The effect of psychological intervention on cancerous wounds

Cancerous wounds, medically known as malignant ulcers or fungal wounds, are chronic wounds formed by the direct invasion of the skin by a tumor or the rupture of metastatic lesions. Unlike ordinary external injuries or surgical incisions, these wounds do not heal in the normal healing sequence; instead, they persist and may even enlarge as the tumor progresses. Statistics show that approximately 5% to 10% of cancer patients develop malignant wounds, with breast cancer patients accounting for the highest proportion (approximately 62%), followed by head and neck cancer patients (approximately 24%).

The four most distressing symptoms of cancerous wounds are: excessive oozing, foul odor, easy bleeding, and persistent pain. When there is a lot of oozing, dressings may need to be changed several times a day, frequently soaking clothes and bed sheets, making patients afraid to go out or let others near them. The foul odor comes from substances produced by bacteria decomposing necrotic tissue in the wound; this smell is noticeable to both the patient and their family members, leading many to refuse visits from relatives and friends and eventually become unwilling to see anyone. Bleeding occurs because the tumor tissue itself is rich in blood vessels and fragile; even slight contact during dressing changes can cause bleeding, and sometimes turning over in bed can also cause bleeding, making patients anxious every time they see red. The pain is usually a persistent dull ache that turns into a sharp pain during dressing changes; over time, patients begin to fear even before dressing changes are scheduled. 

These symptoms combined have a significant impact on patients' mental health. A study involving 1,896 patients with advanced cancer showed that 41% of those with malignant wounds experienced moderate to severe psychological distress, compared to only 31.3% of patients with the same type of cancer but without malignant wounds. This extra 10 percentage points are essentially the additional burden brought by the wound. The most common concerns among patients are: Does a slow-healing wound mean the disease is out of control? Will others find fault with my body odor? Am I becoming a burden to my family by spending so much time caring for my wound every day? 

What can psychological intervention do for these patients?

It doesn't involve separate psychological therapy outside of dressing changes; instead, it integrates attention to the patient's mental state into every dressing change and assessment. For example, during a dressing change, the nurse can inform the patient how much the wound area has shrunk since last week, and how the exudate has decreased from five gauze pads per day to three. These concrete numerical changes represent visible progress for the patient, helping to offset some of their negative expectations. Another example is the issue of odor. In addition to treating the wound with antibacterial and deodorizing dressings, the nurse needs to clearly explain to the patient that the odor is caused by necrotic tumor tissue and is unrelated to personal hygiene. This statement can significantly reduce the patient's feelings of guilt and shame.

Pain during dressing changes is also a significant psychological trigger. If each dressing change is excruciatingly painful, the patient may develop anticipatory anxiety, experiencing palpitations, sweating, and even resistance to the change even before it's time. Oral analgesics can be administered half an hour before the change. When changing the dressing, use a non-adhesive dressing, such as a silicone gel-coated foam dressing or petroleum jelly gauze, avoiding directly applying and tearing dry gauze to the wound. This can significantly reduce pain, and the patient's fear of dressing changes will gradually decrease.

The things family members can do are also very specific. Regular video calls with doctors or nurses allow patients to receive professional guidance at home, rather than having to figure things out on their own after discharge. Encourage family members to participate in dressing change training, at least learning to observe for signs of worsening bleeding or infection, so patients don't feel like they're carrying the entire burden alone. Cancerous wounds themselves cannot be cured; the goal of care is to control symptoms, reduce pain, and maintain the patient's quality of life. Psychological intervention, within this framework, breaks down unseen fears and stress into manageable tasks, letting patients know what to do instead of being overwhelmed by uncertainty. For more information on Innomed® Silicone Contact Layer, refer to the Previous Articles. If you have customized needs, you are welcome to contact us; You Wholeheartedly. At longterm medical, we transform this data by innovating and developing products that make life easier for those who need loving care.

Editor: kiki Jia