Frequency and Management of Hemorrhagic Malignant Wounds: A Retrospective, Single-Center, Observational Study



      The prevalence of bleeding episodes in malignant wounds (MW) is poorly documented, with no distinction between minor and potentially severe bleedings. This affects the quality of care.


      Assessing the frequency and management of hemorrhagic malignant wounds at Institut Curie hospital, an anti cancer center.


      Retrospective study conducted from the medical records of patients followed up by the Research and Wound Care Unit from Curie Institute (Paris, France), between 2017 and 2018. Patients >18 years of age, seen at least once by the Unit, and with an MW > 10 cm2 were included.


      Ninety patients were included, 74.4% female and 25.6% male, with a median age of 64 years (32-92). The most frequent etiologies were breast cancer (52.2%), sarcomas (12.2%), squamous cell carcinoma ear, nose and throat (11%), and pelvic cancer (8.9%). The median survival of patients after their first consultation was 5.6 months (95% CI: 4.6-8.4). Minor bleedings were observed in 38.9% of situations. Bleedings were significantly higher in malignant fungating wounds (P < 0.01). They were treated by the application of alginate or nonadherent dressings. The presence of at least one minor bleeding significantly increased the risk of more severe bleedings (P < 0.001). Hemorrhagic episodes were reported in 18.9% of patients, and 2.2% of patients died as a result of these bleeding episodes. Hemorrhages were fully controlled by hemostatic dressings in 70.6% of cases. The appearance of bleeding (minor or hemorrhagic) was significantly associated with survival (P < 0.001).


      MWs with bleedings appear to be associated with a poor prognosis and could be a reason for early palliative care even if the patient's general condition is preserved. Palliative care must incorporate wound care skills to provide the most appropriate solutions to this anxiety-provoking symptom.

