The Effect Wound Bed Status and Health related Quality of Life of a Ionic Silver Dressings in Cancer Patients with Malignant Fungating Wound
Date Issued
2010
Date
2010
Author(s)
Lo, Shu-Fen
Abstract
Aim. This study examined the effectiveness of a silver ionic dressing on health related quality of life and wound bed status of head and neck cancer patients with malignant fungating wounds (MFW).
Background. Malignant Fungating Wounds (MFWs) are chronic, slow-healing complex wounds that can bleed, generate exudates, become malodorous and painful, and cause both physical and psychological distress to patients. A systematic review and meta-analysis of the effectiveness of silver-containing dressings for management of various chronic wounds has demonstrated their effectiveness in wound healing, reducing odor, decreasing wound exudates and improving patients’ quality of life. However, few studies have empirically tested this treatment approach in managing MFWs.
Design. A randomized control trial, single blind, and parallel experimental study design was developed and implemented to assess the impact on patient quality of life when using silver-containing dressings in the treatment of MFWs.
Methods: Subjects were recruited from a 1,000-bed academically based medical center with six special units ward (palliative care, oncology ward) for head and neck cancer patients with MFW in north Taiwan. A total of 32 MFW participants were randomly assigned to silver dressing (SD) group (n=14) or non silver dressing group (NSD) (n=18) with a follow-up at two weeks after treatment. The primary outcome variable was wound bed status as measured by a malignant fungating wound assessment tool. The secondary outcome variable was health related quality of life as measured by the McGill quality of life questionnaire. Data were analyzed by Wilcoxon test , Mann-Whitney U-test and generalized estimating equations (GEE) using SPSS 17.0 software.
Results: The intervention and control groups were comparable at baseline .There was no significant difference in demographic variables between SD and NSD groups (p>.05). This study shows that the MFWAT-N(P=0.005) , amount of necrotic tissues(P=0.006), amount of exudates(P=0.028), quality of exudates
(P=0.001), bleeding(P=0.025), weight of exudates(P=0.042) in the experimental group saw a greater improvement than in the control group, as determined by the Mann-Whitney U-test. The SD group also reported significantly higher scores on the MQOL physical symptoms subscale than the NSD group (P=0.049). Also , GEE analysis showed that participants in the SD group had significant improvements in the MFWAT-N (P=0.014), amount of exudates (P=0.018) and bleeding( P=0.000) over those in the NSD group.
Conclusions. MFWs have a negative impact on patients’ HRQOL. Hydrofiber dressings that contain silver can control malodor, exudates, and amount of bleeding in patients undergoing MFW palliative care, thereby improving HRQOL in these patients. Further research is needed in order to developed well-structured MFW management guidelines. A more comprehensive health economic evaluation needs to be undertaken. Further studies exploring a longer term follow up are also required.
Declaration of in interest: The study was financially supported by TZU-CHI College of Technology project No.TCCT-961A10, Hualien, Taiwan.
Subjects
Health related quality of life
Malignant fungating wound
Silver dressing
Head and neck cancer
Patients
SDGs
Type
thesis
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