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Intervention for symptom management in patients with malignant fungating wounds - a systematic review.

PURPOSE
To identify the latest data on interventions in the management of malignant fungating wounds (WFWs).


METHODS
A systematic review has been conducted to explore the original research about symptom management of malignant fungating wounds. Keywords and time constraints were used for the period 2008-2017 using the online Medline database (NCBI) with combined inclusion and exclusion criteria.


RESULTS
Eleven original research studies met the inclusion criteria. Nine of them referred to the use of materials and methods for managing the main symptoms which are malodour, exudate, pain and bleeding. An improvement in symptoms was observed in the involving intervention studies. According to the results, odor and exudates were significantly decreased by the use of honey and silver dressings. Wound cleaning with saline or tap water and the use of metronidazole had also positive results. Pain management was performed by the systematic use of opioids and the administration of an additional dose prior to the dressing change.


CONCLUSION
Patients with MFWs need a holistic treatment approach. They often seek late for health services and professional help. The disease is already locally advanced and a variety of symptoms leads to suffering and low quality of life. The effective management of symptoms by health professionals is vital to support patients in advanced disease. The need for constant briefing and updating of knowledge is imperative.