Malignant Fungating Wounds in Advanced Cancer: Pathophysiology, Odor Control, and Dignity-Centered Management

Area of Science:

• Oncology
• Palliative Medicine
• Microbiology
• Bioethics

Background:

• Malignant fungating wounds (MFWs) affect 5-10% of advanced cancer patients, severely impacting quality of life.
• Current management often isolates issues like odor, myiasis, and dignity, lacking a unified approach.
• A comprehensive framework is needed to address the biological, clinical, and ethical aspects of MFW care.

Purpose of the Study:

• To introduce and apply a triple-framework approach for managing malignant fungating wounds (MFWs).
• To integrate biological (microbial metabolism, VOCs), clinical (odor, myiasis), and ethical (dignity) dimensions of MFW care.
• To provide a unified clinical framework for oncologists and palliative care teams.

Main Methods:

• Review of literature on MFW pathophysiology, microbiome, and management strategies.
• Application of a triple-framework: Biological (microbial VOCs), Clinical (odor/myiasis control), and Ethical (dignity-centered care).
• Synthesis of evidence for antimicrobial therapy, wound care adjuncts, myiasis management, palliative radiotherapy, and community-based care models.

Main Results:

• Anaerobic bacteria drive MFW odor; topical metronidazole is effective, with cadexomer iodine and Manuka honey as adjuncts.
• Effective strategies for wound myiasis include debridement, larval asphyxiation, and ivermectin.
• Palliative radiotherapy and community-based palliative care models offer viable solutions for odor control and dignified care, even in low-resource settings.
• Emerging tools like electronic nose technology aid objective odor quantification.

Conclusions:

• A unified, dignity-centered approach to MFW management is crucial.
• The triple-framework provides practical algorithms for odor and myiasis control.
• Equitable access to evidence-informed palliative wound care globally is imperative.