Palliative Care Service, National Cancer Institute, School of Nursing, University of São Paulo, Brazil.
Nursing Educating of A. C Camargo Cancer Center São Paulo, Brazil.
J Pain Symptom Manage. 2021 Jun;61(6):1278-1286. doi: 10.1016/j.jpainsymman.2020.10.020. Epub 2020 Oct 20.
Topical management is the main form of control of signs and symptoms regarding malignant wounds (MWs) arising from tumor progression on the skin. Nevertheless, few studies have explored this theme and evidence on the effectiveness of the methods used to control bleeding is unknown, leading to a lack of consensus to support clinical practice.
Identify and evaluate current evidence on topical MW hemostasis from breast cancer and suggest new topics for future research.
This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes. Seven indexed databases were consulted using the terms: "breast neoplasms"; "breast cancer"; "malignant fungating wounds"; "malignant wounds"; "bleeding."
From the 112 articles identified in total, six were included in this review: a descriptive cohort study (n = 32), two case series (n = 21) and three case reports (n = 3). Fifty-six patients were exposed to 11 types of topical treatments using calcium alginate, surgical hemostats, adrenaline, nonadherent dressings, silver nitrate, modified Mohs Paste, and 10% formalin. There were no reports of significant adverse effects.
Although studies have promoted positive results of topical hemostasis, scientific evidence is still weak and arises from studies with poor methodological quality. Randomized controlled trials were not identified. The results highlight the crucial need for pilot studies to evaluate effect size, study procedures, and measurable results.
局部治疗是控制皮肤肿瘤进展引起的恶性伤口（MWs）体征和症状的主要方法。然而，很少有研究探讨这个主题，也不知道用于控制出血的方法的有效性证据，导致缺乏支持临床实践的共识。
确定和评估乳腺癌局部 MW 止血的现有证据，并为未来的研究提出新的主题。
本综述按照系统评价和荟萃分析的首选报告项目进行。使用以下术语在七个索引数据库中进行检索：“乳腺肿瘤”；“乳腺癌”；“恶性蕈样伤口”；“恶性伤口”；“出血”。
总共确定了 112 篇文章，其中 6 篇被纳入本综述：一项描述性队列研究（n=32）、两项病例系列研究（n=21）和三项病例报告（n=3）。56 名患者接受了 11 种局部治疗方法，包括藻酸钙、手术止血夹、肾上腺素、非粘性敷料、硝酸银、改良的 Mohs 糊剂和 10%甲醛。没有报告明显的不良反应。
尽管研究报告了局部止血的积极结果，但科学证据仍然薄弱，且源于方法学质量较差的研究。没有发现随机对照试验。结果强调了迫切需要进行试点研究，以评估效果大小、研究程序和可衡量的结果。
