Psychological factors associated with malignant fungating breast wounds

Background Malignant fungating breast wounds, or malignant fungating wounds (MFWs) hereinafter, indicate a poor prognosis. For patients, malodour and copious exudate are the common distressing symptoms that require careful management. In addition to local wound management, patients require sensitive psychological support to improve their quality of life. Aim To review the current evidence on the psychological effects of MFWs. Findings In women with an MFW, feelings of anxiety associated with malodour and exudate were common, which affected their femininity and restricted their choice of clothing. In turn, this affected their body image and identity, in addition to creating a sense of social isolation, shame, and embarrassment. Moreover, the presence of an MFW served as a constant reminder of impending death, and the risk of bleeding was a major concern. Multiple studies have identified the positive influences of specialist and supportive care. Conclusion The evidence suggests that the main psychological aspects of an MFW in the breast are associated with the symptoms and visual nature of the wound, which act as a perpetual reminder of the person’s disease and mortality. The studies reviewed herein demonstrate how an MFW affects a woman’s femininity, body image, and self-esteem, leading to feelings of embarrassment, fear, and shame, and Correspondence: hollowaysl1@cf.ac.uk Conflicts of interest: None consequently, social isolation. The implications for clinical practice that emerged from the review highlight the importance of the management of wound malodour and exudate and also draw attention to the importance of access to specialist wound care support as these have been shown to have a positive effect on quality of life and mitigate some of the psychosocial effects of MFW. Key messages This review explored the psychological factors associated with an MFW of the breast. The results highlight that individuals with MFW experience low self-esteem the effects of which extend into many aspects of their daily lives, including their sex lives and social interactions. For many patients odour and exudate were the main contributing factors to feelings of shame and embarrassment, Furthermore for those individuals who experienced bleeding as a symptom of their wound reported being frightened of bleeding to death. A number of studies were able to show the positive effects of specialist wound care and counselling on the psychological wellbeing of the affected women. INTRODUCTION In the UK, 54,751 cases of breast cancer in the female population were reported in 2015.1 The incidence rates of breast cancer increase progressively from the ages of 30–34 years and more remarkably from the ages of 70–74 years.1 During 2016, 11,563 deaths occurred in relation to breast cancer, accounting for 7% of all cancer-related deaths, with mortality peaking at 90 plus years of age.1  Psychological factors associated with malignant fungating breast wounds Science, Practice and Education Malignant fungating wounds (MFWs) can be a distressing consequence of breast cancer. Although the true prevalence of MFWs is unknown, existing figures suggest that rates may be as high as 62%, and this figure increases with age. Multiple studies have examined the psychological consequences of MFWs in the breast. This review presents a summary of some of the research to examine the role of specialist wound advice.