title: A prospective, descriptive cohort study of malignant wound characteristics and wound care strategies in patients with breast cancer.
abstract: Few studies have addressed the effects of dressings on malignant wounds. A 20-month (May 2010 to January 2011) descriptive, prospective cohort study was conducted by the Wound Care Unit of Institute Curie, Paris, France to evaluate the use of various local care procedures and characteristics of malignant wounds. Symptoms and wound management methods were observed over a period of 42 days in 32 patients (all women, mean age 60 years, range 30-96 years, most with infiltrating ductal carcinoma). After cleansing (with either sterile saline or water), a variety of wound treatments were used based on specific wound characteristics, including calcium alginate, hydrocellular, interface, and active charcoal and superabsorbent dressings. Wound size, color (red, pink, black, yellow), periwound condition, surface wound organisms (number of species and quantity), and signs of infection, along with wound-related pain (rated on a verbal rating scale), odor, bleeding (spontaneous or induced), and exudate (rated on a four-level scale as none, slight, moderate, intense) were assessed at baseline and on days 21 and 42 of treatment. The degree to which each symptom was managed was scored as controlled, partly controlled, or not controlled. Mean initial wound size did not change over the evaluation period; most (74%) wounds were characterized as being inflamed. No infectious episodes were observed during the duration of the evaluation. Exudate and bleeding were generally controlled with hemostatic dressings, calcium alginate dressings, or absorbent pads. Odor was not completely controlled with charcoal dressing and was noted to be significantly greater in patients with >105/g bacterial counts and/or with one or more anaerobic bacteria (P = 0.05). At day 0, 13 out of 25 patients (50%) had uncontrolled pain; pain ratings did not change over the course of the study. Clinical research on specific clinical practice (eg, topical morphine for pain) and to assess the comparative efficacy of different care approaches on controlling the local symptoms of malignant wounds is warranted to improve the quality of care, which may affect patient quality of life.
authors.affiliation: Institute Curie, Paris, France; email:isabelle.fromantin@curie.fr.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Fromantin
authors.affiliation: Institute Curie, Paris, France.
authors.forename: Sarah
authors.initials: S
authors.lastname: Watson
authors.affiliation: Institute Curie, Paris, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Baffie
authors.affiliation: Institute Curie, Paris, France.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Rivat
authors.affiliation: Institute Curie, Paris, France.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Falcou
authors.affiliation: Institute Curie, Paris, France.
authors.forename: Irene
authors.initials: I
authors.lastname: Kriegel
authors.affiliation: Institute Curie, Paris, France.
authors.forename: Yann
authors.initials: Y
authors.lastname: de Rycke Ingenior
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014947:Wounds and Injuries / Q000473:pathology* / Q000628:therapy