient who has a wound where the cancer has penetrated the skin and is making an awful mess?
The biggest problem for those cancer patients are the smell from the wounds, they can smell it all the time. It’s very difficult for the patient themselves and for the relatives, but also for hospital staff. So you have to keep down the bacteria in the wound and you can do that with silver bandages, honey bandages that have an effect on the bacteria that are in the wound. So you can put that on and make a combination with a hydrocellular dressing or something like that to keep inside the smell and it can help very much.
And the amount of care and the cleanliness is an issue, isn’t it, as well?
Yes it is. You have to clean it, you have to have nurses who especially know about these kind of wounds and the district care nurses need to be involved too.
And to what extent can you lean on the effectiveness of cancer therapy itself, perhaps to make that cancer regress?
It helps but not without making a combination with the wound care. If you only give chemotherapy or anti-hormone therapy or something like that, of course it has an effect because what is coming for those wounds is that there is cancer in the wound bed. So, of course, when you affect all the cancer with antineoplastic treatment you affect the wound too but not so much that you can heal the wound. So you need to have this wound care to make an effort for all these palliative problems in the wound.
One of the biggest issues though, surely, is the psychological impact of having this wound. How can the nurse or the carer help with that?
In my study I used cognitive interventions, I used dialogues and I used relaxation training. Dialogues to have the patient focussed on more positive thinking because the positive thinking will make you feel better and the relaxation training, again, to distract the thoughts and you can feel better. That was a significant difference from before to after intervention for a four week intervention with this kind of intervention, cognitive intervention on anxiety and depression, so it helps.
I’d like you to tell me just a little bit about the study, you started to discuss it, because data are thin on the ground. I go to a lot of cancer conferences and you don’t see this issue being addressed, do you? So what are the data from the study that you did? What did you do and what did you find?
I had a study with 69 patients in Denmark with cancer wounds, malignant wounds. Of course you can say it’s a smaller study but it’s rather big when you see how many people have these cancer wounds. We made a wound care where we compared honey dressings with silver dressings and in combination with psychosocial support and relaxation training.
And you found a big benefit of both, didn’t you?
I found a benefit of both, yes. So we recommend both things, both the silver and the honey, but we could not find any difference between the two.
And from your historical knowledge of how these conditions were being managed before, how much of a difference do you think can be made?
About 60-70% can have an effect of the honey or the silver for the wound, the odour, the exudation, the bleeding, the pain. So there’s a lot to do.
What would you like to advise people all over the world to do to improve this situation?
Do something. Many of the people who have this cancer diagnosis and the cancer wounds say that no-one takes responsibility for them, they do themselves. And that is not OK, we need to take action and do something for those people, and to do something it’s possible with these bandages to help a lot.
In your study it was a very specialised group and a very knowledgeable care team, do you think the average clinician can make a significant difference?
Yes, I think it’s possible to make some guidelines that are guiding nurses and doctors to see that it’s possible to do something and they can follow this guideline and it will be possible, yes.
Betina, thank you very much indeed.