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Evidence summaries

Topical Agents and Dressings for Fungating Wounds in People with Advanced Cancer

Miltefosine solution (6%) applied topically to cancer patients with superficial fungating breast lesions (smaller than 1cm) may slow disease progression, and foam dressings containing silver may reduce malodour in the care of malodorous malignant fungating wounds. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 4 studies with a total of 164 subjects. One RCT in women with superficial breast lesions compared 6% miltefosine solution with placebo and found that miltefosine delayed tumour progression. Time to treatment failure was longer in the miltefosine group (median 56 days) than in the placebo group (median 21 days, p = 0.007). A second trial compared topical metronidazole with placebo and found that metronidazole reduced malodour, but the results up to the point of cross-over were not statistically significant. A third trial compared the effect of foam dressings containing silver to foam dressings without silver and found that more patients experienced decreased malodour in the foam with silver group than in the foam alone group (p = 0.049). The fourth trial compared the effect of manuka honey-coated dressings with nanocrystalline silver-coated dressings and found no statistically significant difference with regard to exudate, malodour and wound pain.

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment) and by imprecise results (few patients and wide confidence intervals).

References

  • Adderley UJ, Holt IG. Topical agents and dressings for fungating wounds. Cochrane Database Syst Rev 2014;(5):CD003948. [PubMed]

Primary/Secondary Keywords