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        • Grocott P.
        The palliative management of fungating malignant wounds.
        J Wound Care. 2000; 9: 4-9
        • Tilley C.
        • Lipson J.
        • Ramos M.
        Palliative wound care for malignant fungating wounds: Holistic Considerations at end-of-life.
        Nurs Clin North Am. 2016; 51: 513-531
        • Schmidt F.M.Q.
        • Firmino F.
        • de Felício Bortucan Lenza N.
        • de Gouveia Santos V.L.C.
        Nursing team knowledge on care for patients with fungating wounds.
        Rev Bras Enferm. 2020; 73: e20170738
        • Tsichlakidou A.
        • Govina O.
        • Vasilopoulos G.
        • Kavga A.
        • Vastardi M.
        • Kalemikerakis I.
        Intervention for symptom management in patients with malignant fungating wounds-a systematic review.
        JBUON. 2019; 24: 1301-1308
        • Gaertner J.
        • Siemens W.
        • Meerpohl J.J.
        • et al.
        Effect of specialist palliative care services on quality of life in adults with advanced incurable illness in hospital, hospice, or community settings: systematic review and meta-analysis.
        BMJ. 2017; 357: j2925
        • Hickman D.S.A.
        • Pawlowski C.L.
        • Sekhon U.D.S.
        • Marks J.
        • Gupta A.S.
        Biomaterials and advanced Technologies for hemostatic management of bleeding.
        Adv Mater. 2018; 30: 10
        • Chiara O.
        • Cimbanassi S.
        • Bellanova G.
        • et al.
        A systematic review on the use of topical hemostats in trauma and emergency surgery.
        BMC Surg. 2018; 18: 68
        • Dolbeault S.
        • Flahault C.
        • Baffie A.
        • Fromantin I.
        Psychological profile of patients with neglected malignant wounds: a qualitative exploratory study.
        J Wound Care. 2010; 19: 513-521
        • Clark J.
        Metronidazole gel in managing malodorous fungating wounds.
        Br J Nurs. 2002; 11: S54-S60
        • Lookingbill D.P.
        • Spangler N.
        • Helm K.F.
        Cutaneous metastases in patients with metastatic carcinoma: a retrospective study of 4020 patients.
        J Am Acad Dermatol. 1993; 29: 228-236
        • Alexander S.
        Malignant fungating wounds: epidemiology, aetiology, presentation and assessment.
        J Wound Care. 2009; 18 (276-8, 280): 273-274
        • Adderley U.J.
        • Holt I.G.
        Topical agents and dressings for fungating wounds.
        Cochrane Database Syst Rev. 2014; (published online May 15)
        • Maida V.
        Wound management in patients with advanced illness.
        Curr Opin Support Palliat Care. 2013; 7: 73-79
        • Pereira J.
        • Phan T.
        Management of bleeding in patients with advanced cancer.
        Oncologist. 2004; 9: 561-570
        • Maida V.
        • Ennis M.
        • Kuziemsky C.
        • Trozzolo L.
        Symptoms associated with malignant wounds: a prospective case Series.
        J Pain Symptom Manage. 2009; 37: 206-211
        • Grocott P.
        • Cowley S.
        The palliative management of fungating malignant wounds – generalising from multiple-case study data using a system of reasoning.
        Int J Nurs Stud. 2001; 38: 533-545
        • Fromantin I.
        • Watson S.
        • Baffie A.
        • et al.
        A prospective, descriptive cohort study of malignant wound characteristics and wound care strategies in patients with breast cancer.
        Ostomy Wound Manage. 2014; 60: 38-48
        • Vanbutsele G.
        • Van Belle S.
        • Surmont V.
        • et al.
        The effect of early and systematic integration of palliative care in oncology on quality of life and health care use near the end of life: a randomised controlled trial.
        Eur J Cancer. 2020; 124: 186-193
        • Groenvold M.
        • Petersen M.A.
        • Damkier A.
        • et al.
        Randomised clinical trial of early specialist palliative care plus standard care versus standard care alone in patients with advanced cancer: the Danish Palliative Care Trial.
        Palliat Med. 2017; 31: 814-824
        • Haun M.W.
        • Estel S.
        • Rücker G.
        • et al.
        Early palliative care for adults with advanced cancer.
        Cochrane Database Syst Rev. 2017; 6: CD011129
        • Vanbutsele G.
        • Pardon K.
        • Van Belle S.
        • et al.
        Effect of early and systematic integration of palliative care in patients with advanced cancer: a randomised controlled trial.
        Lancet Oncol. 2018; 19: 394-404
        • Vaneau M.
        • Chaby G.
        • Guillot B.
        • et al.
        Consensus panel recommendations for chronic and acute wound dressings.
        Arch Dermatol. 2007; 143: 1291-1294
        • Seaman S.
        Management of malignant fungating wounds in advanced cancer.
        Semin Oncol Nurs. 2006; 22: 185-193
        • Merz T.
        • Klein C.
        • Uebach B.
        • Kern M.
        • Ostgathe C.
        • Bükki J.
        Fungating wounds - Multidimensional challenge in palliative care.
        Breast Care. 2011; 6: 21-24
        • Neuwirth M.G.
        • Song Y.
        • Sinnamon A.J.
        • Fraker D.L.
        • Zager J.S.
        • Karakousis G.C.
        Isolated limb perfusion and Infusion for Extremity Soft tissue sarcoma: a Contemporary systematic review and meta-analysis.
        Ann Surg Oncol. 2017; 24: 3803-3810
      1. Recommendations for the care of patients with malignant fungating wounds EONS education.
        (2015 Available from)
        Date accessed: March 18, 2020
        • Harris D.G.
        • Noble S.I.R.
        Management of terminal hemorrhage in patients with advanced cancer: a systematic literature review.
        J Pain Symptom Manage. 2009; 38: 913-927
        • Hulme B.
        • Wilcox S.
        Guidelines on the management of bleeding for palliative care patients with cancer. Leeds: Yorkshire Palliative Medicine Clinical Guidelines Group.
        • Emmons K.R.
        • Dale B.
        • Crouch C.
        Palliative wound care, part 2: application of principles.
        Home Healthc Nurse. 2014; 32: 210-222
        • Welch M.
        • Barratt J.
        • Peters A.
        • Wright C.
        Systematic review of prehospital haemostatic dressings.
        BMJ Mil Health. 2020; 166: 194-200