Topical opioids and antimicrobials for the management of pain, infection, and infection-related odors in malignant wounds: A systematic review

Problem Identification Patients with malignant wounds report pain, distress from odour and exudate, decreased self-esteem and poor quality of life. This systematic review explores topical opioids, antimicrobials and odour-reducing agents for preventing or managing malignant wound pain, infection and odour. Literature Search CINAHL, CENTRAL, Medline, PsychINFO and reference lists were searched to identify relevant studies. Data evaluation Eligible study designs included interventions with pre- and post-intervention data. Data extraction and risk of bias assessments were conducted using the Cochrane approach. Synthesis No studies evaluated opioid use. Five studies (four RCTs) evaluated topical antimicrobials for infection and odour. All studies reported clinically (although generally not statistically) significant improvements in outcomes. Conclusion While not as prevalent as formerly, 5-10% of tumours, especially in breast cancer, sarcoma and melanoma, are expected to fungate. Gaps in the literature pertain to topical opioids and antimicrobials for managing pain, odour and infection control in malignant wounds. Implications for Practice or Research Current recommendations for topical control of malignant wounds are based on case reports and observational studies in breast cancer patients. Robust, controlled trials of topical opioid and antimicrobial use are warranted in patients with melanoma, breast or head and neck cancer.