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Wounds Related to Malignancy in Postacute and Long-term Care: A Case Series
Jeffrey M Levine1, Rikitha Menezes, Santhini Namagiri
1In New York, New York, Jeffrey M. Levine, MD, AGSF, is Wound Care Consultant, New Jewish Home; Rikitha Menezes, MD, is Geriatric Fellow, Mount Sinai Hospital; and Santhini Namagiri, MD, is Physician, New Jewish Home. Acknowledgments: The authors thank Orah Burack, Senior Research Associate at The New Jewish Home, who assisted with study design and statistical analysis. Gary Brandeis, MD, assisted in the early stages of this project. Ruth Spinner, MD, supported the project and assisted in its completion at The New Jewish Home. The authors have disclosed no financial relationships related to this article. Submitted March 10, 2019; accepted in revised form April 23, 2019.
Objective:
To study the epidemiology and characteristics of wounds related to malignancy in a large, academically affiliated postacute/long-term care (PALTC) facility.
Design:
Retrospective case series of 1 year of wound care consultations. Inclusion criteria included a cancer diagnosis with wounds related to malignancy or complications from cancer-related debility and/or treatment.
Setting:
Academically affiliated 514-bed PALTC facility.
Participants:
Of 190 consults, 27 residents (14.2%) met the inclusion criteria. Of these, 20 (74.1%) were female, and 7 (25.9%) were male. The average age of residents with a cancer diagnosis and wounds was 69.5 years (range, 48.1-86.7 years), and 25 (92.6%) were on the postacute service.
Results:
The most common reasons for consultation included pressure injuries (44.4%), surgical wounds (21.4%), and malignant wounds (14.8%). Seventy-six percent of pressure injuries were present on admission. Breast (29.6%), gastrointestinal (25.9%), and gynecologic (11.1%) malignancies were most common. Of the studied residents, 14 (51.9%) had metastases, and 13 (92.9%) had pressure injuries.
Conclusions:
These findings begin to fill a gap in understanding the spectrum of wounds in PALTC residents with cancer and reinforce the importance of the wound care skill set, including pressure injury prevention. Quality cancer care for older adults must anticipate severe skin complications not only from the tumor and its treatment, but also from the sequelae of immobility, immune compromise, malnutrition, and skin failure. The close association of metastatic disease with pressure injury raises issues of unavoidability and casts new doubt upon the use of pressure injuries for quality measurement.
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